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
Hauptverfasser: 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
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container_end_page 1627
container_issue 11
container_start_page 1623
container_title Heart rhythm
container_volume 7
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. 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source MEDLINE; ScienceDirect Journals (5 years ago - present)
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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