Pacemakers and defibrillators are commonly implanted in France (respectively 75000 and 10000 devices per year) and in developed countries, thus helping to improve cardiovascular morbi-mortality, whereas in developing countries have limited access to life-saving medical technology. There are about 1 million people dying each year in the world due to lack of pacemakers.
Implantable devices are powered by batteries. Pacemakers have an average lifespan of around 8-10 years, and they are regularly explanted before batteries are used:
- Should any unexpected complications arise, in particular infectious complications, devices may be replaced earlier. They may also be replaced by more efficient devices in order to improve pacemaker / defibrillation systems (upgrading).
- Pacemakers are currently removed after death. Pacemaker explant is compulsory before cremation due to the risk of implosion and it is recommended as regards environmental impact.
Healthcare settings must collect many explanted Active Implantable Medical Devices (AIMD). Yet waste disposal both represents risk of infection (Infectious Healthcare Waste (IHW)) and risk of toxicity. Thus, explanted devices are currently returned to the manufacturer. The problem is the same for thanatopractitioners and funeral homes who rely on reprocessing companies which are specialized in hazardous waste management. Finally, a large number of non-defective explanted devices are thrown away because there are no organized humanitarian recycling networks.
Reusing explanted pacemakers is not allowed in France and in most of developed countries, whereas it is feasible, safe and efficient. Many studies have shown this technique is relevant as from 30 years. Such works were scientifically proven in 2011 through the first meta-analysis which was carried out on 2270 patients included in 18 essays. Ever since, the Sorin Pescariu team has published a series of retrospective case-control studies on 157 defibrillators and 127 cardiac rhythm management (CRM) devices which could be safely reimplanted.
Most often cooperation could arise from relationships which were woven when cardiologists came in France in order to follow training courses and then organized cardiac rhythm management (CRM) activity in their own country. Of course, we try to make sure that teams requiring devices are going through an honest process; and that patient selection criteria are respected, in both economic (rich or insured patients pay for the new devices they have received) and medical terms. Healthcare has evolved over the last 40 years, and among hospitals receiving donated pacemakers, Pondicherry (India) is the most regular partner thanks to the excellent relationships which have been built with JIPMER hospital physicians who are highly qualified and let us know about patients follow-up. Their newly published literature mentioned above is a vibrant plea for reusing explanted devices (Click here to read the article). Timisoara, Rumania, has long been a “privileged” healthcare center. It was the first hospital reimplanting defibrillators and biventricular pacemakers. Its integration into Europe put an end to reusing explanted medical devices. Vietnam, the Ivory Coast, Chili, Ecuador, Ethiopia…can also be quoted.
We would like to warmly thank our partners, not only cardiologists but also healthcare workers and technicians, who have been shipping donated pacemakers for many years, thus helping to create this solidarity chain and save human lives (link). We are also grateful to thanatopractitioners, mortuaries and funeral homes professionals who recently began to cooperate with STIM développement. This website will make it possible to regularly publish our donor list, in the same way as Stimucœur review used to (See letters to subscribers and activity reports).
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Crawford TC, Eagle KA. Reuse of cardiac implantable electronic devices to improve and extend lives: a call to action. Heart Asia 2017;9:34–35. doi:10.1136/heartasia-2016-010835 Click here to read the article