Reuse of Cardiac Rhythm Control Devices: A Review

Abstract

Cardiac rhythm control devices i.e. pacemakers, implantable cardioverter-defibrillators (ICDs) and biventricular pacemakers are at times lifesaving treatment and prevention of arrhythmia. But, despite definite indications, many people in the developing countries cannot afford these devices due to high cost, and succumb to premature death. On the other hand, after implantation, pacemakers and ICDs are sometimes underutilized because of premature explantation due to death of the recipient, device infection, or upgradation, leaving a considerable extent of serviceable battery life unused. Majority of these explanted devices are simply thrown away. Though made for single use, a growing body of evidence indicates the safety, efficacy and feasibility of reimplantation of the prematurely explanted devices in patient in need who is otherwise unable to afford a new one. Patients, physicians, morticians, and even the general public support the idea of device donation and recycling. A number of organizations around the world have engaged themselves in this benevolent effort, and t he feasibility of device reutilization programme has already been established. However, some logistic, legal and ethical concerns are yet to be solved. The statutory bodies and professional organizations should address the issue of device recycling to solve the unsolved issues and formulate standard practice guidelines. In that case, such medical wastes may turn into invaluable resources, and help ensuring equitable medical care throughout the world. Cardiovascular Journal Volume 6, No. 1, 2013, Page 52-59 DOI: http://dx.doi.org/10.3329/cardio.v6i1.16116

Spanish Rhythm Association member´s perspectives on cardiac implantable electronic device reuse in low- and middle-income countries

“…Although explanted CIEDs are treated as hazardous waste, a considerable number could still have sufficient battery life and adequate function to be reconditioned and reused [ 16 ]. Although in Spain there is no legal framework on the ownership of implants, the ownership is considered to belong to the patients, so they or their relatives could claim them once they have been removed [ 17 ].…”

“…Furthermore, it has been stated that the reutilization of used devices is a safe practice, provided that they are reprocessed and sterilized appropriately [7]. For this reason, initiatives that recover used CIEDs in the USA and France, recondition and implant them on LMIC where national regulations allow device reutilization have emerged [8][9][10].…”

Reuse of cardiac implantable electronic devices in developing countries perspectives: A literature review

“…On one hand, due to property rights, carriers or family members of a deceased carrier could claim the ownership of the implant once it is removed from the body 39 . On the other hand, even if reutilization of CIEDs is usually not allowed locally, nonprofit donation of used devices to developing countries is not prohibited 7 . Therefore, this may open the door to the implementation of CIED donation initiatives in many developed countries.…”

“…Among CVDs, bradyarrhythmias are a frequent clinical observation and include various cardiac rhythm disorders, such as sinus node dysfunction and atrioventricular conduction abnormalities 6 . Bradyarrhythmias have a huge impact on the quality of life of patients, due to their low tolerance to exercise, persistent fatigue and recurrent syncopes, symptoms that weaken more those living in the demanding conditions of developing countries 7 . The only actual treatment for bradyarrhythmias in their persistent form is to stimulate the heart using a CIED, such as a pacemaker.…”

“…Reprocessing CIEDs for reimplantation is not allowed in the United States either, due to the risk of infection 24 . However, there are no prohibitions on collecting used CIEDs and donating them to foreign countries where reutilization is permitted 7 . For this reason, organizations such as “Project My Heart Your Heart” and “Project Pacer” in the United States (US) or “Stimubanque” in France collect used CIEDs donated by patients, hospitals and funeral homes and ship them to developing countries, so they can be reused in patients in need 25,26…”