Green transplant: A scoping review of sustainability challenges and opportunities in transplantation

Green transplant refers to the realization of the importance of understanding and improving the environmental footprint of transplantation through sustainable practices. This involves assessing the entire transplantation process including preoperative evaluation, donation, organ and patient transportation, surgery, postoperative recovery, and follow-up. This is a topic that has not been fully addressed yet, but its importance is being increasingly appreciated in surgery. The aim of this study was to investigate the carbon footprint associated with transplantation and propose sustainable mitigating solutions. A comprehensive review of the existing literature on transplantation was conducted and supplemented with findings from the broader fields of surgical and perioperative care, given the scarcity of available data. The analysis identified the most involved environmental factors and attempted to offer practical solutions based on current sustainability practices. Notably, no study has yet examined the carbon footprint associated with the entire transplantation procedure. Only five studies have attempted to assess the environmental impact of kidney or liver transplants, but they focused, almost explicitly, on specific steps of the process. By employing an extrapolative methodology from the broader surgical field, we determined that the primary contributors to the environmental impact of transplantation are energy, consumables and materials, anesthesia and pharmaceuticals, transportation, and water. This review offers practical solutions utilizing the 5R framework, emphasizing sustainability to ensure transplantation remains clinically and environmentally relevant.