Shaping the Future of AI in Organ Transplantation: Position Paper of the European Society for Organ Transplantation.

Advances in AI hold considerable promise for organ transplantation. While every transformation brings change, not all change is transformative. Despite the rapid growth of AI in medicine, most applications remain in developmental or experimental stages, with relatively few having been successfully integrated into routine clinical practice. As a professional society, ESOT recognises that achieving meaningful impact will require more than technical progress. This position paper outlines five critical domains for successful implementation. (1) High-quality development: Coordinated collaboration and methodological rigour are prerequisites for trust; AI is only as robust as the data used to train it. (2) Ethical considerations: We must address risks to equity and access to care, and move from generic ethical principles to transplantation-specific ethical guidance. (3) Regulatory landscape: AI in transplantation is regulated under both EU medical device and AI legislation; compliance is central to stakeholder trust. (4) Responsible adoption: AI should augment, not replace, human expertise. Strengthening AI literacy is essential for meaningful adoption. (5) Participatory design: Active involvement of transplant professionals and patients is essential to address real clinical needs. These statements serve as a strategic framework to guide clinicians, researchers, and policymakers in making AI a genuine force multiplier for the transplant community.