Availability and limits of intermediate cardiovascular technology.

Abstract

Cardiovascular technology has been applied in the treatment of various diseases in Indonesia since its development in the late 1970s. Medical experts who have completed their training abroad began to implement their knowledge in cardiovascular service while a multifactorial limitation occurred in the country. The major limiting factor is still the country's infrastructure, which should support the treatment measures in modern cardiovascular technology. Other limiting factors concern nonmedical subjects, e.g., ethics, beliefs, religion, and the financial and basic organization of organ transplantation. Organ replacement started with artificial kidney/hemodialysis in the late 1970s, and was successfully carried out together with the further commencement of living related donor renal transplantation. Development of cardiac surgery with extracorporeal circulation gave rise to the stimulation of animal trials of cardiac transplant, pancreas transplant, and other subsets of organ transplantation. With the increasing modus of modernization, major hospitals in 3 large cities have shown increasing needs for organ transplant, and, parallel to that, the increasing number of potential organ donors, the cause of death dominated by brain death resulting from traffic accidents. The emerging need for liver and cardiopulmonary transplants has also been observed during the last 5 years, despite the improvement of general health care. However, similar to many Asian countries, because of religious and cultural considerations, it may be difficult to find donors whose relatives are willing to donate organs from their deceased relatives, especially for heart, lung, liver, and pancreas transplants. Alternative methods for artificial organs should receive more emphasis. We present the activities which have been established so far and how we should cope with the question of how present technology brings answers to the needs of organ transplant and artificial organs. Some innovative steps that we have made will be outlined.