Article
Coordinating the preparation of this special issue of the European Journal of Transplantation, devoted to the first sixty years of clinical transplantation in Italy and conceived in conjunction with the sixtieth anniversary of the Italian Society for Organ, Tissue Transplantation and Regenerative Medicine (SITO), has proven both a demanding and an intellectually invigorating undertaking. The difficulty lay chiefly in the unexpectedly vast body of material that required careful collection and rigorous critical appraisal. The intellectual stimulation, by contrast, arose from the many “unknown episodes” that emerged in the course of this work, some of them previously unfamiliar even to a transplant surgeon of long-standing experience such as myself. The richness and cultural vitality that first nurtured, and subsequently sustained, the development of transplantation in Italy have revealed themselves to be truly remarkable.
This work has also brought to light the contributions of surgeons not traditionally identified with transplantation. Such a finding, however, is entirely consistent with a conviction I have long held: that transplant surgery, and more broadly transplantation medicine, should be regarded above all as an intellectual training ground, one that ought to engage a wide spectrum of physicians, and arguably all surgeons, at least during their formative years.
This endeavor has likewise been a source of personal pride, as it has allowed me to appreciate more deeply the dedication, commitment, and vision with which our predecessors pursued the ideal of transplantation. They were guided by a principle that is both enduring and, in medicine, uniquely indispensable: that of the physician wholly at the service of the patient, animated by an unwavering determination to seek solutions for those afflicted by disease. It is a model of medical professionalism with which I strongly identify, and one I hope will continue to inspire future generations.
The history of solid organ transplantation in Italy has undoubtedly been a history of excellence. This is evidenced by the gradual disappearance, over time, of the phenomenon of Italian patients travelling abroad in search of advanced transplant care. Indeed, the reverse trend has emerged, with patients now coming to Italy to undergo transplantation. This phenomenon involves not only individuals from countries with more limited socioeconomic and healthcare resources, as was once the case for us, but also patients from nations of comparable development.
This historical reconstruction has also underscored the bureaucratic and legislative challenges faced by our predecessors, challenges they confronted with both wisdom and courage, often anticipating the work of lawmakers and contributing to the shaping of legislation that has frequently proved remarkably forward-looking.
It is evident, however, that these sixty years represent only the beginning. Many more lie ahead, bringing with them new challenges and, inevitably, new achievements. For this positive trajectory to continue, it is essential to develop appropriate instruments, including legal frameworks, capable of fostering a renewed equilibrium between physicians and patients. Excessive litigiousness, at times driven more by economic than clinical considerations, represents a significant deterrent for young physicians considering entry into a field that, by its very nature, entails uncertainty and therefore risk. For this reason as well, some young doctors who choose transplantation ultimately pursue their careers abroad, despite having received in Italy one of the most rigorous medical educations available anywhere.
Similarly, the relatively low remuneration of Italian physicians, among the lowest in Western countries, and their confinement within rigid national contractual frameworks, which leave limited scope for the economic recognition of professional merit, are factors that merit serious reflection. Here too, the risk is one of migration either abroad (where, within Europe, physicians may earn up to five times more than in Italy) or toward specialties that offer greater opportunities for private practice, and thus enhanced autonomy, improved financial reward, better quality of life, and reduced exposure to medico-legal risk.
Finally, it should not be overlooked that distinguished transplant physicians and surgeons ought to be accorded the social standing and prestige that characterized our predecessors, an element that likely contributed, at least in part, to motivating many of us to pursue this demanding yet profoundly rewarding path. For a country such as Italy, it is, I believe, an important objective to identify strategies capable of further encouraging the continuation of this remarkable story, inspiring new generations of talented and enthusiastic physicians to dedicate themselves to transplantation and to its future advancement.
I conclude by expressing the hope that readers will appreciate the collective effort of myself, Professor Francesco Paolo Schena, Professor Luciano Gregorio De Carlis, SITO, and all those who have contributed with such enthusiasm to this synthesis of the first sixty years of transplantation in Italy.
History
Received: April 30, 2026
Accepted: April 30, 2026
