nor education 8 min read

By TerraCare

Medical Devices and Implants During Terramation (colloquially referred to as human composting)

If you or a loved one lives with a medical implant — a pacemaker, an artificial hip, breast implants — it is natural to wonder what happens to those devices during natural organic reduction (NOR). The short answer is: most medical devices can be accommodated. Some must be removed before the process begins, others remain intact and are separated from the resulting soil afterward, and a small number require special consultation. Your NOR provider and funeral home work together to handle all of this — and knowing what to expect in advance makes the planning conversation much easier.

What happens to medical implants and devices during terramation?

Most medical implants can be accommodated. Pacemakers and ICDs must be removed before the process begins because their batteries can rupture — the same requirement as cremation. Metal orthopedic implants (titanium, cobalt-chromium) pass through NOR intact and are screened out and recycled afterward. Silicone implants vary by provider — some require removal, others recover them at the end. Radioactive implants require immediate provider notification.

  • Pacemakers and implantable defibrillators must always be removed before NOR begins — their batteries can rupture, just as with cremation.
  • Metal orthopedic implants (hip and knee replacements, surgical rods and pins) are chemically inert and pass through NOR unchanged, then are separated by screening and typically recycled.
  • Silicone implants are not biodegradable; provider policies vary between requiring pre-removal and recovering them during post-process screening.
  • Radioactive seed implants require immediate disclosure to the provider and may involve coordination with state radiation safety regulators.
  • Families should locate implant cards, note devices in advance planning documents, and inform the funeral director before any disposition steps are taken.
  • Having implants does not disqualify someone from terramation — only active radioactive devices require case-by-case consultation that may affect eligibility.

Why Do Medical Implants Matter During NOR?

Natural organic reduction works by accelerating the body’s natural decomposition through heat, moisture, oxygen, and microbial activity. The process transforms human remains into nutrient-rich soil over a period of several weeks to a few months, depending on the system. Biological materials — soft tissue, bone — break down completely. Non-biological materials do not.

Most implanted medical devices are made from metals, silicones, or synthetic polymers that are specifically designed to resist the body’s biological environment. That resistance does not go away during NOR. Unlike soft tissue, these materials remain largely intact at the end of the process.

That does not create a problem — it simply creates a protocol. NOR providers have established procedures for identifying, removing where necessary, and responsibly handling every category of common implant.

Which Devices Must Be Removed Before Terramation?

Pacemakers and Implantable Cardioverter-Defibrillators (ICDs)

Pacemakers and defibrillators must be removed before NOR begins. This is the same requirement as cremation, and for a similar reason: pacemakers contain batteries that can rupture or cause damage if exposed to conditions that disrupt their sealed enclosures. While NOR does not involve the intense heat of cremation, standard funeral home protocols — shared across both disposition methods — require removal before any disposition process begins.

If you are pre-planning and have a pacemaker or ICD, make a note of it in your planning documents. Your funeral director will coordinate removal; it is a routine step they are familiar with. Most implant patients receive a wallet card from their device manufacturer at the time of implantation — keeping this card with your other planning documents is helpful.

The FDA maintains guidance on medical device implants and end-of-life considerations that families and providers may find useful when navigating these decisions.

Neurostimulators and Insulin Pumps

Implanted neurostimulators (used for chronic pain, Parkinson’s disease, and other conditions) and insulin pumps contain electronic components and batteries. These are handled on a case-by-case basis, and the protocol generally mirrors that of pacemakers — notify your provider, and they will determine whether removal is required.

What Happens to Metal Implants That Stay?

Orthopedic Implants: Hip Replacements, Knee Replacements, Rods, and Pins

Metal orthopedic implants — titanium and cobalt-chromium alloys used in hip replacements, knee replacements, surgical rods, screws, and pins — do not decompose during NOR. They are designed to be chemically inert inside the body, and they remain inert throughout the NOR process.

After the process is complete, NOR operators screen the resulting organic material. Metals are separated from the soil at this stage — the same approach used in cremation, where metal remains are collected after the retort process. According to the American Academy of Orthopaedic Surgeons, these implants are most commonly made from titanium alloys, cobalt-chromium alloys, or stainless steel — materials that can be recycled.

Separated metals are typically sent to medical metal recycling programs rather than disposed of in landfills. Families may also request that recovered implants be returned to them, though policies vary by provider — this is worth asking about during intake.

Dental Work

Dental fillings, amalgam, metal crowns, and dental implants are covered in detail in our companion article, Dental Fillings and Metal During Terramation. The short version: dental metals do not decompose and are separated from the soil after the process.

