Pacemakers Constitute a Heartfelt Gift

The family arrived at the hospital just moments after Annie Kuntz died. Her daughter reached out to touch the still-warm body one last time, then recoiled, her eyes wide with shock.

“Her heart’s still beating,” she cried out to her husband.

A nurse quickly explained that Kuntz was really dead. What her daughter felt was her pacemaker, still trying to do its work.

On the ride home from the Billings, Mont., hospital that day in 1988, Bill Daem and his wife--Kuntz’s daughter, Evelyn--talked about the six healthy years the pacemaker had added to Kuntz’s life. What a shame, they thought, to waste such a precious item.

They asked everyone they could think of what they could do with the electronic device, which stimulates electrical activity to keep the heart beating regularly and typically costs between $5,000 and $10,000. “Everyone said nothing, so we buried it with her,” Bill Daem said.

It would take many years and another jolt, but Daem eventually started what is now a thriving pacemaker recovery program he calls Heart Too Heart.

Every morning, he checks the metal cooler he keeps chained to his doorstep for deliveries of pacemakers, which are sent to him from about 225 funeral homes across the country. He then forwards the devices to doctors who reimplant them in destitute patients overseas. Neither Daem nor the manufacturer nor the doctor makes any money from the program.

Daem quickly learned that pacemakers cannot be recycled in the United States, where the Food and Drug Administration approves them for one use only. But when he looked into shipping them overseas, he discovered that many Third World countries have no rules governing their use and are eager to acquire more of them.

He initially contacted Montana’s senators, who agreed that there was no obvious legal impediment to a doctor donating them overseas. Then he checked into the medical aspects.

As the retired assistant chief of emergency medical services in Billings, Daem knew many people in the medical community. He learned that manufacturers of the pacemakers oppose recycling them, citing liability issues and questions about whether they can be sterilized safely.

He also discovered that the devices are routinely sterilized and reused at hospitals in Sweden. And, he quickly became convinced, a heart patient with a used pacemaker--as long as it was properly checked--is almost certainly better off than a heart patient with no pacemaker.

The issue of the United States exporting second-class medical care to the Third World has become a concern in recent years, but several cardiologists contacted about Daem’s program spoke highly of it.

“Heart Too Heart is a wonderful organization, doing lifesaving work,” said Peter Alagona Jr., a fellow of the American College of Cardiology and president of Heartbeat International. His group procures from manufacturers new pacemakers nearing their expiration date and ships them to 24 countries overseas. “But pacemakers are like hearts: You can never harvest enough of them to make a dent in the world.”

As long as the pacemakers are properly sterilized and reassessed for performance, recycling them is “a very reasonable idea,” said David Hayes, director of pacemaker services at the Mayo Clinic in Rochester, Minn.

An FDA spokeswoman did not explain why it approves pacemakers for one-time use only. But because the devices are covered by Medicare, Medicaid and most insurance policies, there is no demand for reuse in the United States. Some doctors attribute the U.S. one-use policy more to business concerns than to medical safety.

“Americans only want the best and newest of everything,” Alagona said, “but people overseas don’t quibble when a pacemaker can give them extra years of life.”

The idea was not yet ripe when it first occurred to Daem at his mother-in-law’s bedside. It was only years later, during a ride in an undertaker’s limousine, that he was inspired again.

Daem occasionally helps at funerals as a Roman Catholic deacon. That day, he was catching a ride from the cemetery when funeral director Bill Gray mentioned he’d been having problems with pacemakers blowing up during cremation.

Gray explained that the lithium battery that runs a pacemaker explodes under intense heat. One had recently caused $12,000 worth of damage to a crematorium in Missoula, he said.

Gray added that in his own business, he removed pacemakers if he knew about them. “He said some were so new the stitches from the surgery were still in the body,” Daem said. “Knowing the price, he said he couldn’t bear to throw them away, and had a whole drawer full.”

The conversation “was like a knock on the shoulder from Annie,” Daem said. “It was like she was saying, ‘This is my second attempt to get your attention that something should be done with these things.’ ”

So he began calling funeral homes. Soon a Montana funeral directors’ association spread the word to similar organizations in other states. Heart Too Heart was on its way.

As the pacemakers started to come in, Daem and his wife enlisted friends and civic groups to help log and check them. A Knights of Columbus chapter pays for office supplies. A major carrier that wishes to remain anonymous supplies free shipping.

The funeral homes are responsible for disinfecting the pacemakers, and the receiving doctor sterilizes them and checks them with computer equipment, reusing only those with 80% of their battery power remaining.

On the receiving end, Daem’s first partnership was with a New York doctor, Bernard H. Boal, who has taken more than 700 of the pacemakers to Israel. Daem, a deeply religious man, sees the hand of God in the operation.

“It strikes me as more than odd,” he said, “that the person gathering them is Roman Catholic, the main person helping me organize is one of the state’s leading Methodists, the doctor I give them to is Jewish.” And some of the recipients are Muslim.

Now the recipient pool is expanding. A group of doctors last month took a batch of pacemakers to Eastern Europe, and Daem is trying to enlist medical missionaries from two major denominations.

Beyond the obvious gain to recipients, some side benefits have emerged as the program has grown.

Coni Lynn Gasch-Grady occasionally recovers pacemakers for Daem from clients at Gasch Funeral Home in Hyattsville, Md. “It’s a wonderful thing for the people receiving them,” she said, “but my main interest is the families who donate. It’s a positive step forward in the grieving process.”

She routinely asks families if they want to donate eyeglasses, hearing aids, walkers and such. Otherwise, she said, people typically “either keep them or throw them away, and that’s very hard on families either way.”

Asking if they want to donate something implanted in the body is harder, she said, but she finds families are grateful for the opportunity.

The idea makes some people squeamish, but according to Lisa Carlson of the Funeral and Memorial Societies of America, “If people knew what was involved in embalming, they wouldn’t worry about taking out something the size of a silver dollar from right under the skin.”

In any case, Heart Too Heart is expected to get a big boost from a couple of new initiatives. An association of retirees from Southwestern Bell is about to begin a campaign to visit every funeral home in the southwestern United States with a Heart Too Heart information packet. And in May, the Funeral and Memorial Societies of America, a nonprofit industry watchdog, began distributing medical device donor cards.

“Please recycle my medical devices,” read the wallet-sized cards. The cards allow donors to specify pacemakers and defibrillators, which are implanted in a person’s chest; insulin pumps, which can be implanted in the stomach; hearing aids; glasses; and “other.”

But there are thousands of funeral homes in the United States, and more than a million elderly Americans now wear pacemakers. Can Daem handle the flow if cooperation mushrooms?

“I believe,” he answered, “that if God provides, then God provides.”