The cost of cardiac implantable electrophysiologic devices (CIEDs) remains prohibitively high for many patients in low- and middle-income countries. Recent efforts have focused on obtaining CIEDs for donation and reuse in low- and middle-income countries from funeral homes and after device upgrades. Most patients in the United States die in health care facilities, yet few data exist on the acceptability for reuse of devices from hospital morgues. Three hundred thirty-four autopsies were performed at the University of Pennsylvania morgue from February 2009 to July 2011, during which CIEDs were routinely removed and collected. Devices were interrogated to ascertain remaining longevity. When a longevity estimate was not provided by the device, the manufacturer was contacted to obtain an estimate. Date of death was obtained from the electronic medical record. Twenty-seven patients (8% of autopsies performed) had CIEDs, of which 17 (63%) were pacemakers and 10 (37%) were implantable cardioverter-defibrillators. Two of the defibrillators were part of cardiac resynchronization therapy systems. CIEDs were interrogated 1.7 ± 0.7 years after death. The mean time between implantation and death was 2.5 ± 2.3 years, but 13 (48%) devices were implanted within 1 year of death. Nine devices (33%) had <1 year of battery life remaining, 10 devices (37%) had an estimated longevity of 1 to 4 years, and 8 devices (30%) had longevity estimates of ≥4 years. In conclusion, a significant percentage of patients who underwent autopsy had CIEDs implanted <1 year before death. Hospital morgues may serve as a source for devices in reuse programs, provided patients or their next of kin authorize donation.
Symptomatic bradycardia remains the major indication worldwide for pacemaker placement. Unfortunately, many patients in low- and middle-income countries remain without the means to undergo pacemaker implantation. Pacemaker reuse may help alleviate this burden. Although device recovery from funeral homes has been investigated, no data exist regarding device recovery from patients who expire while in the hospital. We sought to determine whether devices explanted at the time of autopsy in the hospital morgue had suitable battery longevity to be considered for reuse.
Methods
Cardiac implantable electrophysiologic devices (CIEDs) are explanted as part of the routine autopsy procedure at the Hospital of the University of Pennsylvania. We interrogated all devices explanted during autopsy procedures performed from February 2009 to July 2011. Remaining battery longevity and date of implantation were recorded from the devices. In cases in which the devices did not provide estimates, the manufacturers were contacted. Longevity estimates were provided by manufacturers using the remaining voltage and the dates of implantation. The electronic medical record was searched to determine dates of death.
Results
From February 2009 to July 2011, 334 autopsies were performed. Twenty-seven patients (8%) who underwent autopsy had CIEDs. This included 17 pacemakers (63%) and 10 defibrillators (37%). Two defibrillators were part of cardiac resynchronization therapy (CRT) systems. The average age at the time of implantation was 65.3 ± 13.4 years. The average age at the time of death was 67.8 ± 14.7 years. Devices were interrogated 1.7 ± 0.7 years after death. Thirteen devices (48%) were implanted within 1 year of death. This included 6 pacemakers and 7 implantable cardioverter-defibrillators (ICDs); 2 of these defibrillators were part of CRT systems. Two devices (7%) were implanted 1 to 3 years before death. Twelve devices (45%) were implanted >3 years before death ( Figure 1 ). The shortest amount of time a device functioned within a living patient was 33 days, and the longest time was 6.6 years.
Longevity could be estimated in 20 devices (74%); the manufacturers were contacted for the remaining 7 devices (26%). Nine devices (33%) had <1 year of estimated longevity remaining. This included 8 devices that had reached the end of life and 1 device that had reached the elective replacement indicator. Ten devices (37%) had estimated longevity of 1 to 4 years. Eight devices (30%) had estimated longevity of ≥4 years ( Figure 2 ). Of these 8 devices, 6 were pacemakers, 2 were ICDs (1 CRT device), and 7 provided their own longevity estimates.
Results
From February 2009 to July 2011, 334 autopsies were performed. Twenty-seven patients (8%) who underwent autopsy had CIEDs. This included 17 pacemakers (63%) and 10 defibrillators (37%). Two defibrillators were part of cardiac resynchronization therapy (CRT) systems. The average age at the time of implantation was 65.3 ± 13.4 years. The average age at the time of death was 67.8 ± 14.7 years. Devices were interrogated 1.7 ± 0.7 years after death. Thirteen devices (48%) were implanted within 1 year of death. This included 6 pacemakers and 7 implantable cardioverter-defibrillators (ICDs); 2 of these defibrillators were part of CRT systems. Two devices (7%) were implanted 1 to 3 years before death. Twelve devices (45%) were implanted >3 years before death ( Figure 1 ). The shortest amount of time a device functioned within a living patient was 33 days, and the longest time was 6.6 years.
