Transplantations are highly complex procedures that are only performed at specialized centers. Given the high-profile nature of transplant programs and the perceived halo effect on other services, in the past, transplantation programs were opened at almost every university hospital. In Germany in particular, this has led to a large number of transplant programs competing with each other for patients and donor organs. Among these are high, medium and low-volume transplantation programs. This surgical viewpoint focuses on the adverse effects resulting from the fragmentation of transplantation medicine.