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When heart patients die, what happens to the defibrillators and pacemakers implanted in their chests?

University Of Chicago : 16 June, 2007  (Technical Article)
A used pacemaker could keep someone else ticking but most aren't removed from patients who die. Pacemakers typically cost $4,000 or $5,000, and defibrillators $20,000 to $30,000. Yet even though these expensive devices often have years more of useful life, they are usually buried with patients.
Dr. Bradley Knight, a University of Chicago specialist in heart rhythm problems said 'We take out people's organs and reuse them. I don't see why we can't do it with hardware.'

Knight is co-author of two recent studies on what happens to heart devices after patients die.

It's illegal in the United States to reuse pacemakers and defibrillators in other patients. But it is legal to donate such devices to poor patients in developing countries or even to use them in horses and dogs.

Alternatively, families can return the devices so manufacturers can evaluate how well they performed and check for possible defects.

A pacemaker sends electric impulses to the heart to help maintain a regular rhythm. A defibrillator provides an electric shock to restore normal heartbeats if the rhythm suddenly goes haywire.

A U. of C. survey of 100 Chicago area funeral homes found that pacemakers and defibrillators are almost always buried with patients.

When patients are cremated, however, the battery-operated devices are removed so they don't blow up. In cremations, 44 percent of funeral homes said they throw away the devices, 18 percent donate them to developing countries, 10 percent give them to the families and 8 percent keep them on site. A few funeral homes said they return devices to the manufacturer or hospital, or donate them to veterinary schools.

The funeral home study was published in a letter to the New England Journal of Medicine.

In a followup study, researchers surveyed 150 heart patients and found that 87 percent had no idea what would happen to their pacemakers and defibrillators after they died.

But 79 percent would be willing to return the devices. Manufacturers encourage this option. 'We can conduct tests to assess overall product performance and use that data to improve our devices,' said a spokeswoman for Medtronic.

Seventy-two percent of patients were willing to sign an 'advance directive' stating their wishes for the devices. Of this group, 91 percent would be willing to donate to developing countries and 79 percent would give the devices to pets. The second study was presented at an American Heart Association meeting.

Lead author Dr. James Kirkpatrick, now at the University of Pennsylvania, is developing an advance directive for pacemakers and defibrillators, and plans to test it in Chicago, Pennsylvania and Ohio.

Recycled devices help the poor in Bolivia
An organization affiliated with the Archdiocese of Chicago has donated several hundred recycled pacemakers to poor patients in Bolivia.

The patients have Chagas disease, which can cause slow heart rate and other cardiac problems. Patients typically are 30 to 60 years old, and many become bedridden.

The devices are tested, sterilized and recalibrated before they are donated to Bolivian clinics.

'It's a wonderful high-tech instrument that makes a lot of difference in people's lives,' said Juan Hinojosa of Solidarity Bridge, which distributes the devices in Bolivia.

Heart to Heart, a nonprofit group in Billings, Mont., collects pacemakers and defibrillators from funeral homes and families, and gives them to Solidarity Bridge and other groups for use in Third World countries. Only devices that retain at least 80 percent of their original battery life are used.

Recycled devices have been implanted in about 1,400 people and have worked well, said Heart to Heart founder Bill Daem.

But Medtronic, a leading manufacturer, opposes reusing the devices in people. A spokeswoman said the company cannot ensure recycled devices are as safe and reliable as new devices. The complex devices might be hard to sterilize, and cleaning and reprocessing could have a 'debilitating effect on the durability of the materials.'
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