“Most doctors like to golf, but I don’t. I love to collect these devices and take pleasure in interrogating and cleaning them. To me, it’s like finding gold. In fact, the device itself is much more expensive than gold,” Mascarenhas, clinical professor of medicine at Drexel University College of Medicine, told India-West via phone. 

 

A pacemaker is a medical device which is implanted under the skin to maintain a normal heartbeat. Mascarenhas received his MBBS and MD from King Edward Memorial Hospital in Mumbai. While doing his fellowship there in cardiology, Mascarenhas witnessed many of his patients dying right in front of his eyes.

 

Many individuals did not have the money to support themselves let alone purchase medical devices, and new pacemakers cost well over $6,000. Other medical devices such as a defibrillator can cost up to $27,000 according to Mascarenhas. “Most individuals in India cannot afford the cost for the devices. Even if it was half the price, they couldn’t afford it either,” added Mascarenhas. 

 

“I wanted to make a change in a small way. Even if it was a drop in the ocean,” he said. After moving to the United States, Mascarenhas knew he needed to do something about the lack of affordable pacemakers and medical devices. In the late ‘80s and early ‘90s, the Indian American cardiologist began sending expired catheters, stents and other medical devices to places like Croatia and Mumbai. 

 

According to Mascarenhas, it is illegal to reuse pacemakers in the United States. He also noted that many pacemakers with batteries remain intact in a deceased person’s body. Many pacemakers, when fully tested and sanitized, function normally once implanted to another individual’s body, he explained. 

 

In 2003, the cardiologist took it one step further by sending defibrillators and pacemakers from deceased Americans, with the permission of family members from funeral homes, to the King Edward Memorial Hospital in Mumbai, and later, The Holy Family Hospital, also in Mumbai. 

 

Mascarenhas eventually started a pacemaker bank at the Holy Family Hospital in Mumbai. He is one of the key individuals among other Goan professionals in India and the United States who are credited for starting the Goa-America Heart Foundation. 

 

A recent study about Mascarenhas’ work with pacemakers was published Jan. 15 in the American Journal of Cardiology as well as the British Medical Journal. 

 

The study discussed how 121 permanent pacemakers from deceased individuals were donated to a hospital in Mumbai. According to the study, 53 pacemakers were intact and able to be reused in all 53 patients. The implant was successful, and no complications, infections or device malfunctions occurred.

 

The abstract concluded, “With proper device sterilization and handling protocols, reuse of explanted PPMs in poor patients in developing countries is safe and effective. Implantation of donated PPMs can not only save lives but also improve quality of life of needy, poor patients.” 

 

Dr. Nitish Badhwar, assistant professor of medicine and associate chief of electrophysiology at the University of California, San Francisco, provided some insight on pacemakers and whether they are safe enough to reuse on patients, say, in developing countries. He noted that the main concern is the fact that pacemakers need to be properly sterilized to ensure that no infections can be transmitted to the recipient of the pacemaker.

 

Badhwar said that when proper safety precautions are followed, reusing pacemakers is safe and beneficial to individuals living below the poverty line in developing countries. “The main issue we have with any kind of implantable device is that they have to be sterile devices,” Badhwar told India-West.

 

“They have to go through a regulatory process to make sure that the device cannot transmit any infections through the patient,” the Indian American professor said. 

 

When asked if there are any alternative and affordable medical devices similar to pacemakers, he said that as of now, there haven’t been any known medications which can replace the use of a pacemaker. 

 

“Pacemakers have advanced with technology, most of which comes from the Silicon Valley. The goal is to develop new technology that is cost-effective. In the future, we hope to find devices where you don’t need to implant huge pacemakers,” added Badhwar. 

 

According to Reuters, the FDA has restricted the use of recycled pacemakers for patients in the United States. “Pacemakers that are collected in the U.S. but sterilized overseas may not, however, fall under the FDA’s jurisdiction,” added Reuters. 

 

Over the years, Mascarenhas has received countless letters from individuals in India who have had successful pacemaker implants. 

 

“I am a recipient of a pacemaker donated by you. I’m a 60-year-old retired man and have suffered health problems for a very long time until I was advised to receive a pacemaker implant. The high cost was out of our reach. But the timely support from Dr. Lokhandwala and your generous contribution saved my life,” said a Mumbai patient in a letter to Mascarenhas in April 2006. 

 

Christopher Nunes, president of the U.S.-based Goa America Heart Foundation Inc., reflected on Mascarenhas’ work, adding that he makes arrangements to ensure that the collection of medical devices and pacemakers are properly shipped as soon as possible to those who are less fortunate in India, having carried a duffel bag himself for Mascarenhas.

“Whenever he’s got an opportunity to send things to India, he makes arrangements and ships it right away,” Nunes told India-West. 

 

“The problem in India is that a lot of people are poor and they can’t pay for pacemakers. In the U.S., if the medical devices are expired or close to an expiration date, they can definitely use it over there in India,” added Nunes. 

 

Mascarenhas noted that several hundred devices have been implanted over the past nine to ten years. Over the years, he has sent more than 400 pacemakers and defibrillators to India. 

 

As of now, the cardiologist visits areas such as Goa and Mumbai where there is a high demand for pacemakers. He often conducts clinics while educating others about pacemakers. 

 

“When I was in Goa in December, I carried a duffle bag filled with unopened, expired medical devices as well as pacemakers and defibrillators from funeral homes in the U.S.,” said Mascarenhas. 

 

Mascarenhas said he has primarily focused on collecting and donating pacemakers and defibrillators to hospitals in Mumbai because he feels it is his duty to give back to his country. “When you are here in the U.S., you count your blessings and realize that there are so many unfortunate people in other countries. You learn to give back.”