Societal views of pacemaker reutilization for those with untreated symptomatic bradycardia in underserved nations

• Published in: Journal of interventional cardiac electrophysiology 2011-04, Vol.30 (3), p.261-266
• Main Authors: Gakenheimer, Lindsey, Lange, Dave C., Romero, Joshua, Kirkpatrick, James N., Sovitch, Patricia, Oral, Hakan, Eagle, Kim A., Baman, Timir S.
• Format: Article
• Language: English
• Subjects: Bradycardia - therapy; Cadaver; Cardiology; Demography; Developing Countries; Equipment Reuse; Female; Humans; Logistic Models; Male; Medical Waste Disposal; Medicine; Medicine & Public Health; Michigan; Middle Aged; Pacemaker, Artificial - supply & distribution; Pacemaker, Artificial - utilization; Prospective Studies; Public Opinion; Surveys and Questionnaires
• ISSN: 1383-875X; 1572-8595
• DOI: 10.1007/s10840-010-9534-0

Purpose Significant healthcare disparities exist between the developed world and low and middle income countries (LMIC), specifically in the field of cardiac electrophysiology. As a result, pacemaker reutilization has been proposed as a viable option for those in LMIC and no other means of obtaining a device. Little data exist regarding the feasibility of establishing a reuse program in addition to understanding the views of society on device reutilization. This study investigated the views of funeral directors, patients with cardiac devices, and members of the general population regarding reutilization of previously implanted pacemakers. Methods Ninety funeral directors in Michigan were surveyed regarding current practice as well as preferences for post-mortem device disposal. One hundred and fourteen patients with devices and 1,009 members of the general population were surveyed regarding post-mortem device handling. Results Funeral directors had an average of 21 years of experience with an annual volume of 120 deceased persons per year, with a cremation rate of 35%. When asked about disposal methods of explanted devices, the majority of devices (84%) were discarded as medical waste or stored with no intended purpose, with a total of 171 devices currently in possession at the funeral homes. Eighty-nine percent of funeral directors expressed a desire to donate devices for reuse in LMIC and 10% acknowledged previous device donation. Eighty-seven percent of device patients and 71% of the general population also expressed a desire to donate devices. Conclusions The results of our survey show that a large percentage of funeral directors, patients with implantable devices, and members of the general population support a pacemaker reutilization initiative. This study lends further evidence that collection of devices for reuse is feasible and that establishing a framework for regional pacemaker reutilization program is warranted. If successful, the feasibility of this model should be investigated in other parts of the country in order to alleviate the burden of untreated symptomatic bradycardia in our world.