Patient preferences regarding device reuse and potential of devices for reuse - a study in a veteran population

Spanish Rhythm Association member´s perspectives on cardiac implantable electronic device reuse in low- and middle-income countries

BACKGROUND

Postmortem explanted cardiac implantable electronic devices (CIEDs) from developed countries could provide patients unable to afford new devices in low- and middle-income countries (LMIC) a treatment they lack. This study describes the preferences of electrophysiologists and device implanting cardiologists from Spain on the management of explanted CIEDs and opinions and concerns regarding reuse in LMIC.

METHODS

A nationwide self-administered questionnaire was sent to members of the Spanish Rhythm Association (n = 1110), between December 2020 and January 2021.

RESULTS

Forty-two physician responses were obtained (response rate 5%). There was a strong preference to donate explanted devices for reuse in humans (61.9%) or animals (31%). The vast majority of the participants thought device reutilization was safe, ethical, and a reasonable alternative if a new device is not accessible. Moreover, they indicated they would be comfortable asking patients to consider post-mortem donation, and willing to implant post-mortem explanted and resterilized devices if they were unable to obtain new ones. 57.1% of respondents considered it would be beneficial for patients to have a document so they could reflect their wishes regarding device handling after their death. The most mentioned concerns regarding device reuse were malfunction (57.1%) and infection (54.8%).

CONCLUSIONS

The majority of respondents support reusable CIED donation to LMIC. It would be interesting to study the feasibility of a nationwide device reutilization program.

Reuse of cardiac implantable electronic devices in developing countries perspectives: A literature review

INTRODUCTION AND OBJECTIVES

Access to cardiac implantable electronic devices (CIEDs) is limited in developing countries. Postmortem CIED donation from developed countries to developing countries could be an important resource for those who cannot afford a new one. The objective of this paper was to identify and synthesize the perspectives on the donation of CIEDs for potential reuse in patients without resources living in developing countries.

METHODS

A bibliographic review was carried out in the PubMed, Web of Science and Scopus databases. The search strategy was limited to articles published in English or Spanish.

RESULTS

Eight publications were analyzed. The main results were grouped into two large frameworks on perceptions, preferences, attitudes and opinions of developed countries and developing countries towards the donation and reuse of CIEDs. Positive perspectives were identified towards the donation of CIEDs for their reuse in the majority of patients with a CIED, relatives, funeral homes and physicians of developed countries, as well as in physicians and potential recipient patients of developing countries.

CONCLUSIONS

This review highlights the positive perspectives on CIED donation from developed countries to patients in need of developing countries among all studied groups. In view of the feasibility of collecting postmortem devices, we advocate studying the feasibility of more local CIED donation initiatives.