Yes, I know I’m supposed to bring you the stunning conclusion to my top ten list of medical advances. But I was so excited to talk about this article I read recently that I’m bringing you this post instead. The top ten medical advances (1-5) will be up in 2 weeks. Unless I decide to bump it again.
We live in a golden age of technology and manufacturing. An age in which we’ve been spoiled by machines, personal devices and electronics have been created to ever increasing standards. Just a few decades ago, you couldn’t buy a Chevy Nova whose bumper didn’t fall off a week after you drove it off the lot. But today’s cars are engineered so well that they easily go hundred thousand miles and beyond. Consumers expectations are now so high, that to ensure that electronics last the expected amount of time, they‘re engineered to last much longer than that. The cell phone(s) in your closet that you forgot about when you renewed your contract probably makes calls just as well as the one you’re using now.
The same goes for medical devices, particularly crucially important medical devices like implantable cardiac defibrillators (ICD). To ensure that they last the expected amount of time and deliver their life sustaining jolts, they have to be built to last. (For the amount of money they charge for them, they had better be). Unfortunately, building something like an implantable cardiac defibrillator to such exacting standards makes them extraordinarily expensive. Think your average Mercedes Benz expensive. And that significantly raises the bar for entry, particularly for the poor both in this country and abroad. In third world countries, access to such devices is limited to the super wealthy, as private insurance plans are limited and government resources are typically directed towards more elemental aspects of health that affect the larger population. In other words, in countries like India, if you’re fortunate enough to have lived long enough to have a cardiac problem which warrants the placement of a defibrillator, you had better be rich enough to afford one. If not, you’re on your own.
So if implantable defibrillators are built to last much longer than they are typically used, and they are are out of reach for most of the world’s residents, would it possible for them to get a “pre-owned” one? The idea itself is not a new one. It’s not uncommon to see donated or used equipment in foreign hospitals like ventilators, out of date supplies and medications, etc. . . But some physicians in the U.S recently took this to the next level by actually proposing the implantation of used defibrillators in poor people in India. The physicians recently authored a report published on their experience.
As they mention, the average time that someone has a defibrillator implanted to the time that they pass is a approximately 46 months, while the average time that a defibrillator is good for is in the realm of 7 to 10 years. Normally, when someone with a debrillator dies, the funeral home typically removes the defibrillator before cremation as the battery poses an explosion risk. Defibrillators are also sometimes removed early due to infection of the device or because a different type of device is required. The physicians collected these used defibrillators, which would otherwise been discarded, turned them off to preserve battey life, and then transported them to India. After arrival there, they were sterilized, and reimplanted into people who had a definite indication for one and could otherwise not afford a new one. The devices lasted, on average about 3.5 years and they worked appropriately delivering life saving shocks. Surprisingly, the complication that one might worry about the most in re-implanting used medical devices, infection, did not occur at all.
Do you have to worry about your insurance company asking you to go on Craigslist to find your own ICD? No (at least not yet). This was after all not an actual prospective study, but rather a report of some physicians who undertook a pioneering, charitable task and carefully documented the experiences of a cohort of people. Such an undertaking here in the U.S. would be fraught with legal problems and would happen probably never. However these finding do raise the possibility that re-implantation of re-sterilized devices, particularly defibrillators, is feasible and should be investigated further. Perhaps in the future when people have a defibrillator implanted, they would simultaneously be asked if they would like to give consent for it to be removed and donated once they pass away. After all, if that old cell phone in your closet could save someone’s life, wouldn’t you want someone else to have it?