What About Silicone Implants?

Silicone breast implants and other silicone-based implants are not biodegradable. Silicone is designed to remain chemically stable inside the body indefinitely, and NOR does not change that.

Provider policies vary on silicone implants. Some NOR providers ask that silicone implants be removed before the process. Others permit them to proceed through NOR, with the understanding that they will be recovered as solid material at the end — similar to how metal implants are handled. If you or a family member has silicone implants, this is a direct question to ask your NOR provider during the intake process.

What About Radioactive Implants?

Some cancer patients receive treatment through radioactive seeds or devices implanted directly in or near a tumor — a technique used for prostate cancer, head and neck cancers, and others. These devices emit low levels of radiation, and their handling at end of life requires special consideration.

If the deceased received radioactive seed implants or had an implanted radioactive device, inform your NOR provider immediately. Protocols for handling radiation-containing remains vary by provider and may involve coordination with a health physicist or the state radiation control program. This is not a common situation, but it is one that providers are equipped to handle with proper disclosure.

How Should You Document Your Implants for Your NOR Provider?

The most important thing families can do is gather and communicate information. Here is a practical checklist:

  • Locate the implant card. When a medical device is implanted, patients typically receive a wallet-sized card from the manufacturer listing the device name, model number, and implant date. Keep this with your advance planning documents.
  • Note it in your advance directive or pre-planning paperwork. Most NOR providers have intake forms that ask about implanted devices. If you are pre-planning, include device information in your written instructions.
  • Inform your funeral director. Even if you have pre-planned, communicate directly with the funeral home at the time of death. Funeral directors are trained to ask these questions and coordinate with the NOR facility.
  • Obtain medical records if needed. If the implant card is unavailable, your physician or the hospital where the procedure was performed can provide device documentation.

For more on pre-planning terramation, see our complete guide to natural organic reduction and the state-by-state guide at /blog/state-guides/. For a full overview of what can and cannot go into a terramation vessel alongside the body, see our article on what materials go into a terramation vessel.

Does having a pacemaker disqualify someone from terramation?

No. Having a pacemaker does not disqualify someone from terramation. The pacemaker must be removed before the NOR process begins — this is a standard step that funeral homes perform routinely, just as they do for cremation. Once removed, the NOR process proceeds normally.

Can my family get back metal implants after terramation?

Policies vary by provider. Some NOR providers return recovered metal implants to the family upon request; others recycle them through certified medical metal recycling programs. This is a question to ask during the intake conversation or when pre-planning, and most established providers address it in their FAQ documentation.

What happens to titanium implants during the NOR process?

Titanium is highly resistant to corrosion and does not decompose. Titanium implants — including orthopedic joints, surgical screws, and titanium dental implants — pass through the NOR process intact and are separated from the resulting soil during the screening stage at the end.

Are there implants that would prevent terramation entirely?

Very few. The most complex situations involve active radioactive devices, which require consultation with the provider and potentially state radiation safety regulators before proceeding. For most common implants — orthopedic hardware, pacemakers (removed beforehand), silicone implants — terramation is fully achievable with proper preparation and communication.

How should I bring this up with my family?

If you are pre-planning, document your implant information in writing and share it with the person responsible for your final arrangements. You do not need to have all the answers — your funeral director and NOR provider are experienced in asking the right questions and will guide the conversation.

Ready to Explore Your Terramation Options?

Learn more about terramation providers near you — TerraCare Partners can connect you with NOR providers who handle all stages of preparation, including medical devices and implants.

Ready to explore terramation options? Contact TerraCare Partners to learn more about planning ahead and what to expect throughout the process.

Sources

  1. Washington State Legislature — WAC 246-500 (NOR Rules). https://app.leg.wa.gov/wac/default.aspx?cite=246-500
  2. U.S. Food and Drug Administration — Medical Devices. https://www.fda.gov/medical-devices
  3. American Academy of Orthopaedic Surgeons — Implant Materials. https://orthoinfo.aaos.org/en/treatment/total-hip-replacement/
  4. Washington State Department of Health — NOR. https://doh.wa.gov/
  5. U.S. Environmental Protection Agency — Medical Waste. https://www.epa.gov/rcra/medical-waste
  6. U.S. Environmental Protection Agency — Sustainable Materials Management: Metal Recycling. https://www.epa.gov/smm/sustainable-materials-management-non-hazardous-materials-and-waste-management-hierarchy
  7. National Funeral Directors Association — 2025 Cremation and Burial Report. https://nfda.org/news/statistics