This chapter highlights the evolving landscape of medical device development under sustainability principles and emphasizes that the future of healthcare innovation will depend on the successful integration of environmental, social, and governance (ESG) factors without undermining clinical performance and safety. The medical device industry is undergoing a profound transformation as sustainability becomes an essential element of product development, manufacturing, and life cycle management. Regulatory pressures, growing environmental awareness, and the adoption of circular economy principles are driving manufacturers to rethink materials, design strategies, and operational practices. This shift is leading to the integration of biodegradable and recyclable materials, the refurbishment and modular design of high-cost equipment, and the implementation of take-back and recycling programs for electronic components and batteries. Furthermore, digitalization and artificial intelligence are contributing to sustainability through predictive maintenance, remote diagnostics, and the optimization of healthcare logistics. Despite clear progress, the sector faces significant challenges, including the high safety and performance standards required for medical devices, which can slow the introduction of eco-friendly innovations. Legal, regulatory, and economic barriers—especially for small and medium-sized enterprises—also complicate the widespread adoption of sustainable practices.