Cardiovascular disease is the most common cause of death across the globe. Large disparities in access to cardiovascular care exist in the world. An estimated one million people die each year due to lack of access to life saving pacemaker therapy. We discuss the concept of justice in health and health care as it relates to the use of refurbished pacemakers in patients in low- and middle- income countries, where financial circumstances severely limit access to brand new devices. Egalitarianism, utilitarianism, and justice as fairness are examined, as they relate to provision of re-processed pacemakers. This practice, since it holds promise to improve human functioning and capabilities, can be morally justified with some conditions: transparency, further research in is its safety and efficacy, and its impact on other needs and priorities in those countries.
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