Reuse of pacemakers and defibrillators in developing countries: Logistical, legal, and ethical barriers and solutions
In the wealthy nations of the world, access to implantable cardiac rhythm management devices is widespread. In many underserved low- and middle-income countries (LMIC), where cardiovascular disease is fast becoming a major public health problem, access is often limited. Reuse of pulse generators was...
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Veröffentlicht in: | Heart rhythm 2010-11, Vol.7 (11), p.1623-1627 |
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creator | Kirkpatrick, James N., MD Papini, Christina, MSN, MBE Baman, Timir S., MD Khota, Karthik, BS Eagle, Kim A., MD Verdino, Ralph J., MD, FHRS Caplan, Arthur L., PhD |
description | In the wealthy nations of the world, access to implantable cardiac rhythm management devices is widespread. In many underserved low- and middle-income countries (LMIC), where cardiovascular disease is fast becoming a major public health problem, access is often limited. Reuse of pulse generators was practiced regularly in some European nations in the 1990s with good results. It is performed in LMIC, although the rates of device reuse are unknown. The available literature suggests there is no increased risk of morbidity or mortality with the reuse of devices. Donations of pacemaker and defibrillator pulse generators from developed nations constitute an important source of devices for the poor in LMIC. There are opportunities to increase this supply, but logistical barriers and legal and ethical concerns must be addressed. With proper sterilization, meticulous chains of custody, and advance directives for device handling (pacemaker/defibrillator living wills), patients in LMIC who would otherwise lack access to these devices could benefit from their reuse. |
doi_str_mv | 10.1016/j.hrthm.2010.04.027 |
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In many underserved low- and middle-income countries (LMIC), where cardiovascular disease is fast becoming a major public health problem, access is often limited. Reuse of pulse generators was practiced regularly in some European nations in the 1990s with good results. It is performed in LMIC, although the rates of device reuse are unknown. The available literature suggests there is no increased risk of morbidity or mortality with the reuse of devices. Donations of pacemaker and defibrillator pulse generators from developed nations constitute an important source of devices for the poor in LMIC. There are opportunities to increase this supply, but logistical barriers and legal and ethical concerns must be addressed. With proper sterilization, meticulous chains of custody, and advance directives for device handling (pacemaker/defibrillator living wills), patients in LMIC who would otherwise lack access to these devices could benefit from their reuse.</description><identifier>ISSN: 1547-5271</identifier><identifier>EISSN: 1556-3871</identifier><identifier>DOI: 10.1016/j.hrthm.2010.04.027</identifier><identifier>PMID: 20430113</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Cardiovascular ; Defibrillators - ethics ; Defibrillators - utilization ; Developing Countries ; Equipment Reuse - legislation & jurisprudence ; Humans ; Medical ethics ; Pacemaker, Artificial - ethics ; Pacemaker, Artificial - utilization ; Pacemakers ; Patients ; Reuse of devices ; Underserved</subject><ispartof>Heart rhythm, 2010-11, Vol.7 (11), p.1623-1627</ispartof><rights>Heart Rhythm Society</rights><rights>2010 Heart Rhythm Society</rights><rights>Copyright © 2010 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c413t-5f75bedba214d2ecdd446665382d66078f852e9df8320412f3b06d505306a5a23</citedby><cites>FETCH-LOGICAL-c413t-5f75bedba214d2ecdd446665382d66078f852e9df8320412f3b06d505306a5a23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.hrthm.2010.04.027$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3548,27923,27924,45994</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20430113$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kirkpatrick, James N., MD</creatorcontrib><creatorcontrib>Papini, Christina, MSN, MBE</creatorcontrib><creatorcontrib>Baman, Timir S., MD</creatorcontrib><creatorcontrib>Khota, Karthik, BS</creatorcontrib><creatorcontrib>Eagle, Kim A., MD</creatorcontrib><creatorcontrib>Verdino, Ralph J., MD, FHRS</creatorcontrib><creatorcontrib>Caplan, Arthur L., PhD</creatorcontrib><title>Reuse of pacemakers and defibrillators in developing countries: Logistical, legal, and ethical barriers and solutions</title><title>Heart rhythm</title><addtitle>Heart Rhythm</addtitle><description>In the wealthy nations of the world, access to implantable cardiac rhythm management devices is widespread. In many underserved low- and middle-income countries (LMIC), where cardiovascular disease is fast becoming a major public health problem, access is often limited. Reuse of pulse generators was practiced regularly in some European nations in the 1990s with good results. It is performed in LMIC, although the rates of device reuse are unknown. The available literature suggests there is no increased risk of morbidity or mortality with the reuse of devices. Donations of pacemaker and defibrillator pulse generators from developed nations constitute an important source of devices for the poor in LMIC. There are opportunities to increase this supply, but logistical barriers and legal and ethical concerns must be addressed. With proper sterilization, meticulous chains of custody, and advance directives for device handling (pacemaker/defibrillator living wills), patients in LMIC who would otherwise lack access to these devices could benefit from their reuse.