Ethical considerations for ventricular assist device support: A 10-point model

Ralph J. Petrucci, Lynne A. Benish, Barbara L. Carrow, Lisa Prato, Shelley R. Hankins, Howard Eisen, John W. Entwistle

Research output: Contribution to journalArticle

21 Scopus citations

Abstract

The potential for long-term support on a ventricular assist device (VAD) in the bridge-to-transplant (BTT) and destination therapy (DT) settings has created unprecedented ethical challenges for patients and caregivers. Concerns include the patient's adaptation to life on a device and the ethical, clinical, and practical issues associated with living on mechanical support. On the basis of our experience treating 175 consecutive VAD patients, we have developed a model to address the ethical and psychosocial needs of patients undergoing VAD implantation. Patient preparation for VAD implantation encompasses three phases: 1) initial information regarding the physical events involved in implantation, risks and benefits of current device technology, and the use of VAD as a rescue device; 2) preimplant preparation including completion of advance directives specific to BTT/DT, competency determination, and identifying a patient spokesperson, multidisciplinary consultants, and cultural preferences regarding device withdrawal; and 3) VAD-specific end-of-life issues including plans for device replacement and palliative care with hospice or device withdrawal. This three-phase 10-point model addresses the ethical and psychosocial issues that should be discussed with patients undergoing VAD support.

Original languageEnglish (US)
Pages (from-to)268-273
Number of pages6
JournalASAIO Journal
Volume57
Issue number4
DOIs
StatePublished - Jul 1 2011

All Science Journal Classification (ASJC) codes

  • Biophysics
  • Bioengineering
  • Biomaterials
  • Biomedical Engineering

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    Petrucci, R. J., Benish, L. A., Carrow, B. L., Prato, L., Hankins, S. R., Eisen, H., & Entwistle, J. W. (2011). Ethical considerations for ventricular assist device support: A 10-point model. ASAIO Journal, 57(4), 268-273. https://doi.org/10.1097/MAT.0b013e3182223269