Pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs) are essential for the treatment of arrhythmias and heart failure, as well as the management of cardiovascular diseases. However, these therapies are expensive and unavailable to a significant number of patients and more than three million people die annually from lack of access to pacemakers and implantable cardioverter-defibrillators. The objective of this systematic review is to increase technical and ethical knowledge about the reuse of pacemakers (PMs) and implantable cardioverter defibrillators (ICDs) and provide theoretical elements to support regulatory decisions regarding this practice.

Systematic review with studies that analyzed technical, ethical and regulatory aspects of the reuse of PMs and ICDs, in 7 databases, using the PICOS strategy, identifying 36 studies.

Thirty-six studies were selected: 13 cohort and case-control, 3 systematic reviews with meta-analysis and 20 studies using different methodologies. The studies are unanimous in stating that PM and ICD reuse may be an ethical option to treat patients from low-income countries, since the available data do not show that reusing these devices heightens the risk of infection, malfunction or early battery depletion when compared to new PMs and ICDs.

No scientific, technical or ethical evidence was found to support the regulatory hurdle of banning PM and ICD reuse. However, this practice requires that the health services involved have a sound organizational structure that allows the selection of donors for these devices and adjusts the technical aspects of their functionality and processing in order to guarantee the benefits.