Donations

The most significant change in the last few years regarding donations of health care materials is the concept of responsible donation. Receiving countries do not want items that are expired, poor quality, or require ancillary resources that are unavailable. The primary goal of any donation should be the benefit of the recipient. Using such a method to “green” an operating room is a distant second. Surplus equipment that is in good working condition is of potential value to low-income settings. With approximately 80% of equipment coming from donations, the dependence on donor aid is significant. The World Health Organization (WHO) guidelines on donating equipment to low-income countries seeks to improve donation utilization through action planning.¹¹² The Partnership for Quality Medical Donations (PQMD)¹⁰⁵ was formed with a goal of supporting adherence to and implementation of the WHO guidelines and to encourage and develop appropriate and effective medical donations. The basic principles outlined by PQMD include:

• Governance (contracts and agreements in place)
• Finance (terms disclosed and agreed upon)
• Policies (develop internal standard operating procedures)
• Organizational Evaluation (vet partners)
• General and Needs Assessment
• Quality
• Appropriateness of the Donation
• Logistics (shipping, product stability)
• Disposal
• Monitoring and Evaluation

Responsible Donating

Responsible donating involves providing the right equipment to the right facilities and caregivers. Matching equipment supply and demand is not simply about need, but also receiving conditions. Considerations described by the World Federation of Societies of Anesthesiologists¹¹³ include:

• Evaluation of inconsistent or absent electricity that may limit the use of certain technologies if devices do not use backup batteries or a supply of batteries is not available.
• Sterile processing and clean water availability for equipment reuse.
• Availability of biomedical support for failed devices.

What to Donate – Consumables or Reusables?

Single-use device donations may be concerning as reuse may occur unsafely. For example, needle and syringe reuse increases HIV and hepatitis transmission, but other equipment decontaminated in dilute bleach (if available) may be relatively safe and its reuse feasible. Effective communication to establish an intended recipient’s ability to use and possibly reuse (whether reusable or single-use) equipment safely may be of value.¹⁰⁶

Auctions

Auctions may be a source of inexpensive medical equipment. While the equipment is sold “as is,” the donor should ensure proper working order. In the U.K., up to 50% of auctioned equipment may be sent overseas to low-income countries.¹¹³

Planning Donations

Although well intentioned, failure to donate responsibly consumes precious resources, generates emissions from unnecessary transportation, and essentially outsources disposal management without delivering benefit to the intended recipients. Donors should take responsibility for packaging, shipping, customs clearance, local transportation, and installation expenses. It is recommended that equipment be shipped in bulk. About 50% of donated equipment may be unused due to disrepair or insufficient recipient maintenance infrastructure or knowledge, resulting in equipment graveyards.¹¹³ (See figure 3 below.) A donation action plan can mitigate the risk if it includes operating manuals, accessories provision, spare parts, and effective communication to ensure that the recipient both needs the donated equipment, and can operate and maintain it. Donation contracts should also include a plan for safe disposal.

Additional Resources

• Recovered Medical Equipment for the Developing World (REMEDY)¹¹⁴ is a nonprofit organization that provides institutions with how-to training kits for setting up donation service for an institution, as well as receives and distributes many supplies.
• Equipment Graveyard from Howie SR, Hill SE, Peel D, et al. Beyond good intentions: lessons on equipment donation from an African hospital. Bull World Health Organ. 2008;86(1):52-56. doi:10.2471/blt.07.042994¹¹³
  
  

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