Eighty one adults in Mumbai, India, have been given second hand implantable cardioverter defibrillators, removed from adults in the United States. Collaborating doctors arranged their own transport for the devices, which were taken from the US to the Holy Family. Hospital in Mumbai, where they were cleaned, sterilised, and given to informed patients who were too poor to afford a new cardioverter defibrillator.
Some complications were observed like fractured or dislodged leads, but no secondary infection was reported.
Because the US Food and Drug Administration prohibits the reuse of implantable cardioverter defibrillators and federal laws prohibit funeral directors from collecting them the authors concede that they are on uncertain ground legally and call for changes to liberalise the “charitable use” of second hand cardioverter defibrillators.
Behzad Pavri, from the Thomas Jefferson university Hospital in Philadelphia, is confident that donating used cardioverter defibrillators to patients in India is ethical. The most unethical stance would be to withhold appropriate therapy in a patient who would benefit from therapy simply because of financial considerations. A reused device is better than no device, given the risk of sudden death in such patients. The high utilization rate recorded in this cohort bears testimony to this risk of sudden death.
Giving potentially substandard drugs or devices to the world’s poor is highly controversial and has been rightly discredited in the past. Clear ethical guidance is urgently needed to shape well intentioned efforts to reduce health inequalities and get life saving treatments to those who need them most. First we must ensure that those efforts are safe.
What does the D2D team suggest?
I do agree with Behzad Pavri.
Should the use of second hand ICDs (cardioverter defibrillator) be allowed in poor countries?