Green Pathology: start small, think big. Awareness paper by the Advisory Board of the European Society of Pathology

Healthcare is responsible for approximately 4-5% of global and 3-10% of national greenhouse-gas emissions. The pathology community faces the challenge to critically evaluate and alleviate its ecological footprint as climate change increasingly threatens the resilience of health care systems and global health equity. The environmental impact of anatomical pathology (AP) laboratories is based on physical laboratory operations and expanding digital infrastructures. Pre-analytical practices, overuse of diagnostic resources, and high-volume chemical waste contribute heavily to direct laboratory emissions, while high-resolution whole slide imaging and artificial intelligence produce substantial digital carbon footprints. This awareness paper amalgamates multi-institutional insights and international perspectives to outline a comprehensive plan for sustainable AP. Based on survey data from national pathology societies affiliated with the European Society of Pathology, interdisciplinary diagnostic guidelines, practical waste hierarchy methods, digital carbon mitigation strategies, and national implementation frameworks, we examine current awareness regarding green pathology within Europe, we highlight institutional barriers and provide actionable solutions.