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We appreciate the insightful comments by Dr Pezzella [1Pezzella A.T. Cardiothoracic surgery in developing countries (letter).Ann Thorac Surg. 2017; 104: 373-374Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar] on our article [2Dearani J.A. Jacobs J.P. Bolman R.M. et al.Humanitarian outreach in cardiothoracic surgery: from setup to sustainability.Ann Thorac Surg. 2016; 102: 1004-1011Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar]. He correctly points out the challenges of humanitarian outreach in one of the most complex medical fields, pediatric cardiovascular medicine. His comments focus on two main issues: the role of the nongovernmental organization (NGO) as a facilitator and the role and responsibility of our national societies. Children’s HeartLink (CHL), one of the most experienced NGOs in this arena, has extensive experience in partnering with pediatric cardiac programs in underserved areas of the world to help build their capacity and to help them provide better care for more children. CHL has a proven track record of using a structured model for supporting hospitals to build sustainability and capacity at nascent pediatric cardiac programs. Programs are matched (twinned) with preselected volunteer institutions to provide training and mentoring over the course of a 5- to 10-year partnership. These long-term partnerships rely on mutual trust, transparency, data collection, and outcome tracking with focused goals on improvement in identified areas of weakness [3Dearani J.A. Neorotti R. Kohnke E.J. et al.Improving pediatric cardiac surgical care in developing countries: matching resources to needs.Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2010; 13: 35-43Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar]. The ultimate goal is establishing credibility and recognition as a center of excellence with formal training opportunities for other professionals in their country. CHL also aims to highlight the tremendous inequity in access to pediatric cardiac care, and it calls on leaders in global health development and local policymakers to increase investments for sustainable and equitable access to pediatric cardiac care in their region and country [4Children’s HeartLink. Childhood heart disease and the global health agenda. Minneapolis, MN, 2016. Available at http://theinvisiblechild.childrensheartlink.org/. Accessed December 10, 2016.Google Scholar]. Although this all-inclusive model of education, empowerment, implementation of quality assurance programs, engaging hospital administration, securing government funding, and advocating for regional and global policy making is unique to CHL, many of the educational and quality improvement principles of the twinning model are also common to other NGOs. There are invariably many lessons learned from the respective experiences of each and every NGO in this field. Cooperation among Western NGOs is essential, as is collaboration with local NGOs and governments, so that models of success are shared and pitfalls and shortcomings are avoided. The recent article [2Dearani J.A. Jacobs J.P. Bolman R.M. et al.Humanitarian outreach in cardiothoracic surgery: from setup to sustainability.Ann Thorac Surg. 2016; 102: 1004-1011Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar] can serve as a blueprint with general rules of engagement for medical professionals interested in charitable outreach. It can also serve as a stimulus for a similar type of manuscript to be created by the collective efforts of the many credible NGOs in North America. The ingredients for success in charitable outreach in cardiothoracic surgery can also be enhanced by involvement of our major societies. Importantly, the role of our societies should not be with the development or promotion of individual surgical centers in underserved areas of the world. Instead, societies should collaborate with regional professional bodies supporting regional cardiothoracic training and education opportunities to address the severe shortage of (pediatric) cardiac surgeons; serve as a resource for the most important information on the subject; provide a directory of interested surgeons, institutions, and NGOs; and advocate for more capacity in pediatric and adult cardiothoracic surgery in low- and middle-income countries. Finally, our societies can also be helpful by providing a frequently updated calendar of scheduled trips between twinning programs and other humanitarian alliances, so that involved personnel, institutions, and NGOs are aware of current activities in nearby areas. Cardiothoracic Surgery in Developing CountriesThe Annals of Thoracic SurgeryVol. 104Issue 1PreviewCongratulations to Dr Dearani and colleagues [1] for their meaningful overview of voluntary and humanitarian cardiothoracic (CT) surgery efforts in developing countries and emerging economies with an emphasis on pediatric cardiac surgery. They have outlined in an organized fashion the strategic and tactical elements of this topic. This treatise will serve as a blueprint for those currently involved, or will be involved. A few areas require emphasis and reflection. Demographics will play a key role. Full-Text PDF