“In transplant surgery, we give something to the patient” - a conversation with transplant surgeon Dr. Ádám Varga

19 September 2023

Ádám Varga had aspired to be a doctor from an early age, and he chose surgery after having an appendectomy as a student. As a transplant surgeon, he performed the thousandth organ transplant in Pécs, and his innovative ideas and solutions are also recognized in the broader professional community. We spoke to the assistant professor at the UP Clinical Center Department of Surgery about the exciting but challenging field of transplant surgery, his exciting innovations, and his plans.


Written by Miklós Stemler


A severe illness involving surgery can trigger several reactions, but few people are likely to be tempted to become a surgeon because of it. But if the person in question has a childhood dream of becoming a doctor and ends up on the operating table as a medical student, it is indeed an exceptional case. This happened with Dr. Ádám Varga, who found his calling thanks to appendicitis. It did not happen overnight, of course.

“Although there has never been a doctor in my immediate or extended family, it was clear to me from a very young age that I wanted to be a doctor, which was my answer to the “What do you want to be when you grow up?” questions as a small child according to my parents. I prepared for it purposefully throughout my primary and secondary school years, and I did not have a Plan B when I was applying; I thought if I do not get in now, I will try again next year,” he recalls the beginnings.

However, admission to the Medical School in Pécs was a success because Ádám was also very determined in this respect.

“I am originally from Körmend, so it would have been much easier to continue my studies in Budapest, but I was never attracted to the capital. I already knew Pécs to some extent. I liked the more homely atmosphere of the city, and the Open Day was also a perfect experience.”

Although he wanted to become a pediatrician, he was captivated by the beauty of surgery in his second year. All he needed was a severe illness.

“I was admitted to the Department of Surgery with bad appendicitis, where I had to stay for a long time. It gave me an insider perspective on the work here: everyone was very nice to me, and I felt I could not be in a better place as a patient. Also, as a general medicine student, I could see how varied and exciting the work here is. I got on well with the doctor who operated on me, Dr. Róbert Papp, and thanks to him, I was able to start my TDK work in my third year in the transplantation working group of the department under the leadership of Dr. Péter Szakály, who still gives me a lot of help.”

Transplant surgery is not necessarily the most attractive field for students and trainee specialists because of its complexity and demanding requirements. Still, according to Ádám Varga, it is one of surgery’s most beautiful and rewarding branches.

“As a surgeon, in many cases, we either take something out of the patient or at least modify their body. Organ transplantation is almost the only area where we add something; we try to give patients the possibility of a new life. In addition, I found the practice in Pécs very appealing, that the care of kidney and pancreas transplant patients remains in the hands of the surgeons, i.e., in contrast to the general protocol where the contact with the patients lasts at most until the suture removal, here a long-lasting nexus is established, and we form a big, cohesive community. It also motivates us professionally to step outside our narrow field of expertise."

This, of course, also required maximum support from the heads of the department and its divisions, both as a senior student, trainee specialist, and junior doctor. Nothing better illustrates this than the fact that just a few years after he started working at the department as a resident doctor, he was able to perform the thousandth organ transplant in Pécs.

“This story perfectly describes the supportive environment here. The head of division at the time, Dr. Kalmár Nagy, could have said that he would perform the surgery, most of all because he had performed the first transplantation in Pécs. Instead, he entrusted me with the surgery and assisted me. It was a very nice gesture on his part."

Such occasions are, of course, rare in the transplant division, where the already high stakes of a tense job are made even more difficult by the unpredictability of the work: they never know when an organ is available for transplantation, which can be the difference between life and death for a patient. Ádám Varga is on the front line of this work as one of the doctors on call who must decide within a few minutes whether to transplant an organ, even in the middle of the night.

“As a full member of Eurotransplant, we are informed about potential organs for transplantation, and when I am on call, I must decide whether to accept an organ that has been offered. There is not much time to think about it because the organ must be transplanted in a relatively short period, and to do that, I have to organize its arrival to Pécs, even from the other side of Europe.”

Several factors need to be considered in that short time.

