Article Text

Download PDFPDF
Pacemaker reuse in low-income/middle-income countries: moral duty or dangerous precedent?
  1. Karman Tandon1,
  2. Tyler Tate2,3,
  3. James N Kirkpatrick1,2
  1. 1 Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
  2. 2 Treuman Katz Center for Bioethics, Seattle Children’s Hospital, Seattle, Washington, USA
  3. 3 Department of Bioethics and Humanities, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr James N Kirkpatrick, Department of Bioethics and Humanities, University of Washington, 1959 NE. Pacific St. UWMC Seattle, WA 98125, Washington, USA; kirkpatj{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Cardiac implantable electronic devices (CIEDs) such as pacemakers and implantable cardioverter defibrillators (ICDs) are mainstays in the treatment and prevention of bradyarrhythmias and tachyarrhythmias. Rates of CIED implantation in higher income countries (HIC) have been increasing alongside a rise in the incidence of cardiovascular disease. In 2009, Germany saw pacemaker implantation at a rate of 927 implantations per million population, and in the USA 434 ICDs were implanted per million. In contrast, annual CIED implantation in many low-income/middle-income countries (LMICs) in Central and South-East Asia and Africa has remained at <10 implantations per million.1 This disparity in CIED implantation rates is likely the result of a lack of access to CIEDs due to their high costs, which are up to $5000 for a pacemaker system and $50 000 for an ICD system.2 Conservative estimates set the unmet global pacemaker need to be around one million devices per year.3

Representing the Pan-African Society of Cardiology (PASCAR), Sani and Mayosi provide a review of pacemaker reuse and argue that sterilisation and reimplantation of used pacemakers and ICDs donated by developed nations are potentially a safe and effective solution to bridge the gap between CIED implantation rates in HIC and LMIC.4 To validate this approach, PASCAR plans to join with the University of Michigan’s My Heart Your Heart (MHYH) programme, World Medical Relief and Pace4Life in a randomised controlled trial (RCT) conducted in LMIC that randomises patients with class I indications for pacemaker implantation who are unable to afford a new device to either new or reused pacemaker implantation.

The normalisation of pacemaker reuse and the reuse RCT bring up a myriad of ethical …

View Full Text


  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

Linked Articles