Should We Donate Used Pacemakers to the Needy?

Organ donation is one thing, but what about donating your used pacemaker? Over the past several years a Detroit-based nonprofit called World Medical Relief (WMR) has sent 50 used pacemakers donated from local funeral homes to be sterilized and reused at hospitals in India and the Philippines. Now University of Michigan researchers are looking to shore up these efforts and partner with WMR and local funeral homes to solicit and ship off used cardiac devices to hospitals in the Philippines, Ghana, Nicaragua and Vietnam, helping to close the health-care gap between more- and less-developed countries in the field of electrophysiology.

To see if the public would really be on board with such a venture, the researchers talked to funeral home directors, patients and members of the general population in southeastern Michigan. The response: sounds good to us. Funeral home directors reported they currently have 166 used cardiac devices in storage with no intended purpose and 89 percent of the funeral directors expressed interest in donating them to charity. Eighty-seven out of 100 surveyed patients said they would be interested in donating their devices, too (ahem, after they were done using them) and about 70 percent of the general public said they would be willing to sign off on behalf of a loved one. The lead author of the studies, Timir Baman, a cardiac fellow at the University of Michigan Hospital, spoke to NEWSWEEK's Dina Fine Maron about his findings and how the program could be expanded. Excerpts:

How did you become interested in this issue?
About a year and a half ago one of my patients was just in for a routine checkup and said: "Oh, by the way, when I pass away I want my pacemaker donated for use in the Third World." Honestly, I chuckled a little bit and didn't really think anything of it because I'd never heard of it before. Then when she came back three months later she brought it up again, and at that point I was intrigued and started looking into the literature. I found that was something we really considered doing in the '80s and '90s. My patient had just thought this was the norm.

How widespread are these sorts of donations?
When we talked to 90 local funeral directors around Ann Arbor, Mich., approximately 10 percent had done it before. So this is something that is out there but not highly publicized.

Do we reuse pacemakers or implantable defibrillators at all in the United States?
No we do not reuse them at all.

I honestly don't know.

How much do pacemakers cost?
A low-end pacemaker can cost approximately $5,000, and certain defibrillators can be up to $50,000.

And their shelf life?
It's anywhere from five to 10 years, depending on how much it's used. So when a patient is reliant upon them for use every minute of every day that battery life is five to six years; sometimes pacemakers are only used as a backup—and they can last 10 years.

So what happens to most cardiac devices once a patient dies? Are they buried with them or retooled in some way?
We asked funeral directors within a 50-mile radius of Ann Arbor what they do with these devices and got responses from 90 funeral homes. The majority of the funeral homes said their patients get buried with the devices. However, if you have a cremation it's standard protocol to extract the device due to risk of device explosion during the crematorium process. So for anybody who has a device whose family requests cremation, that device will automatically be explanted. The funeral directors told us that's about 35 percent of the population. And then our funeral directors told us that maybe 10 percent of the deceased are not getting cremated but will also request to have their devices extracted anyway. So our numbers suggest that 45 percent of patients currently have their devices explanted due to request or protocol.

What are they doing with the devices once they extract them?
Many of them are putting them in waste bins or storing them with no intended purpose.

Heart disease is the No. 1 cause of death in America. There's a common belief that heart disease doesn't really occur in lower-income nations to the same extent. Is that accurate?
That is a common conception, but it's actually the exact opposite. The overwhelming amount of people that have heart disease in our world are in low- and middle-income countries. Those living in the Western world often only associate cardiovascular disease with a Western diet that has resulted in obesity. However, many individuals in the Third World eat a diet high in fat and cholesterol and an emergence of "fast food" options has begun a transition to the Western diet with increasing frequencies of obesity and diabetes. Moreover, tobacco abuse occurs at a higher frequency in undeveloped nations, as well.

Are you trying to get cardiac devices reused in America as well?
No. We feel as though our health-care system isn't perfect here but we're trying to address the serious health disparities we see in Third World countries right now.

Is your organization, Project My Heart—Your Heart, soliciting donations? [Project My Heart—Your Heart is a collaborative with patients, physicians and funeral directors of Michigan, the University of Michigan Cardiovascular Center and World Medical Relief Inc.]
Not yet. Our ultimate goal is to create a reproducible model that can be utilized at other academic institutions. We hope to lay the groundwork and show other institutions that a pacemaker reutilization program can be established. We hope to meet with the FDA this summer and create a clinical trial so that we can study the efficacy of device donation to Third World countries on a large-scale basis.