Not everyone can afford a pacemaker, so these doctors recycle them

It's been more than a decade since a man walked into a Michigan hospital and made the unusual request to donate his late wife's pacemaker.

Just a few months before she died of unrelated causes, she had the brand new device implanted, says Dr. Thomas Crawford, a cardiac electrophysiologist at the University of Michigan.

“He said, 'Well, my wife was really into recycling, and I really hope you can actually use it for someone else,'” Crawdord said. As it happens host Nil Köksal.

“We didn't think we could use it because it's not legal to reuse a pacemaker in the United States. But it did make us think about whether we could use this device somewhere else.”

Now Crawford and his colleagues share first results from their randomized study among almost 300 patients in seven countries showing that used pacemakers, when properly sterilized and implanted, work as well as new ones and pose no greater risk of infection.

The findings – presented last week at an 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 are to be commended,” Dr. Calum Redpath, a cardiologist at the University of Ottawa's Heart Institute who was not directly involved in the study, told CBC. “Hopefully we can also offer this service to low- and middle-income countries in the future.”

Millions of people 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 dramatically reduce suffering, Crawford says.

In both Canada and the US, pacemakers are approved as single-use devices, in accordance with the manufacturer's instructions.

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

“Unfortunately, in many countries, the cost of a pacemaker must be borne by the family or patient and paid for before the procedure is completed,” Crawford said.

That's what the University of Michigan Frankel Cardiovascular Center estimates that between one and two million people die every year worldwide due to lack of access to pacemakers and defibrillators.

LOOK | The history of the pacemaker:

First pacemaker implanted in humans

A Swedish man is taking advantage of a life-saving device originally developed by Canadian John Hopps.

That's where the My Heart Your Heart project comes into the picture. The University of Michigan program collects and sterilizes pacemakers from hospitals and funeral homes for use in low- and middle-income countries.

They are currently conducting a clinical trial on 298 patients in Sierra Leone, Venezuela, Nigeria, Kenya, Paraguay, Mexico and Mozambique.

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

They found that there were no significant differences in the health outcomes of either group 90 days after receiving the devices.

There were five cases of implant site infection, three among recipients of new pacemakers and two among those who received used pacemakers. Three patients died, but for reasons unrelated to the devices.

“It shows that the devices are not at greater risk of infection or malfunction,” Crawford said.

The findings are consistent with those of a similar research from Mexico in 2017 And another by researchers in Montreal published in 2020.

Considering the ethics

Redpath, director of the Cardiac Device Clinic in Ontario, says that since the 2000s, Canadian doctors have been attaching used pacemakers from outside the body to patients' hearts to help people with temporary heart blocks related to conditions such as Lyme disease and COVID-19.

But he does not foresee a future in which pacemakers used in this country are surgically implanted.

“It's not that we don't believe these pacesetters aren't good enough in Canada. It's simply because there's no economic drive. That's not necessary because we are a prosperous country,” he said.

To implant a used pacemaker in Canada, a doctor must be licensed by Health Canada. The agency confirmed in an email to CBC that it never issued one.

But Canada can and has been a donor country.

For decades the Montreal Heart Institute is working with funeral homes in Quebec to send pacemakers to Mexico, Honduras, Guatemala, Cuba, Ecuador and the Dominican Republic.

Redpath says he has been involved in similar efforts in Ottawa, but it ultimately proved too logistically challenging.

To make this trial 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 ethical implications. If used pacemakers are not considered safe for use in rich countries, why are they allowed to be used in poor countries?

“There are clearly valid points on both sides of this argument,” Crawford said. “However, using a remanufactured pacemaker can truly change a patient's life, improving quality of life and extending life.”

Redpath says he believes doctors have an ethical imperative to continue this work.

“Here is a legitimate and safe way to treat these patients who otherwise wouldn't get treatment,” he said.

Crawford says his team will publish further results from the clinical trial as it progresses, and provide new devices for participants if necessary.

They also hope to do similar work with implantable heart defibrillators, which can cost three to four times as much as a pacemaker.

“We're in it for the long haul,” he said.