Introduction:
Approximately one million hemodialysis (HD) machines are in operation worldwide, and some 100,000 are discarded each year. In Europe, legislation imposes a maximum lifespan – in France between 10 and 12 years – for HD machines. HD machines contain electronics parts and must be managed as Waste from Electrical and Electronic Equipment (WEEE). WEEEs are often sent to low- and middle-income countries (LMICs): the Agbogbloshie area in Dacca, Ghana, is an example of e-waste mismanagement with a significant impact on the local population. In 1997, the World Health Organization (WHO) indicated that less than 30% of second-hand medical devices sent to LMICs were operational and their destiny is obscure, risking to increase the WEEEs burden in these countries. In recent years, some countries, such as Morocco or Indonesia, have banned the import of exhausted devices from high-income countries (HICs). We tried to shed some light on the destiny of HD machines at the end of their life cycle involving professionals from several countries worldwide.
Methods:
We contacted by email professionals from healthcare centers providing hemodialysis and got answers from colleagues from Argentina, Australia, Botswana, Brazil, Canada, China, Croatia, Egypt, France, Germany, Ghana, India, Italy, Japan, Kenya, Malaysia, Mexico, Morocco, Nepal, New Zealand, Nigeria, Poland, Portugal, Romania, Russia, Saudi Arabia, Singapore, Spain, Sweden, Switzerland, Taiwan, Thailand, Tunisia, Turkey, United Kingdom, United States of America, and Vietnam. In order to understand their policy when the medical equipment has reached its lifespan, we collected the answers on obsolescence rules and disposal practices. Additionally, we explored more in detail the recycling process in France.
Results:
In 4 out of 37 countries, lifespan of HD machines is strictly limited by the number of years or working hours, and specific recommendations are available in further 3 countries. In the absence of regulations, healthcare centers follow the manufacturer’s recommendations, or replace their equipment when the cost of repair becomes higher than acquiring a new machine or there is no more possibility for repair. Usually, nephrologists do not have a clear idea about the destiny of exhausted HD machines. However, we have identified 4 main outcomes for obsolete HD machines: manufacturer take-back with low visibility on the further process; donation to non-governmental organizations (NGOs) in LMICs; reuse or resale of spare parts; disassemble with or without recycling. The recycling process is rather obscure as well: companies in the recycling business are difficult to reach and, in France, only one enterprise agreed to show us around one of its facilities. Globally, it appears that there is a lack of information on the end-of-life of HD machines and on recycling possibilities.
Conclusions:
Obsolesce rules and practices differ in different countries and are not clear as for exhausted HD machines. Policies should be more transparent and standardized around the world. Extending the lifespan of HD machines appears feasible and could be beneficial for the environment and should be encouraged by all the stakeholders. Environmental-friendly recycling processes should be promoted and discarding in WEEE cemeteries discouraged by means of proactive programs at the government level.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.