Sustainability across the Medical Device Lifecycle: A Scoping Review
3.1. Design and Development
Among the studies included, the authors employed two overarching strategies to promote sustainability in the design and development of MDs. Firstly, they adopted a more comprehensive methodological framework encompassing various practices and techniques to integrate sustainability considerations into product design and development. Secondly, they adopted a more targeted approach that centred around specific features of the device, such as energy consumption and the materials used, with sustainability as a critical consideration. A summary of the studies included in the design and development stage, categorised by approach, is presented below.
3.1.1. Ecodesign, Sustainable Design, and Frugal Engineering
Additionally, the grids describe five levels of maturity or achievement for each issue. For example, the maturity grid for product packaging and distribution guides designers and product marketers in assessing the maturity level of five related topics: the space efficiency of packaging; structure of packaging; recycled, reused, or remanufactured content of packaging; recyclability, reusability, or manufacturability of packaging; and polyvinyl chloride content of the packaging. These grids were developed based on semistructured interviews with eight key opinion leaders in healthcare design and were subsequently validated based on interviews with five MD companies. Overall, the grids provide valuable insights to designers and product marketers on improving the design of MDs at different lifecycle stages.
3.1.2. Energy Harvesting and Efficiency Management
3.1.3. Material Selection and Reduction
Among the included studies, the authors followed two approaches to foster sustainability in MD manufacturing. First, one study focused on the production of the MD. Also, some other studies focused on the supply chain associated with the production of some MDs. An overview of the included studies in the manufacture stage grouped by approach is provided below.
3.2.2. Supply Chain
Studies addressing the supply chain associated with the manufacture of MDs focus on its management or configuration (three and two articles, respectively).
3.2.3. Supplier Selection
Each approach impacts the economic and environmental pillars, although the contribution of the social pillar is indirect because the approaches seek the benefit of the users who use the products. However, the impact on the evaluation is limited.
3.4. End of Life
Each of these approaches positively impact the economic and environmental dimensions thanks to the reuse of the products whose end life has been completed, as these products become raw materials to create novel alternative solutions for resolving other types of issues.
This scoping review was performed with the aim of analysing the state-of-the-art research on the sustainability of MDs across their lifecycle and proposing an evidence-based way forward.
From our analysis, it was clear that there is an unequal distribution of research efforts to incorporate sustainability across different lifecycle stages. The “Design and development”, “Manufacture”, and “Use” stages have received acceptable attention, with 39%, 24.4%, and 29.3% of the included studies, respectively, addressing that stage. Contrastingly, the “End-of-life” stage has received minimal attention, with only 7.3% of the studies addressing this stage, highlighting the urgent need for further research in this area. Indeed, it is crucial to develop innovative approaches to handle MDs at their current end of life sustainably (e.g., safely using the discarded device, its parts, or materials in a new product with a different function).
While not as dramatic as the above, an unequal distribution of research efforts was also observed regarding the three dimensions of sustainability (i.e., environmental, economic, and social). Namely, the environmental dimension was the most common, accounting for 39.1% of the occurrences, closely followed by the economic dimension with 37.9% of the occurrences. In comparison, the social dimension was addressed in 23% of the occurrences. Interestingly, while MDs focus naturally on an essential element of sustainability (i.e., health and well-being), the research efforts to improve it across the MD lifecycle have paid more attention to fostering environmental and economic sustainability. This highlights the need for novel approaches to increase the social impact of MDs. For instance, increasing the access of a broader population to healthcare by following frugal engineering principles during the design and development process of MDs.
SDG#9: industry, innovation, and infrastructure (28.6% of the occurrences).
SDG#12: responsible consumption and production (22.6% of the occurrences).
SDG#3: good health and well-being (11.9% of the occurrences).
SDGs #9 and #12 align with the findings above, which revealed the strong attention that research studies have paid to improving the sustainability of MDs during the design and development, manufacture, and use stages. Furthermore, SDG #3 aligns with the intention of MDs to treat, cure, prevent, mitigate, and diagnose disease in humans. Nevertheless, there are still areas of opportunity to improve the environmental impact of MDs by reducing energy and water consumption during their manufacture and use.
Design and development
Context-aware, lifecycle-aware design and development. This principle refers to incorporating sustainability considerations during the product design and development process using eco-, sustainable, and frugal design approaches. This principle loosely matches R1, which refers to rethinking a product to make it more sustainable by design.
Energy considerations include eliminating the need for external supplies to power MDs by harvesting energy from the body or optimising energy usage through electronics design and microprogramming. This principle matches R2, which includes increasing efficiency in product manufacturing and use by consuming fewer resources.
