title: Compassionate deactivation of ventricular assist devices in pediatric patients.
abstract: Despite greatly improved survival in pediatric patients with end-stage heart failure through the use of ventricular assist devices (VADs), heart failure ultimately remains a life-threatening disease with a significant symptom burden. With increased demand for donor organs, liberalizing the boundaries of case complexity, and the introduction of destination therapy in children, more children can be expected to die while on mechanical support. Despite this trend, guidelines on the ethical and pragmatic issues of compassionate deactivation of VAD support in children are strikingly absent. As VAD support for pediatric patients increases in frequency, the pediatric heart failure and palliative care communities must work toward establishing guidelines to clarify the complex issues surrounding compassionate deactivation. Patient, family and clinician attitudes must be ascertained and education regarding the psychological, legal and ethical issues should be provided. Furthermore, pediatric-specific planning documents for use before VAD implantation as well as deactivation checklists should be developed to assist with decision-making at critical points during the illness trajectory. Herein we review the relevant literature regarding compassionate deactivation with a specific focus on issues related to children.
authors.affiliation: Department of Pediatrics (Cardiology), Stanford University Medical Center, Palo Alto, California, USA. Electronic address: seth.hollander@stanford.edu.
authors.forename: Seth A
authors.initials: SA
authors.lastname: Hollander
authors.affiliation: Department of Pediatrics (Cardiology), Stanford University Medical Center, Palo Alto, California, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Axelrod
authors.affiliation: Department of Pediatrics (Cardiology), Stanford University Medical Center, Palo Alto, California, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Bernstein
authors.affiliation: Department of Pediatrics (Palliative Care Services), Stanford University Medical Center, Palo Alto, California, USA.
authors.forename: Harvey J
authors.initials: HJ
authors.lastname: Cohen
authors.affiliation: Department of Pediatrics (Palliative Care Services), Stanford University Medical Center, Palo Alto, California, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Sourkes
authors.affiliation: Department of Pediatrics (Cardiology), Stanford University Medical Center, Palo Alto, California, USA.
authors.forename: Sushma
authors.initials: S
authors.lastname: Reddy
authors.affiliation: Center for Biomedical Ethics, Stanford University, Palo Alto, California, USA.
authors.forename: David
authors.initials: D
authors.lastname: Magnus
authors.affiliation: Department of Pediatrics (Cardiology), Stanford University Medical Center, Palo Alto, California, USA.
authors.forename: David N
authors.initials: DN
authors.lastname: Rosenthal
authors.affiliation: Department of Pediatrics (Cardiology), Stanford University Medical Center, Palo Alto, California, USA.
authors.forename: Beth D
authors.initials: BD
authors.lastname: Kaufman
mesh_terms: D002648:Child; D006333:Heart Failure; D006353:Heart-Assist Devices; D006801:Humans; D010166:Palliative Care; D016896:Treatment Outcome
keywords: mechanical support; palliative care; pediatrics; quality of life; ventricular assist