Ethical, legal, and sociocultural considerations in neural device explantation: a systematic review

Abstract

INTRODUCTION: Implantable neural devices, including brain-computer interfaces and spinal cord stimulators, hold significant therapeutic promise for conditions such as paralysis and chronic pain. However, the novelty of these technologies introduces unique ethical challenges. While much of the existing literature emphasizes development-related concerns such as device safety, the ethical issues surrounding explantation remain relatively underexplored. METHODS: We conducted a systematic review to identify ethical, legal, and sociocultural considerations relevant to the explantation of neural devices. The review applied the IEEE BRAIN Neuroethics framework as a guiding structure for the categorization of the themes. A subsequent thematic analysis was performed to categorize and synthesize findings across studies. RESULTS: Thematic analysis revealed that medical motives were the predominant factor in discussions of explantation, with 83% of studies citing medical complications as a central concern. Additional themes identified included changes in cognition and behavior, emotional well-being, lack of therapeutic benefit, identity, financial issues, autonomy, post-trial considerations, and neurorights. DISCUSSION: Our findings underscore the multifaceted nature of neural device explantation, extending beyond purely medical considerations to include psychological, financial, legal, and sociocultural dimensions. These results highlight the necessity of interdisciplinary approaches to adequately address the broad spectrum of challenges associated with explantation.