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Ethics: When to Turn Off the VAD

  • Scott B. Grant
  • Peter AngelosEmail author
Chapter
Part of the Difficult Decisions in Surgery: An Evidence-Based Approach book series (DDSURGERY)

Abstract

VAD recipients are a challenging group of patients for whom end-of-life issues must be recognized and taken seriously. The involvement of palliative care specialists in VAD patient care is examined in an evidence-based manner to assess the impact of this involvement.

Keywords

VAD Palliative care End-of-life care Hospice 

References

  1. 1.
    Kirklin JK, Pagani FD, Kormos RL, et al. Eighth annual INTERMACS report: special focus on framing the impact of adverse events. J Heart Lung Transplant. 2017;36:1080–6.PubMedCrossRefGoogle Scholar
  2. 2.
    McIlvennan CK, Wordingham SE, Allen LA, et al. Deactivation of left ventricular assist devices: differing perspectives of cardiology and hospice/palliative medicine clinicians. J Card Fail. 2017;23:708–12.PubMedCrossRefGoogle Scholar
  3. 3.
    Feldman D, Pamboukian SV, Teuteberg JJ, et al. The 2013 international society for heart lung transplantation guidelines for mechanical circulatory support: executive summary. J Heart Lung Transplant. 2013;32:157–87.PubMedCrossRefGoogle Scholar
  4. 4.
    Centers for Medicare & Medicaid Services. Ventricular assist devices for bridge-to-transplant and destination therapy. Medicare learning Network (MLN) Matters 2014. Available at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Netword-MLN/MLNMattersArticles/downloads/MM8803.pdf.
  5. 5.
    The Joint Commission. Revised ventricular assist device destination therapy requirements. Jt Comm Perspect. 2013;33:6, 13.Google Scholar
  6. 6.
    Swetz KM, Verdoorn BP, Luckhardt AJ, et al. Acceptability, feasibility and implementation of preparedness planning for patients receiving left ventricular assist device as destination therapy—a single-center, 5-year experience. J Heart Lung Transplant. 2015;34:S334–5.CrossRefGoogle Scholar
  7. 7.
    Luo N, Rogers JG, Dodson GC, et al. Usefulness of palliative care to complement the management of patients on left ventricular assist devices. Am J Cardiol. 2016;118:733–8.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Sinha S, Belcher C, Torke A, et al. Development of a protocol for successful palliative care consultation in a population of patients receiving mechanical circulatory support. J Pain Symptom Manag. 2017;54:583–8.CrossRefGoogle Scholar
  9. 9.
    Solomon S, Frankel H, Chuang E, et al. Implementing routine palliative care consultation before LVAD implantation: a single center experience. J Pain Symptom Manag. 2018;55:1350–5.CrossRefGoogle Scholar
  10. 10.
    Brush S, Budge D, Alharethi R, et al. End-of-life decision making and implementation in recipients of a destination left ventricular assist device. J Heart Lung Transplant. 2010;29:1337–41.PubMedCrossRefGoogle Scholar
  11. 11.
    Meyers DE, Goodlin SJ. End-of-life decisions and palliative care in advanced heart failure. Can J Cardiol. 2016;32:1148–56.PubMedCrossRefGoogle Scholar
  12. 12.
    Sagin A, Kirkpatrick JN, Pisani BA, et al. Emerging collaboration between palliative care specialists and mechanical circulatory support teams: a qualitative study. J Pain Symptom Manag. 2016;52:491–7.CrossRefGoogle Scholar
  13. 13.
    Petrucci RJ, Benish LA, Carrow BL, et al. Ethical considerations for ventricular assist device support: a 10-point model. ASAIO J. 2011;57:268–73.PubMedCrossRefGoogle Scholar
  14. 14.
    Makdisi T, Makdisi G. Ethical challenges and terminal deactiviation of left ventricular assist device. Ann Transpl Med. 2017;5:331–4.CrossRefGoogle Scholar
  15. 15.
    Swetz K, Freeman M, AbouEzzeddine O, et al. Palliative medicine consultation for preparedness planning in patients receiving left ventricular assist devices as destination therapy. Mayo Clin Proc. 2011;86:493–500.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Verdoorn BP, Luckhardt AJ, Wordingham SE, et al. Palliative medicine and preparedness planning for patients receiving a left ventricular assist device as destination therapy—challenges to measuring impact and change in institutional culture. J Pain Symptom Manag. 2017;54:231–6.CrossRefGoogle Scholar
  17. 17.
    Sulmasy DP. Within you/without you: biotechnology, ontology, and ethics. J Gen Intern Med. 2008;23(Suppl 1):69–72.PubMedCrossRefGoogle Scholar
  18. 18.
    Swetz KM, Ottenberg AL, Freeman MR, et al. Palliative care and end-of-life issues in patients treated with left ventricular assist devices as destination therapy. Curr Heart Fail Rep. 2011;8:212–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Mueller P, Swetz K, Freeman MR, et al. Ethical analysis of withdrawing ventricular assist device support. Mayo Clin Proc. 2010;85:791–7.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Belanger S. Check your advance directive at the door: transplantation and the obligation to live. Am J Bioeth. 2010;10(3):65–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Shaefer KG, Griffin L, Smith C. An interdisciplinary checklist for left ventricular assist device deactivation. J Palliat Med. 2014;17:4–5.CrossRefGoogle Scholar
  22. 22.
    Wordingham SE, McIlvennan CK, Fendler TJ, et al. Palliative care clinicians caring for patients before and after continuous flow-left ventricular assist device. J Pain Symptom Manag. 2017;54:601–8.CrossRefGoogle Scholar
  23. 23.
    Teuteberg W, Maurer M. Palliative care throughout the journey of life with a left ventricular assist device. Circ Heart Fail. 2016;9:e003564.PubMedCrossRefGoogle Scholar
  24. 24.
    Quill TE, Abernethy AP. Generalist plus specialist palliative care—creating a more sustainable model. N Engl J Med. 2013;368:1173–5.PubMedCrossRefGoogle Scholar
  25. 25.
    MacIver J, Ross HJ. Withdrawal of ventricular assist device support. J Palliat Care. 2005;21:151–6.PubMedGoogle Scholar
  26. 26.
    McGonigal P. Improving end-of-life care for ventricular assist device (VAD) patients: paradox or protocol? Omega. 2013;67:161–3.PubMedCrossRefGoogle Scholar
  27. 27.
    Kitko LA, Hupcey JE, Birriel B, et al. Patients’ decision making process and expectations of a left ventricular assist device pre and post implantation. Heart Lung. 2016;45:95–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Dunlay SM, Strand JJ, Wardingham SE, et al. Dying with a left ventricular assist device as destination therapy. Circ Heart Fail. 2016;9:e0030906.CrossRefGoogle Scholar
  29. 29.
    Nakagawa S, Yuzefpolskaya M, Colombo PC, et al. Palliative care interventions before left ventricular assist device implantation in both bridge to transplant and destination therapy. J Palliat Med. 2017;20:977–83.PubMedCrossRefGoogle Scholar
  30. 30.
    Wright AA, Keating NL, Balboni TA, et al. Place of death: correlations with quality of life of patients with cancer and predictors of bereaved caregivers’ mental health. J Clin Oncol. 2010;28:4457–64.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.CareMount MedicalCarmelUSA
  2. 2.University of ChicagoChicagoUSA
  3. 3.MacLean Center for Clinical Medical EthicsChicagoUSA

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