The Business of Giving Back

Each year, many prostheses are discarded or outgrown by their users – but not all are going to waste. Three humanitarian organizations are recouping and renewing used components, and delivering them around the world to those who need them most.

Making a mark

One of these organizations is the Florida O&P Outreach Team (FOOT) Foundation. Founded by Dino Scanio, CO, LO, and wife, Lisa, the FOOT Foundation is a 501(c)3 nonprofit organization with a mission to provide care to impoverished countries and local communities.

Most recently, they held a clinic in Guatemala City where they provided devices to more than 45 children, and taught local practitioners techniques to continue care in their communities. The FOOT Foundation has been recouping and renewing used components since in 2007.

Dino Scanio, CO, LO
Dino Scanio

Much like the FOOT Foundation, Ability Prosthetics & Orthotics Inc., a company that provides both custom and readymade devices, is making a mark as well. They recently donated 100 pre-owned limbs to Physicians for Peace, a Virginia-based humanitarian organization that redistributes prosthetic limbs to patients in developing countries. Ability estimated the approximate value of its donation at $750,000.

Tyler Manee, CPO, who has been with the company for 2 years, said Ability’s role is to serve “as kind of a collection point for components,” a role similar to that of the Prosthetic & Orthotic Component Clearinghouse (P.O.C.C.).

P.O.C.C. provides individuals, manufacturers, distributors and facilities a clearinghouse to make tax-deductible orthotic and prosthetic donations, and to save usable goods from being sent to landfills.

Robert S. Kistenberg, MPH, L/CP, FAAOP, president and founder of Prosthetic Hope International (PHI), got the idea in 1996, when he was providing services to impoverished communities in Central America.

Robert S. Kistenberg, MPH, L/CP, FAAOP
Robert S. Kistenberg

“I had been recycling components basically out of my basement. [Other] practitioners would collect donated prostheses and send them to me as well,” he said. “Once every month [or every] 6 weeks, I would get a package on my doorstep and save it until it was time to take a trip.”

Kistenberg noticed a number of organizations with recycling activities of their own. He proposed the idea for an O&P component clearing house to a student group at the Georgia Institute of Technology called Promoting Orthotics & Prosthetics (POP). In conjunction with the U.S. International Society for Prosthetics and Orthotics (US-ISPO), MedShare International and the Barr Foundation, P.O.C.C. was formally launched in 2007.

A look at logistics

For practices looking to get involved in similar efforts, one question is how to collect pre-owned devices. At Ability, it is mainly done by word of mouth, Manee said.

“Because we [create prostheses], we tend to know the people. It is people that we made a leg for [who have] outgrown them,” he said. “If someone no longer walks or unfortunately has passed away, the family may donate the leg to us as well. They know us because they are our patients [and] because we talk to them and they talk to each other.”

The Foot Foundation collects used O&P devices and recycles them for use by children in developing countries. Shown are some recycled devices.
The Foot Foundation collects used O&P devices and recycles them for use by children in developing countries. Shown are some recycled devices.

Image: Scanio D, The Foot Foundation.

Donations also come from manufactures, Kistenberg said. “When they are cleaning out their warehouse, [if they] have a stock of version 2.0 and have just come out with 3.0, they may need to clear some space. Maybe a facility ordered [a device] and the patient does not like it, but they already purchased it.”

Mostly any component can be reused, he added, aside from sockets and liners, which are custom made for each device.

For Ability, donations are broken down and sent out about once every 6 months. “We do not want to do it piecewise,” Manee said. “Say we get one donation a week of a leg, we store them up so we can do it in bulk, or until we have enough to make a project out of it.”

When it comes to breaking down and sorting, “it is a simple process,” Manee added. “It is only four or eight screws that have to be removed. We will have some kind of event where we get help from surrounding communities in breaking them down and separating them into components.”

Like Ability, FOOT has a similar process for repurposing components. The clinical team is solely involved in breaking down devices, which helps quickly determine what is reusable for humanitarian purposes.


Tax and regulations

When the donations are ultimately sent to a humanitarian organization, a tax donation receipt may be offered in return. PHI suggests deducting the amount spent on shipping and basing the worth of donated goods on the amount paid out of pocket or the value of the components that can be salvaged from the donation.

Due to legal considerations and federal and state billing regulations, the donated limbs cannot be reused in the United States and are thus sent to developing countries.

“We can only provide a prosthesis to someone [who] is covered under the manufacturer’s warranty,” Manee said. “Since that warranty only covers the initial user, even if the person just used it for a day, none of the parts can be sold again.”

According to P.O.C.C.’s guidelines for recipients, the use of O&P goods should be restricted to the provision of O&P services; components should be provided by trained professionals; and the receiving organization is responsible for shipping costs, warehouse fees, navigating customs and any duties or associated taxes.

Part of the reason regulations are so strict, according to Scanio, is because devices often are sold illegally in developing nations, and patients may end up with devices not suited to their individual needs.

Scanio has written several articles related to this concern of “illegally” selling components intended for humanitarian use and said that further education is needed so that O&P supplies are appropriately used abroad.

He suggests investigating beforehand, as there are only 13 non-governmental humanitarian organizations that have been awarded the “Code of Conduct for Humanitarian Organizations” by ISPO.

Getting involved

Since 2007, P.O.C.C. has processed more than 7 tons of O&P components. Today, the organization continues to partner with clinics in developing nations. Ability and the FOOT Foundation maintain ongoing relationships with humanitarian organizations and are currently planning trips to Central America.

According to Manee, the experience not only makes a difference in the lives of patients, but makes a difference in the lives of the providers as well.

“Get involved,” he said. “If you want to join in this type of effort, let it be known that you do this. Send parts over for sure, but if you have the availability, send people.

“Go to Haiti, go to Belize, go to China. There is a need for our skills worldwide, so find the organization and give. Not just the parts, but give your time.” – by Shawn M. Carter

Disclosures: Kistenberg, Manee and Scanio report no relevant financial disclosures.

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