Minireviews
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Apr 26, 2017; 9(4): 296-303
Published online Apr 26, 2017. doi: 10.4330/wjc.v9.i4.296
Pacemaker recycling: A notion whose time has come
Mason W Runge, Timir S Baman, Sheldon Davis, Kevin Weatherwax, Ed Goldman, Kim A Eagle, Thomas C Crawford
Mason W Runge, Kim A Eagle, Thomas C Crawford, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, United States
Timir S Baman, OSF HealthCare, Peoria, IL 61603, United States
Sheldon Davis, Project My Heart Your Heart Advisory Board, Ann Arbor, MI 48109, United States
Kevin Weatherwax, Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI 48105, United States
Ed Goldman, University of Michigan Law School, Ann Arbor, MI 48109, United States
Author contributions: All authors contributed to the conception and design of the work; Runge M wrote the original draft of the manuscript; all authors reviewed, edited, and approved the final manuscript.
Supported by University of Michigan Frankel Cardiovascular Center, Mr. and Mrs. Sheldon Davis, Craig R. and Sue L. Sincock, William and Sandra Lefkofsky, The William and Flora Hewlett Foundation, LLC, and The Mardigian Foundation.
Conflict-of-interest statement: All the authors declare they have no competing interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Thomas C Crawford, MD, Assistant Professor, Department of Internal Medicine, University of Michigan, 1500 E Medical Center Drive SPC 5856, Ann Arbor, MI 48109, United States. thomcraw@med.umich.edu
Telephone: +1-888-2871082 Fax: +1-734-2324505
Received: January 28, 2016
Peer-review started: January 28, 2016
First decision: March 23, 2016
Revised: February 24, 2017
Accepted: March 12, 2017
Article in press: March 13, 2017
Published online: April 26, 2017
Processing time: 456 Days and 2.1 Hours
Abstract

The purpose of this paper is to summarize the need, feasibility, safety, legality, and ethical perspectives of pacemaker reutilization in low- and middle-income countries (LMICs). It will also describe, in-depth, Project My Heart Your Heart (PMHYH) as a model for pacemaker reuse in LMICs. The primary source of the discussion points in this paper is a collection of 14 publications produced by the research team at the University of Michigan and its collaborative partners. The need for pacemaker reutilization in LMICs is evident. Numerous studies show that the concept of pacemaker reutilization in LMICs is feasible. Infection and device malfunction are the main concerns in regard to pacemaker reutilization, yet many studies have shown that pacemaker reuse is not associated with increased infection risk or higher mortality compared with new device implantation. Under the right circumstances, the ethical and legal bases for pacemaker reutilization are supported. PMHYH is a proof of concept pacemaker donation initiative that has allowed funeral home and crematory directors to send explanted devices to an academic center for evaluation and re-sterilization before donation to underserved patients in LMICs. The time is now to pursue large-scale studies and trials of pacemaker reuse for the betterment of society. PMHYH is leading the way in the effort and is poised to conduct a prospective randomized, non-inferiority, multicenter study to confirm the clinical efficacy and safety of pacemaker reuse, for clinical and legal support.

Keywords: Pacing and clinical electrophysiology; Bradyarrythmia; Disparity; Project My Heart Your Heart; Cardiovascular disease

Core tip: The purpose of this paper is to summarize the need, feasibility, safety, legality, and ethical perspectives of pacemaker reutilization in low- and middle-income countries (LMICs). It also illustrates Project My Heart Your Heart as a model for pacemaker reuse in LMICs. The primary source of the discussion points in this paper is a collection of 14 publications produced by experts at the University of Michigan and their collaborative partners.