“At this point, I already know the basic characteristics of the organ: how old the donor is, approximately what condition it is in. With this information in mind, I must decide, for example, whether to transplant an organ from a diabetic, hypertensive donor over sixty years old with suboptimal renal function, which is definitely available to a young patient who does not yet need dialysis, or to wait for a kidney with better parameters, which is uncertain.”

This also shows that, in addition to perfectly performing a specific procedure, a transplant surgeon must make several significant decisions that will determine a patient’s life for decades, but Ádám Varga says that the stakes should not paralyze the doctors.

“I cannot say that I slept very well during my first few days on call, knowing that I could get a phone call at any time and have to make that decision, but I got used to it, and of course, as I gain experience it gets a bit easier.”

Perhaps it is already apparent from the above that Ádám likes to look beyond the concrete surgical work, and thanks to this point of view, he has managed to introduce innovations in Pécs that have also been well received in other transplant departments in the country - even though they mean potential extra work for the doctors.

“There may be problems with the functioning of the transplanted kidneys, which may require several stages of examination. This includes histological examinations, which we used to perform with the help of radiologists, but due to the radiology workload, these were often not done in time. So, we started thinking about doing the sampling ourselves, and I was chosen to organize it. Then, I started experimenting with the old ultrasound machine in the department, and I got more and more excited about it. I attended a course for emergency doctors with one of my thoracic surgeon colleagues, which was very good for answering practical questions about our work with ultrasound, and this way, I managed to get support from our director, Professor Vereczkei, and now we have a new ultrasound machine to perform the examinations. I can now check for some of the more common lesions we encounter.

Also, one of the main problems after a kidney transplant is that we do not know precisely how much fluid is in the patient’s body, which is very important. There can be severe consequences if the patient becomes dehydrated and too much fluid is given, leading to pulmonary edema.

Methods of measuring fluid levels have previously been of questionable reliability, but there is now a large body of literature showing that relatively accurate data can be obtained by measuring the diameter of the largest vessel, the inferior vena cava, in patients in shock who have suffered significant blood or fluid loss. I experimented with some of these tests and having been successful, they are now part of our protocol. And, unexpectedly for me, the lecture on this topic was such a success at this year’s transplant conference that, with the sponsorship of a pharmaceutical company, we are organizing a course in the autumn to enable other transplant departments in Hungary to use this method.”

Ádám Varga emphasizes that these innovations can only be achieved with the support of the department’s management and colleagues, for which he is very grateful. This supportive atmosphere was also vital for another development he and his colleagues implemented, which enabled them to solve a multi-million HUF test method for only tens of thousands of HUF.

“What you need to know is that the contrast agent indocyanine green, or ICG, is beneficial in various surgical examinations, for example, to detect tumors in the liver, which is vital information when planning surgical interventions. However, seeing the substance requires unique cameras and equipment, which cost around ten million HUF.

With my colleague Zoltán Sándor, we started thinking about whether there was an alternative solution to this problem and somewhat naively thought that we could build something suitable. So, we started ordering the necessary things from eBay and Alibaba, but it turned out to be more complicated than we thought because those stores did not sell precise tools.

That is when we involved a physicist and, eventually, my father, who is a mechanic. This is how we put together a very cheap camera, which worked well; although it is certainly not capable of as many things as a 20-million-dollar device, it is perfectly usable for examinations, and we use it regularly.”

Ádám’s undiminished enthusiasm to improve his work and support his colleagues, in addition to his mandatory duties, is evident from our conversation. Of course, in addition to the work environment, this also requires the support of his family, and he feels lucky in this respect, too - after all, it would be a source of tension in any family if our partner were regularly called in to work in the middle of the night.

“My wife also works in the health sector, so she understands and supports my work to the full, and luckily, my parents are also there to help, which is very important on a daily basis.”

And what does the future hold? If it is up to Ádám Varga, it is Pécs, and more transplants performed here.

“I feel very comfortable at the department in Pécs. Sometimes, traveling and seeing how things work elsewhere is nice, like this spring when I was in Austria on a study visit. But I am also motivated to find what works better elsewhere and what I can take home from it. I am planning my future here.”