The family of an octogenarian who died on November 22 is still waiting to be able to cremate her. The patient was wearing a miniature pacemaker which prevents cremation.
The affair is as Kafkaesque as it is tragic. Since November 22, an octogenarian patient in the cold rooms of the crematorium of Bourges (Cher). His family is trying to organize his funeral. But the establishment refuses cremation.
In question: a miniature pacemaker, implanted on the deceased on October 25. No procedure can be initiated until the medical device has been removed. Only problem, no one agrees to take care of it, as reported Slate and The Republican Berry.
Surgical practice
The deceased made it clear before her death: she wanted to be cremated. The law is clear regarding people with pacemakers. The device must be removed from the body before it is put into the coffin. The lithium present in batteries presents a risk of explosion, when exposed to high temperatures, and pollutes the environment.
But the device in question is of the latest generation. “This is the smallest pacemaker in the world. It is about the size of a one euro coin, ”says Antoine Audry, Director of Public & Regulatory Affairs for Medtronic, which produces the Micra model.
This is where the problem emerges. The device is so small that it can be implanted directly into the heart, intravenously. Its predecessors are placed under the skin because they are too bulky. On paper, the embalmer is responsible for extracting the pacemakers. But the Micra model presupposes surgical knowledge. “You have to go under the rib cage and recover the heart”, emphasizes Antoine Audry. The Bourges crematorium refuses to intervene. Surgeons cannot. They are no longer authorized to operate 48 hours after death. It remains to contact a forensic doctor … but the judicial authorities are opposed to it.
Ongoing tests
Removing the device is however necessary: the pacemaker mechanism remains the same, and the pill is made of lithium – although it is 10 times smaller. Exploration therefore falls within a legal vacuum. “Technology is evolving faster than regulation,” concludes Antoine Audry. We are in a transitional phase. In fact, these situations are likely to recur at an increasing rate. Implantable medical devices are increasingly present on the market.
Medtronic had however anticipated this situation: the manufacturer carried out a laboratory study in the United States. No need to explant, she concludes. Cremation does not cause an explosion or environmental pollution. But the Ministry of Health has decided to carry out tests in France. They are still in progress. The High Authority of Health (HAS), in its opinion, makes no mention of this situation.
While waiting for the situation to unblock, the octogenarian remains in a cold room before freezing. “We were offered to tour the crematoria in France to find one who would accept”, explains his sister in The New Republic. Medtronic has made available a guide that details the withdrawal procedure. All that remains is to convince the embalassers.
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