</description><subject>Cardiovascular</subject><subject>Defibrillators - ethics</subject><subject>Defibrillators - utilization</subject><subject>Developing Countries</subject><subject>Equipment Reuse - legislation & jurisprudence</subject><subject>Humans</subject><subject>Medical ethics</subject><subject>Pacemaker, Artificial - ethics</subject><subject>Pacemaker, Artificial - utilization</subject><subject>Pacemakers</subject><subject>Patients</subject><subject>Reuse of devices</subject><subject>Underserved</subject><issn>1547-5271</issn><issn>1556-3871</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkd1rFDEUxYMo9kP_AkHmzZfOepNMMlPBQilWCwuCH88hk9zZzXZmsiaZQv97E3f1wZc-3XA454bzu4S8obCiQOX73Wob0nZaMcgKNCtg7TNySoWQNe9a-ry8m7YWrKUn5CzGHQC7lMBfkhMGDQdK-SlZvuESsfJDtdcGJ32PIVZ6tpXFwfXBjaNOPktuzsoDjn7v5k1l_DKn4DB-qNZ-42JyRo8X1YibMkoc07ZoVa9D9h13Rj8uyfk5viIvBj1GfH2c5-Tn7acfN1_q9dfPdzfX69o0lKdaDK3o0faa0cYyNNY2jZRS8I5ZKaHthk4wvLRDx3Mjygbeg7QCBAephWb8nLw77N0H_2vBmNTkosFcaka_RNVKxtqMos1OfnCa4GMMOKh9cJMOj4qCKrjVTv3BrQpuBY3KuHPq7XH_0k9o_2X-8s2GjwcD5pYPGYSKxuFs0LqAJinr3RMfXP2XN6ObC9l7fMS480uYM0BFVWQK1Pdy8XJwCgBNPjf_DWr0p7k</recordid><startdate>20101101</startdate><enddate>20101101</enddate><creator>Kirkpatrick, James N., MD</creator><creator>Papini, Christina, MSN, MBE</creator><creator>Baman, Timir S., MD</creator><creator>Khota, Karthik, BS</creator><creator>Eagle, Kim A., MD</creator><creator>Verdino, Ralph J., MD, FHRS</creator><creator>Caplan, Arthur L., PhD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20101101</creationdate><title>Reuse of pacemakers and defibrillators in developing countries: Logistical, legal, and ethical barriers and solutions</title><author>Kirkpatrick, James N., MD ; Papini, Christina, MSN, MBE ; Baman, Timir S., MD ; Khota, Karthik, BS ; Eagle, Kim A., MD ; Verdino, Ralph J., MD, FHRS ; Caplan, Arthur L., PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c413t-5f75bedba214d2ecdd446665382d66078f852e9df8320412f3b06d505306a5a23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Cardiovascular</topic><topic>Defibrillators - ethics</topic><topic>Defibrillators - utilization</topic><topic>Developing Countries</topic><topic>Equipment Reuse - legislation & jurisprudence</topic><topic>Humans</topic><topic>Medical ethics</topic><topic>Pacemaker, Artificial - ethics</topic><topic>Pacemaker, Artificial - utilization</topic><topic>Pacemakers</topic><topic>Patients</topic><topic>Reuse of devices</topic><topic>Underserved</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kirkpatrick, James N., MD</creatorcontrib><creatorcontrib>Papini, Christina, MSN, MBE</creatorcontrib><creatorcontrib>Baman, Timir S., MD</creatorcontrib><creatorcontrib>Khota, Karthik, BS</creatorcontrib><creatorcontrib>Eagle, Kim A., MD</creatorcontrib><creatorcontrib>Verdino, Ralph J., MD, FHRS</creatorcontrib><creatorcontrib>Caplan, Arthur L., PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Heart rhythm</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kirkpatrick, James N., MD</au><au>Papini, Christina, MSN, MBE</au><au>Baman, Timir S., MD</au><au>Khota, Karthik, BS</au><au>Eagle, Kim A., MD</au><au>Verdino, Ralph J., MD, FHRS</au><au>Caplan, Arthur L., PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Reuse of pacemakers and defibrillators in developing countries: Logistical, legal, and ethical barriers and solutions</atitle><jtitle>Heart rhythm</jtitle><addtitle>Heart Rhythm</addtitle><date>2010-11-01</date><risdate>2010</risdate><volume>7</volume><issue>11</issue><spage>1623</spage><epage>1627</epage><pages>1623-1627</pages><issn>1547-5271</issn><eissn>1556-3871</eissn><abstract>In the wealthy nations of the world, access to implantable cardiac rhythm management devices is widespread. In many underserved low- and middle-income countries (LMIC), where cardiovascular disease is fast becoming a major public health problem, access is often limited. Reuse of pulse generators was practiced regularly in some European nations in the 1990s with good results. It is performed in LMIC, although the rates of device reuse are unknown. The available literature suggests there is no increased risk of morbidity or mortality with the reuse of devices. Donations of pacemaker and defibrillator pulse generators from developed nations constitute an important source of devices for the poor in LMIC. There are opportunities to increase this supply, but logistical barriers and legal and ethical concerns must be addressed. With proper sterilization, meticulous chains of custody, and advance directives for device handling (pacemaker/defibrillator living wills), patients in LMIC who would otherwise lack access to these devices could benefit from their reuse.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>20430113</pmid><doi>10.1016/j.hrthm.2010.04.027</doi><tpages>5</tpages></addata></record> |
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subjects | Cardiovascular Defibrillators - ethics Defibrillators - utilization Developing Countries Equipment Reuse - legislation & jurisprudence Humans Medical ethics Pacemaker, Artificial - ethics Pacemaker, Artificial - utilization Pacemakers Patients Reuse of devices Underserved |
title | Reuse of pacemakers and defibrillators in developing countries: Logistical, legal, and ethical barriers and solutions |
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