Icelandic surgeons provide a wide range of modern surgical services with excellent results. How can a nation of fewer than 300,000 persons accomplish this? The main reasons are a thriving economy, a high standard of living and education, and the training of surgeons. All Icelandic surgeons receive their training overseas, many at university hospitals in the other Nordic countries, particularly Sweden. Others receive training in the United States and Great Britain. Almost 50% of the general and orthopedic surgeons hold PhD degrees from major universities in the Nordic countries. In some other surgical subspecialties, an even greater number possess a PhD degree. This diverse background of training creates a stimulating and international outlook among the surgeons. All types of surgery are performed in Iceland, with the exception of surgery for complicated congenital heart disease and transplantation. Recently a living related renal transplant program was started with promising results.