I remember the last funeral I went to was four years ago. My grandfather had passed away. There was a week-long period of mourning but the day of the funeral, we never left the funeral home. I hadn’t thought about it then, but my grandfather was part of a growing group of people who chose to be cremated instead of buried. By 2020, the rate of cremations is expected to rise to 56 percent compared to burials which are declining to 38 percent, according to a 2016 report by the National Funeral Directors Association. One organization is being fueled by this trend and saving lives abroad.
A group of researchers at the University of Michigan are working to sanitize and recycle used pacemakers so that they can be implanted in individuals abroad who do not have access to the same technology. Cardiovascular diseases were the leading cause of death both globally and in the United States in 2015, accounting for an estimated 8.75 million deaths worldwide according to the World Health Organization. A common treatment for chronic heart issues such as blockages or slow heartbeat is to implant a pacemaker that will regulate the electrical signals of the heart. The average battery life of these devices ranges from 5 to 15 years according to Mayo Clinic. My Heart, Your Heart is one organization that aims to prolong lives through recycling used medical devices.
Before a cremation, funeral homes must extract any cardiac devices such as pacemakers from the deceased. A 2011 study by the University of Michigan found that 80 percent of retrieved devices ended up in landfills as typically neither the patient nor the manufacturers wanted them back. “There is an increasing supply of potentially usable devices of becoming available around the world,” said Kim Eagle, a cardiologist at the University of Michigan and one of the founders of the My Heart, Your Heart Project. “It’s ironic that the need for these is going up as heart disease is becoming more ubiquitous around the world in both developing countries and developed countries,” he added.
Kim-Lan Trin, Director of Development and Community Relations of World Medical Relief, a partner of My Heart, Your Heart, examines a used pacemaker in the laboratory where the devices are sanitized and reprogrammed.
According to a 2012 issue of Progress in Cardiovascular Diseases, an estimated one million people die each year because they lack access to cardiac devices such as pacemakers. The symptoms associated with not receiving a pacemaker can vary depending on the disease. Sukit Ringwala, a cardiac electrophysiologist at the Northwestern University, said people with very slow heart rates tend to feel sluggish. He said, “People don’t feel good. It’s not life threatening but it’s affecting their quality of life. They’re suffering. They’re under some degree of duress because their heart isn’t picking up for daily activity.” Individuals who develop heart failure because of the ineffective pumping of their heart face more severe symptoms without early intervention. Ringwala said, “As they get older, the heart doesn’t pump blood as well and it weakens. Usually they will need heart surgery or a heart transplant. These people would benefit greatly from a pacemaker.”
A study conducted by the University of Michigan in 2014 sampled 90 funeral directors in Southeast Michigan and found that 90 percent of directors supported recycling cardiac devices and were willing to participate. My Heart, Your Heart relies on the donations from both patients and funeral homes around the state. The patients or their families sign consent forms allowing the devices to be used in the research process. Stephen Kemp, the past president of Michigan Funeral Directors Association and President of Haley Funeral Home in Southfield, Michigan, said “I’ve had no one in my practice say no.” He estimated that his establishment has donated over 30 devices to date alone. Nationally, as more research has been published, Eagle estimated that the project has received over 20,000 devices in the mail from the public.
The overwhelming support may be because the Food and Drug Administration currently prohibits recycling pacemakers in the United States. One reason is the availability of pacemakers to any individual who needs one. “We don’t believe that Americans are generally denied pacemaker access due to finances right now,” said Eagle. However, the circumstances are different abroad. “If you’re a person in a low-income nation, a pacemaker can be three to four times your annual salary,” said Eagle, “unfortunately for people who are poor, there is no solution because there are no dirt-cheap pacemakers out there.”
This complication adds further responsibility to the project. “We have to develop the necessary science and methodology to prove to the world that this could be done in a reliable and uniformly safe fashion,” says Eagle. The project, which began in 2009, received FDA approval to start a randomized trial in five low income countries early last year.
While there are many obstacles still to be overcome, there are still other factors to be considered once the protocols have been developed. Andrew Shuman, co-director of the Program in Clinical Ethics in the Center for Bioethics and Social Sciences in Medicine at the University of Michigan said it is important to consider the aftermath, “It’s one thing to put it in, but who is going to reprogram it? Who is going to reset it? It needs to be sustainable.” He added further, “It needs to be cheaper to jump through these hurdles than to provide new [pacemakers].”
My Heart, Your Heart has grown significantly in the past seven years, encompassing teams of doctors, nurses, engineers, and volunteers working to make a difference. “To do something big, we need a huge team. There’s a whole village of people who believe in this,” said Eagle. While plenty of work remains before all the pacemakers can be explanted, Eagle said “I feel optimistic that this will be a reality in my lifetime. Anything worth doing takes time.”