Costa Rica has probably the most stable healthcare system in Central America, but this does not mean that they do not have particular needs. Our initial involvement in Costa Rica consisted of providing specialized medical equipment, and hosting physicians and other health providers, primarily nurses and technicians, in Charlotte for various periods of training. These professionals spent time periods anywhere from 6-weeks to 6-months at Carolinas Medical Center, and were provided accommodations and the opportunity to extend and perfect their medical knowledge. Over the years we have had many intensive care nurses, transplant coordinators, dietitians and perfusionists from the Calderon Guardia Hospital as well as from the National Hospital. Dr. Oswaldo Alvarado, Chief of Pediatric Surgery, and Dr. Carlos Salazar, Chairman of Thoracic Surgery, are close and highly respected friends with whom we closely cooperate not only on projects in Costa Rica, but they are also providing us a helping hand in neighboring countries, primarily in Nicaragua. It was our special pleasure to work with them to make heart transplantation in Costa Rica a reality. We have also provided both hospitals with advanced imaging equipment. We look forward to continuing our work with their cardiac transplant team and sending our pediatric cardiac surgeons to work with their Costa Rican counterparts.