Not everyone can afford a pacemaker, so those doctors recycle it

It’s been more than a decade since a man walked into a Michigan hospital with an unusual request to donate his late wife’s pacemaker.

He had a brand new device installed a few months before he died of unrelated causes, said Dr. Thomas Crawford, a cardiologist at the University of Michigan.

“He said, ‘Well, my wife was really into recycling, and I hope you can actually use it for someone else,'” Crawdord said. As It Happened hosted by Nil Kӧksal.

“We didn’t think we could use it because it’s illegal in the United States to reuse a pacemaker. But it made us think if we could use this device somewhere else.”

Now Crawford and his colleagues are participating preliminary results of their randomized study of nearly 300 patients in seven countries indicating that used pacemakers, when properly sealed and installed, work as well as new ones, and do not pose a significant risk of infection.

The findings – presented last week at the American Heart Association conference in Chicago – are preliminary, and have not yet been published in a peer-reviewed journal. But doctors who work with pacemakers are cautiously optimistic about the potential impact of this research.

“These researchers should be commended,” Dr. Calum Redpath, a cardiologist at the University of Ottawa Heart Institute who was not directly involved in the research, told the CBC. “We hope that in the future we can offer this service to low- and middle-income countries.”

Millions cannot afford a life-saving device

Pacemakers are small, surgically implanted, battery-operated devices that prevent the heart from beating too slowly. They save and extend lives and significantly reduce suffering, Crawford said.

In both Canada and the US, pacemakers are licensed as single-use devices, according to the manufacturers’ instructions.

But in less affluent countries, not everyone who needs a pacemaker can afford one.

“Unfortunately, in many countries … the cost of a pacemaker has to be borne by the family or the patient, and it has to be done before the procedure is done,” Crawford said.

University of Michigan’s Frankel Cardiovascular Center rating that every year, between one and two million people die worldwide due to lack of access to pacemakers and defibrillators.

This is where the My Heart For Your Heart project comes in. A University of Michigan program collects and sterilizes pacemakers in hospitals and funeral homes for use in low- and middle-income countries.

Currently, they are conducting a clinical trial of 298 patients in Sierra Leone, Venezuela, Nigeria, Kenya, Paraguay, Mexico and Mozambique.

Half of the participants received new pacemakers between 2022 and 2024, while half received refurbished ones that were determined to be in good condition and with at least five years of battery life left.

They found that 90 days after receiving the devices, there was no significant difference in the health outcomes of both groups.

There were five cases of infection at the implant site, three among those who received new pacemakers, and two among those who received used ones. Three patients died, but from causes unrelated to the equipment.

“It shows that the machines don’t have a high risk of infection or malfunction,” Crawford said.

Findings are similar to those from a a similar study from Mexico in 2017 again another by Montreal researchers published in 2020.

Ethical considerations

Redpath, director of Ontario’s Cardiac Device Clinic, says that since the 2000s, Canadian doctors have been attaching pacemakers to the hearts of patients who are out of the body to help people with temporary heart block associated with conditions such as Lyme disease and COVID-19.

But he does not see a future where used pacemakers are surgically implanted in this country.

“It’s not that we don’t believe that these heart surgeons are not good in Canada. It’s because there is no economic impetus. There is no need for us to do that because we are a rich country,” he said.

To install a used heart machine in Canada, a doctor will need a license from Health Canada. The agency confirmed in an email to the CBC that it never released it.

But Canada can be, and has been, a donor country.

For decades, the Montreal Heart Institute has partnered with funeral homes in Quebec to send heart machines to Mexico, Honduras, Guatemala, Cuba, Ecuador and the Dominican Republic.

Redpath says he was involved in similar efforts in Ottawa, but in the end it proved to be too much of a challenge.

To make this research possible, Crawford says his team worked with manufacturers, funeral homes, hospitals, regulatory agencies, as well as doctors and governments in recipient countries.

They also had to consider the moral consequences. If used pacemakers are not considered safe to use in rich countries, why is it OK to use them in poor countries?

“Obviously there are valid points on both sides of this argument,” Crawford said. “However, the use of a modified pacemaker can really change a patient’s life and improve their quality of life and increase their longevity.”

Redpath says he believes doctors have a moral obligation to continue the profession.

“Here is a legal and safe way to treat these patients who would otherwise not receive treatment,” he said.

Crawford says his team will publish other results of their clinical research as it progresses, and provide newly developed devices to participants as needed.

They hope to do the same job with implantable cardiac defibrillators, which can cost three or four times as much as a pacemaker.

“We’re going to be gone for a long time,” he said.