Avramidou E, Tsoulfas G, Alexiou M, Papachristou C. Breaking the scalpel ceiling: Gender inequality in global transplant surgery. World J Methodol 2026; 16(2): 114180 [DOI: 10.5662/wjm.v16.i2.114180]
Corresponding Author of This Article
Eleni Avramidou, MD, Department of Transplantation Surgery, Center for Research and Innovation in Solid Organ Transplantation, School of Medicine, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, Thessaloniki 54642, Greece. h.k.avramidou@gmail.com
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Transplantation
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Observational Study
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Jun 20, 2026 (publication date) through Apr 23, 2026
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World Journal of Methodology
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2222-0682
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Avramidou E, Tsoulfas G, Alexiou M, Papachristou C. Breaking the scalpel ceiling: Gender inequality in global transplant surgery. World J Methodol 2026; 16(2): 114180 [DOI: 10.5662/wjm.v16.i2.114180]
World J Methodol. Jun 20, 2026; 16(2): 114180 Published online Jun 20, 2026. doi: 10.5662/wjm.v16.i2.114180
Breaking the scalpel ceiling: Gender inequality in global transplant surgery
Eleni Avramidou, Georgios Tsoulfas, Maria Alexiou, Christina Papachristou
Eleni Avramidou, Georgios Tsoulfas, Maria Alexiou, Department of Transplantation Surgery, Center for Research and Innovation in Solid Organ Transplantation, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
Christina Papachristou, Department of Psychology, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
Author contributions: Avramidou E, Alexiou M, and Papachristou C contributed to data collection; Avramidou E conceptualized the idea, visualized and analyzed the data, and wrote the manuscript; Tsoulfas G critically reviewed the manuscript; Papachristou C provided methodological guidance. All authors have read and approved the final manuscript.
Institutional review board statement: The study protocol was reviewed and approved by the Bioethics Committee of the Aristotle University of Thessaloniki Medical School (approval No. 161/2024).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: De-identified participant data are available as supplementary material.
Corresponding author: Eleni Avramidou, MD, Department of Transplantation Surgery, Center for Research and Innovation in Solid Organ Transplantation, School of Medicine, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, Thessaloniki 54642, Greece. h.k.avramidou@gmail.com
Received: September 15, 2025 Revised: October 21, 2025 Accepted: January 13, 2026 Published online: June 20, 2026 Processing time: 222 Days and 22.3 Hours
Abstract
BACKGROUND
Gender disparities across nearly all surgical specialties have become an issue of increasing attention, reflecting persistent inequities in representation, leadership, and career advancement. Despite growing numbers of female medical graduates worldwide, women continue to remain underrepresented in surgery, particularly in subspecialties such as transplantation surgery.
AIM
To explore gender inequalities among transplant surgeons from the perspective of transplant unit directors and female surgeons worldwide.
METHODS
This study consists of two arms: (1) An 8-item anonymous questionnaire was sent to transplant centers to assess the gender distribution of consultant surgeons’ positions and academic roles among female and male surgeons; and (2) A 23-item anonymous questionnaire with closed and open questions was distributed to female transplant surgeons worldwide, addressing demographic profile, working experiences, and suggestions towards professional equality. The questionnaires were promoted through email, social media and professional platforms.
RESULTS
Of 46 transplant units participated. Among the 381 board-certified surgeons reported to work in these transplant centers, 102 were women (27%). In the second arm, 75 female transplant surgeons responded. The respondents had a mean age of 43.7 ± 8.8 years (24-70), with most of them working in European transplant centers (65.3%) and self-identifying as White/Caucasian (76%).72% reported gender discrimination, 56% faced verbal sexual harassment from colleagues, and 26.6% from patients, 41.3% were dissatisfied with their work-life balance, with commonly reported challenges including balancing career and family, lack of institutional support and inclusion and sexual harassment. The majority of recommendations involved mentorship, equal opportunities for leadership positions, and flexible working hours.
CONCLUSION
This is the first cross-sectional study addressing gender equity within the field of transplantation surgery worldwide, documenting gender disparities, professional conflicts, and concerning experiences of sexual harassment. This study provides preliminary evidence that underscores the need for further research and structural reforms to promote gender equity in transplantation surgery.
Core Tip: This manuscript presents the results of the first worldwide cross-sectional study to document gender inequities in transplantation surgery. By surveying both transplant unit directors and female transplant surgeons, it reveals disparities in academic and leadership roles, frequent experiences of gender discrimination and sexual harassment, and highlights the need for mentorship, equitable leadership opportunities, and institutional policies that support work-life balance.
