Second-hand pacemaker anyone?

A pacemaker can keep you alive if your heart's electrical system shorts out, misfires, or otherwise needs a steadying electronic reminder to maintain a healthy beat. Some 350,000 new devices are implanted each year in the United States, but at $10,000 to $50,000 each, they remain beyond the reach of many in less wealthy regions. Though "lifestyle" conditions such as heart disease are often thought of primarily as afflictions of wealth and consumption, of the 17.5 million deaths attributed to heart disease in 2005, fully 80% were in low to middle-income countries. In some cases, a pacemaker would have been enough to keep the deceased in good health. One way to get a price-break on pricey pacemakers? Recycle them.

A study published today in the Journal of the American College of Cardiology reports on a series of 12 patients in the Philippines who received recycled pacemakers that had been removed from folks who died in the US. After death, the devices were removed, disinfected and inspected. About 35% met the criteria for recycling: Having at least 70% of their battery life remaining and being in good physical condition. To date the recipients, who range in age from 28 to 82, have only been followed for 6 months, but their outcomes appear to be the same as if they had received new units. The reuse of the cardiac device is currently restricted by US regulators.

What typically happens when a pacemaker recipient dies? "If the body is cremated, the devices is extracted, " Kim Eagle, M.D., one of the study authors told Justmeans, "Otherwise it may blow up in the crematorium. Often it is discarded. If the deceased is buried, the device is often left in the body."

While the idea of removing hardware from a corpse for re-implantation in an otherwise healthy person may seem slightly ghastly, it makes sense. After all, we transplant human organs, and they are not nearly as easy to disinfect or inspect for damage.

Clearly more research is needed before this becomes common practice, but the sheer number of devices availableandnumber of lives they might save, is impressive. "There's a potential pool of 35,000 devices available each year," Dr. Eagle says, "though the number may well be far higher." If the 35% reuse rate from the study applies, that'd potentially be over 12,000 lives saved. Reduce, reuse, recycle.

As with other situations where materials discarded by the wealthy are redistributed to others, there may be ethical considerations. Are these devices "not good enough" for Americans but "good enough" for someone from the Philippines, or Ecuador, or Ghana? Do you have ethical, logistical or practical concerns about this type of medical device redistribution?