title: Ethical considerations for ventricular assist device support: a 10-point model.
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.
authors.affiliation: Department of Psychiatry, Drexel University College of Medicine/Hahnemann University Hospital, Philadelphia, Pennsylvania 19102, USA. Ralph.Petrucci@drexelmed.edu
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Petrucci
authors.forename: Lynne A
authors.initials: LA
authors.lastname: Benish
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Carrow
authors.forename: Lisa
authors.initials: L
authors.lastname: Prato
authors.forename: Shelley R
authors.initials: SR
authors.lastname: Hankins
authors.forename: Howard J
authors.initials: HJ
authors.lastname: Eisen
authors.forename: John W
authors.initials: JW
authors.lastname: Entwistle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002309:Cardiology / Q000941:ethics*; D004992:Ethics, Medical; D005260:Female; D017408:Guidelines as Topic; D006333:Heart Failure / Q000601:surgery; D016027:Heart Transplantation / Q000941:ethics / Q000379:methods*; D006352:Heart Ventricles / Q000601:surgery; D006353:Heart-Assist Devices / Q000941:ethics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D010166:Palliative Care