COMMENTARY

Donating Used Pacemakers to the Third World? Why Not Keep Them Stateside?

Melissa Walton-Shirley, MD

Disclosures

May 31, 2013

Years ago, I convinced an elderly patient to allow me to implant a pacer for profound bradycardia. The procedure was without incident. As I removed my gloves, I stuck my head under her drape and joked that she was now "the bionic woman," that she had received the "Cadillac" of pacemakers. She smiled with gratitude and relief. Days later, she died of a sudden massive gastrointestinal bleed with seemingly no risk factors. It was a devastating blow to her family, and of course, I mourned her death as any practitioner does when a much-beloved patient passes away.

I also mourned the wasted monetary resources that Medicare had expended, with no payoff in patient-years. In my naïveté, immediately postcode, I told the family that surely there must be some way we could put this less-than-14-day-old pacer to good use. Like many families who make the hard decision to donate organs in the midst of unfathomable grief, they agreed to let me explant it, hopeful that they could help someone else. I placed it in a ziplock bag before exiting the hospital room; took it to my desk in the department of cardiology; and there it sat in the darkness, entombed, languishing and depleting, until we finally threw it away some years later.

Helping Local Folk

My partner told me of a gentleman who took used pacers to Third World countries. In the prehistoric days before Internet, I was left to attempt to track down this person with only a hint of what part of the United States he might reside in. I finally located someone who told me that he had sent them successfully on occasion, but his connection was no longer reliable and he couldn't find a way to ship them. Then there was the problem of needing to find leads, which were even more difficult to come by. And what about upgrades? Future generator replacements, etc? I spoke to a pacer rep in that dark age of device therapy, suggesting we use it locally. He recoiled slightly in horror at the notion.

"They can't ever get those things sterile enough for use. Think of the malpractice issues. What if they got an infectious disease?" he said, his mouth all twisted as if he were sucking a lime.

I would try from time to time to find someone to take my pacer, but never successfully, and even at 5 years, it had several good years left on it. (I recall changing out a generator 2 decades ago that was 13 years old and just approaching "EOL.") Although I called it "a Cadillac," it certainly wasn't one of the energy hogs that are implanted today, with puny 6-year generator durability. I remember thinking how sleek, shiny, and smooth it was, beaming beautifully through my ziplock baggie. I admired this perfect marriage of technology and need. As I tossed it, I thought, "For shame," as it sunk slowly, sliding beneath discarded paper cups and wrappers, disappearing to the bottom with a final clunk. Soon it would be on its way to the local dump. I might as well have stuffed a few thousand-dollar bills in that plastic bag and dropped it down a well.

A Few Lame Excuses

Years later, I attended a device-sponsored "meet and greet" at the American Heart Association (AHA), followed by a panel discussion. When the audience was asked if we had a topic we would like discussed, I raised my hand. A large padded microphone appeared, and I simply asked, "Why aren't we reusing gently used devices in this country?" A nervous laughter arose from the crowd, a few lame excuses were given after an awkward silence, and they quickly moved on to another topic. Several cardiologists converged upon me after that meeting who shared my sentiment. I was told later that my question had been edited out of the program.

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