Material reduction and selection, including optimising the amount of materials in MDs and using more recyclable materials (e.g., less single-use plastics). The latter matches R8, which refers to processing materials to obtain high- or lower-grade materials, while the former matches R2, which also includes consuming fewer materials to manufacture a product.
Energy savings in production processes. While the included studies refer specifically to reducing energy usage during production, this principle can be extended to lowering all the required resources (e.g., energy and water). Hence, this principle aligns with R2, which includes increasing the efficiency of producing MDs by consuming fewer resources.
Supply chain management, which considers optimising the entire supply chain to reduce the resources involved in product manufacturing, from supplying raw materials to distributing finished products. This principle also aligns with R2.
Reusable vs. disposable. This principle refers to reusing MDs after proper sterilisation procedures whenever possible, which directly matches R3. Needless to say, scientific and clinical evidence must support the decision to reuse specific MDs to meet applicable safety standards.
Adapting existing solutions to current needs and customer demands. This principle can align with R1, which considers using the same product for different functions, thus eliminating the need for a new product, or with R7, which considers using a discarded product (or its parts) in a new product with a different function.
Repairing MDs based on decision-making tools, which extends the service life of MDs, reducing the need for new products. This principle aligns with R4 repair and R5 refurbish.
End of life
Repurposing. This principle aligns directly with R7 repurposing, which considers using a discarded product or its parts in a new product with a different function.
Designing and implementing a take-back system for single-use MDs. Take-back systems aim to reduce MD manufacturers’ environmental impacts and increase efficiency and economic value by recycling or remanufacturing products or their materials. This principle aligns with R6 to R8, which includes remanufacturing, repurposing, and recycling.
Improving waste management and communication between medical centres and waste centres. This principle aligns with R8 and R9 as it focuses on recovering the waste generated by MDs to recycle some of their materials or recovering energy from their incineration.
Current MD regulations (e.g., 2017/745) essentially do not consider sustainability—although some are moving in this direction (e.g., the new UK regulation on MDs). In this regard, there is only one international standard relative to sustainability and MDs, IEC 60601-1-9, amended in 2020, which broadly asks medical electrical equipment manufacturers to consider their potential adverse impacts on the environment. This, however, needs to implement a full decarbonisation of the supply chain of MDs as well as a drastic reduction in the use of single-use plastics both in packaging and the end products. Beyond the regulatory hurdle, promoting sustainability in MDs requires a detailed yet holistic understanding of the sources of emissions throughout the design, manufacture, use, and end-use stages discussed.
This work underscores the critical importance of integrating sustainability principles into the entire lifecycle of MDs. While the global movement towards sustainability is imminent, the MD industry faces significant challenges in aligning its practices with environmentally conscious approaches.
Our scoping review reveals a notable disparity in research efforts across the different lifecycle stages of MDs. Considerable attention has been given to their design, development, manufacture, and use, which represents an advancement in achieving more sustainable MDs. In contrast, the end-of-life stage still needs to be further explored, which represents an opportunity for researchers, the industry, and healthcare providers. The distribution of research across the three dimensions of sustainability (environmental, economic, and social) also highlights the need for increased focus on the social dimension, given the inherent impact of MDs on health and well-being.
Regulatory constraints, particularly the need to consider sustainability in current MD regulations, pose a substantial barrier. Despite a recent shift in UK regulation and the existence of international standards like IEC 60601-1-9, more comprehensive measures are required to drive sustainability in medical device production, supply chains, and end-of-life management.
The identified flagship sustainability principles, aligned with the 9R framework and frugal engineering principles, offer a structured approach to addressing MDs’ environmental impact. These principles span design and development, manufacturing, use, and end-of-life stages, emphasising the importance of energy savings, material reduction, and a circular economy approach.
Ethical considerations further complicate the sustainability discourse, emphasising the need for responsible practices throughout the MDs’ lifecycle. The ethical implications extend from environmental concerns to issues of distributive justice, intergenerational equity, and the doctor–patient relationship. The debate between reusable and single-use MDs, influenced by historical events and infection control, adds another layer of complexity.
Moreover, the concept of responsibility and liability emerges as a critical aspect, necessitating a shift in the paradigm of priorities where health and sustainability precede economic considerations. The polluter-pays principle and extended producer responsibility schemes are proposed as avenues to hold manufacturers accountable for the environmental impact of their products.
Integrating ethical guidelines grounded in equity, responsibility, and sustainability is fundamental to achieving a more sustainable and fair global healthcare system. This ethical framework can guide decision making in the healthcare sector, ensuring equitable access to care, responsible resource use, and environmentally conscious practices. The call for climate justice and solidarity underscores the urgency of reshaping the healthcare paradigm to align with the broader goals of sustainability and planetary well-being.
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