There are, however, some challenges to creating this level of organization. As participants mentioned, some are resistant to centralized organization due to concerns over increased bureaucracy and loss of autonomy in global surgery work. Additionally, it is difficult to determine whether new organizational bodies are needed or whether organization should occur through already existing groups. Although developing this type of organizational structure might be difficult, it is necessary to begin considering fluid models that could ease the process of involvement in ISTCs. Those who are involved in global surgery efforts should work together and expand networks in a unified way .