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perceived fatigue. Dexterity was assessed using dominant hand tracking accuracy and sequence reaction/accuracy testing. Results: 3 nights required hospital return (OCI), 37 on call nights did not (OCH) and 241 off duty (OD). Median 3.7 disruptions per OCH night and 7.1 for OCI were recorded (p<0.001 compared to OD). OCI sleep disruption was 15.3%. Sleep initiation was significantly longer (75min) than OD nights. OCI median total sleep time was 3hr 20min. OCI restful sleep was 75 mins, 139 mins OCH. Average OD heart rate was 56bpm, 65bpm OCI/ OCH. OCH/OCI HRV was 49ms improving to 59ms for OD (p<0.001). OCI/OCH tracing accuracy and reaction time was significantly worse than OD (p<0.001). Chalder analysis showed no OD/OCI/OCH difference. Conclusion: On call sleep disturbance is associated with loss of heart rate variability suggesting adverse health effects. Reduced dexterity/reaction times are concerning for surgeons expected to operate subsequently. Chalder analysis suggests a lack of awareness by the surgeon of the effects of sleep deprivation and on their technical skill levels when patient safety during complex operations of long duration is paramount. Further study is urgently warranted on the health effects of transplant on call rotas for surgeons, the effects of fatigue on technical ability and patient safety as surgeons seem unaware of these objectively measured and concerning effects.