The aging population in the United States imposes clinical, financial, and ethical challenges for healthcare facilities. As cancer risk rises with age, an urgent need exists to create organized and comprehensive geriatric oncologic care. Barriers to equitable care include physiologic decline, cultural biases, communication challenges, social determinants, and financial toxicity. This paper examines these five domains, highlighting their clinical implications and the ways they restrict access to standard oncologic care. Defining an organizational framework that emphasizes cultural competence, communication, diversity, and social responsibility offers one potential pathway to mitigate these challenges. Recognizing and addressing barriers at multiple levels is essential for building equitable, patient-centered cancer care systems capable of serving an expanding geriatric population.

Leadership is a topic of great significance in the practice of surgery. While once acceptable for surgeons to expect control, power, and ultimate authority in their offices and operating rooms, it is now realized that a leader's strongest quality is their ability to influence circumstances in a situational fashion. A review of the definition of leadership, the qualities and styles of leaders, and opportunities for leadership development brings the principles of leadership to the forefront from which surgeons will favorably develop. These opportunities include leadership development programs during the training of surgeons to permit deliberate practice throughout their careers. The goal of these exercises is to assist individuals in converting from the prevailing or epistemological model of leadership, where one knows theories and concepts of leadership, to the emerging or ontological/phenomenological model of leadership, where one practices those theories and concepts as a consummate leader in the House of Surgery.

Normothermic regional perfusion (NRP) is a novel organ procurement strategy used for donation after circulatory death (DCD) involving in situ organ perfusion. This cross-sectional survey study assesses US public attitudes toward organ donation and willingness to donate organs after DCD-NRP, standard DCD and after brain death, comparing registered donors (registrants) and non-registered participants (non-registrants). More registrants agreed with having trust in the medical system and registrants were more likely to agree with donation in every scenario. Almost half of respondents agreed that a person must be dead to donate their vital organs. This study found that willingness to donate was associated with donor registration and trust in the medical system. A secondary finding was that there is not universal understanding of the dead donor rule and implications of first-person authorization. Overall, our findings suggest that public support for donation remains strong, and that NRP utilization does not diminish that support.