Northwest - used, recycled, harvested pacemaker,

Update May 2013. HRS survey.

In 1997, Northwest Signal Processing, Inc., initiated a project with the Funeral Homes Association of Oregon to recycle pacemakers and other similar cardiac devices, namely defibrillators, to help poor patients in Vietnam.

During the period from 1997 through July 2011, we received 1253 devices. Of these, we were able to ship back to Vietnam 564 devices that still have useful remaining service lives.

During the period from 1997 till about 2001, the majority of pacemakers implanted in Vietnam were these recycled pacemakers that we provided free of charge to poor patients through the implanting hospitals. During this period 308 pacemakers were received and we were able to send to Vietnam 121 devices. The vast majority of these devices were implanted in hospitals south of Hue. For obscure reasons, the culture north of Hue precluded the use of recycled pacemakers. It has more to do with bureaucratic inflexibility that any real medical issue.

With the improved economic situation of Vietnam, the need for pacemakers has decreased in the large urban areas. However as more implant hospitals come on line, they are serving a poorer population in the countryside. Thus there has been recently an increased need for these recycled devices. Also, there is a need for the more advanced devices such as defibrillators (much thicker devices than the pacemakers) and triple chamber devices, both pacemaker and defibrillators, for patients with heart failure. These latter devices are still considerably expensive for the general Vietnamese population.

Also due a higher incidence of Brugada syndrome, there is a constant demand for defibrillators that we have unfortunately not been able to meet. This is a disease that is found with a higher incidence rate in Southeast Asia. It strikes typically middle aged males apparently healthy during rest and typically during sleep. Typically it is only after an episode of syncope that the patient will find out from an EKG taken at the hospital that he has the Brugada syndrome. In families with close relatives (father, brother) who have died unexpectedly young, the diagnostic strikes real fear in the patient.

We also need the triple chamber devices for our training and humanitarian projects. The most recent one , our fourth, was in Hue in July 2011. Cardiologists need more training before they can be comfortable implanting these advanced devices. And in the inital stage, patients with heart failure will need a recycled device since they cannot afford a new one.

Thus we would like to appeal to funeral homes for their continued support for this humanitarian project to help a fellow human being, and also to reduce adding more "junk" to our landfills. Our slogan is "give a pacemaker a second life!". You will need to remove these devices anyway from patients who are to be cremated (take a look at an incinerated defibrillator), due to the danger of device exploding when subject to high temperatures. There is no need to remove the leads. You can cut them short leaving a stub of about 2-3 inches. Disinfect them in your usual bath of disinfectant. Instead of throwing it in a drawer or putting it in the thrash, put it in a plastic bag, and mail it to us at

Attn: Dr Tran Thong
Northwest Signal Processing, Inc
8780 SW Pacer Dr
Beaverton OR 97008
e-mail: nwspi@comcast.net

You can just mail the package by regular US post on a weekly basis. Don't be alarmed if the defibrillators (the thicker bigger devices) put out alarms daily, typically in the morning or evening. The alarm is caused by the fact that the device has been removed from the body and the leads cut.

When we receive the devices, we will further clean and disinfect/resterilize and bag them. Those devices that pass an initial electrical test, will be hand carried back to Vietnam, where they will be checked with a programmer from the manufacturer. Finally those that pass this final test will be resterilized with ethylene-oxide and made available to poor patients.

A couple of years ago, during the height of the recall of medical devices, attorneys from the pacemakers companies have written letters to funeral homes informing them that the FDA requires that explanted devices be returned to the manufacturer. In 2009, theheart.org had an article debunking these threats. Since then, there has been a number of articles presented at major cardiology conferences reporting on efforts to re-use these devices outside the US. The only truth is that the FDA prohibits the re-implantation of these devices in the US. We have no intention of reusing these in the US, only in Vietnam! The typical FDA position is that it neither prohibits nor encourages re-use of these devices outside the US. So, let's be green and recycle these for use outside the US.

Interesting article presented at the 2009 Heart Rhythm Scientific Session, a major cardiology conference, held in Boston, MA, on the opinion of funeral directors with regard to recycling pacemakers.

Opinion

A recent article (12/07/2011) was written in Science Daily about the recycling of pacemaker for the benefit of poor patients in India. One of the items mentioned is that the FDA has no objection to the use of these recycled devices outside the US. You can also read the abstract of the paper that was the origin of this article. This paper is a very interesting article and if you would like to read it, please e-mail us at nwspi@comcast.net .

In an earlier article Dr. Hasan et al. (PACE 2011) discussed the FDA issue and the response of the general public about donating an implanted device:

Recent paper presented at the 2013 Heart Rhythm Society meeting in Denver, CO. This is the largest meeting of cardiologists who implant pacemakers. Note that the survey was approved by HRS. The last sentence spells out that currently these pacemakers are "wasted".

The patient

Some of you may raise the question, what happens when the recycled device reaches its end of life? It needs to be replaced. How?

Vietnamese are a very proud people. When first confronted with the need for a pacemaker, the patient is caught short, unprepared and thus needs a free recycled pacemaker. But once he/she gets better with the device, he is able to work and typically starts saving for the time he will need to replace the device. So, we have observed quite a few patients who managed to save, sometimes with the help of relatives, for the replacement devices and are proud that they needed our help only once. The elder patients will receive the support of their children and grand children. Some have a tougher time saving, so will need a second device. But in general, nobody takes the free devices for granted.

In 2011 the situation is much better. Government health insurance will almost cover the cost of a basic pacemaker. But the patient must have had uninterrupted coverage for 6 months prior. So, the first thing the patient would do after receiving a recycled pacemaker (because he did not have health insurance in the first place) is sign up for health insurance!

The sitatuation with defibrillators is more difficult because of the much higher expenses, well above the coverage of the health insurance. But some have managed to buy their own second generation device. A few have approached us for the second generation device. It has been tough at time to tell them, sorry but we don't have any yet!

So, if you know a funeral director, pass the word that most pacemakers/defibrillators can still save life after the first patient has passed away. So, don't throw it in the thrash or in a drawer (the article above reports that 166 devices are stored in drawers in southeastern Michigan ... instead of saving lives! What a waste!), recycle it for the sake of a patient in Vietnam!

To the relatives of a deceased with an implanted pacemaker, defibrillator, cardiac resynchronization device

You can instruct the funeral director to have the device removed from your relative body and mail it to us per the instruction above. We will be glad to send you an acknowledgement.

The device technically belongs to your deceased relative and you as the relative can direct its disposal. Please help

give he device a second life and through this
give a Vietnamese cardiac patient a chance at life!

Philippines

We have expanded the program to the Philippines starting in late 2011. The Philippines is a nation of 94 million people, a population a little bigger than Vietnam with over 85 million people. In discussions with our colleagues from the Philippines, we understand that while healthcare is accessible to most of the people, there is no fund available for devices. Thus, poor patients with a slow heart rate are just sent home! Even though the GDP of the Philippines is twice that of Vietnam, national health insurance is not as advanced.

So your contributions will now also help poor patients in the Philippines.

If we get enough devices, we will gladly expand our program to to help poor patients in other Asian countries.

You can reach us by e-mail at lienlac@systolicvn.com. We will strive to reply to you in the shortest time possible. Thank you for stopping by our NWSPI web site.

Recycling pacemakers, defibrillators

Philippines