Skip to main content
SpringerLink
Log in

Left ventricular assist devices: An ethical analysis

  • Published:
Science and Engineering Ethics Aims and scope Submit manuscript

Abstract

United States statistics continue to indicate that the human donor heart pool does not and will not meet the great demand for hearts. For those patients unresponsive to maximal medical therapy (approximately 60,000 patients per year), cardiac transplantation is currently their best hope for increased survival. To address the need for additional end-stage congestive heart failure (CHF) therapy options, three medical device manufacturers have developed implantable left ventricular assist devices (LVAD) which act as a pump for hemodynamic support of the patient’s diseased heart. Although LVADs have been shown to improve patient disease state prior to organ transplantation. LVADs do nothing to increase the pool of human donor hearts, and they negatively impact the United Network for Organ Sharing (UNOS) waiting list by increasing the size of the waiting pool. This paper identifies and explores the ethical challenges presented by the use of LVADs as a bridging technology for heart transplant candidates. Although LVADs raise some ethical concerns, these concerns are outweighed by the proven medical efficacy of these devices. Thus, this technology should continue to be used and further developed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Tyagi S. C. (1998) Extracellular matrix dynamics in heart failure: a prospect for gene therapy. Journal of Cell Biochemistry 68: 403–410.

    Article  Google Scholar 

  2. Simons W. R., Haim M., Rizzo J., Zannad F. (1996) Effect of improved disease management strategies on hospital length of stay in the treatment of congestive heart failure. Clinical Therapeutics 18: 726–746.

    Article  Google Scholar 

  3. Kriett J M & Kaye M P (1991) The registry of the international society for heart and lung transplantation. Journal of Heart and Lung Transplantation 10: 491–498.

    Google Scholar 

  4. First Alternative Implant of Mechanical Heart Pump at CMPC. Doctor’s Guide to Medical and Other News, P∖S∖L consulting Group Inc., April 12, 1996.

  5. Ctanese K A, Goldstein D J, Williams D L, Foray A T, Illick C D, Gardocki M T, Wenberg A D, Levin H R, Rose E A & Oz M C (1996) Outpatient left ventricular assist device support: a destination rather than a bridge. Annals of Thoracic Surgery 62: 646–653.

    Article  Google Scholar 

  6. Dipla K., Mattiello, J.A., Jeevanandam, V., Houser, S.R. & Margulies, K.B. (1998) Myocyte recovery after mechanical circulatory support in humans with end-stage heart failure. Circulation 97:2316–2322.

    Google Scholar 

  7. Maugh, T.H. (16 June 1998) "Heart Assist Pumps Found to Revive Cells.” Los Angeles Times:A1.

  8. Frazier, O.H., Rose, E.A., McCarthy, P., Burton, N.A., Tector, A., Levin, H., Kayne, H.L., Porirer, V.L. & Dasse, K.A. (1995) Improved mortality and rehabilitation of transplant candidates treated with a long-term implantable left ventricular assist system. Annals of Surgery 222: 327–338.

    Article  Google Scholar 

  9. Burnett, C.M., Duncan, J.M., Frazier, O.H., Sweeney, M.S., Vega, J.D. & Radovancevie, B. (1993) Improved multiorgan function after prolonged univentricular support. Annals of Thoracic Surgery 55: 65–71.

    Article  Google Scholar 

  10. Levin, H.L., Chen, J.M., Dasse, K.A. & Graham, T.R. (1995) End-organ function during mechanical left ventricular assistance, In: Lewis, T. & Graham, T.R., eds., Mechanical circulatory support. Edward Arnold Press, Boston: 179–185.

    Google Scholar 

  11. Dew, M.A., Kormos, R.L., Roth, L.H., Armitage, J.M., Pristas, J.M., Harris, R.C., Capretta, C. & Griffith, B.P. (1993) Life quality in the era of bridging to cardiac transplantation bridge patients in an outpatient setting. American Association for Artificial Internal Organs Journal 39: 145–152.

    Google Scholar 

  12. Levin, H.R., Chen, J.M., Oz, M.C., Catanese, K.A., Krum, H., Goldsmith, R.L., Packer, M. & Rose, E.A. (1994) Potential of left ventricular assist devices as outpatient therapy while awaiting transplantation. Annals of Thoracic Surgery 58: 1515–1520.

    Article  Google Scholar 

  13. Burton, N.A., Lefrak, E.A., Macmanus, Q., Hill, A., Marino, J.A., Spier, A.M., Akl, B.F. & Arbus, R.A. (1993) A reliable bridge to cardiac transplantation: the TCI left ventricular assist device. Annals of Thoracic Surgery 55: 1425–1431.

    Article  Google Scholar 

  14. Blue Cross and Blue Shield Association (1997) Ventricular assist devices in bridging to heart transplantation. Blue Cross Blue Shield Technology Evaluation Center Assessment Program 11: 1–26.

    Google Scholar 

  15. Farrar, J.D. & Hill, J.D. (1993) Univentricular and biventricular Thoratec VAD support as a bridge to transplantation. Annals of Thoracic Surgery 55: 276–282.

    Article  Google Scholar 

  16. Pennington, D.G., McBride, L.R., Miller, L.W., Peigh, P.S. & Swartz, M.T. (1994) Eight years’ experience with bridging to cardiac transplantation. Journal of Thoracic and Cardiovascular Surgery 107: 472–481.

    Google Scholar 

  17. Herrmann, M., Weyand, M., Greshake, B., von Eiff, C., Proctor, R.A., Scheld, H.H. & Peters, G. (1997) Left ventricular assist device infection is associated with increased mortality but is not a contraindication to heart transplantation. Circulation 95: 814–817.

    Google Scholar 

  18. Massad, M.G., McCarthy, P.M., Smedira, N.G., Cook, D.J., Ratliff, N.B., Goormastic, M., Vargo, R.L., Navia, J., Young, J.B. & Stewart, R.W. (1996) Does successful bridging with the implantable left ventricular assist device affect cardiac transplantation outcome? Journal of Thoracic and Cardiovascular Surgery 112: 1275–83.

    Article  Google Scholar 

  19. Institute of Medicine (1991) The artificial heart: prototypes, policies and patients. National Academy Press, Washington DC: 74–75.

    Google Scholar 

  20. Oz, M.C., Rose, E.A. & Levin, H.R. (1995) Selection criteria for placement of left ventricular assist devices. American Heart Journal 129: 173–177.

    Article  Google Scholar 

  21. Arabja, F.A., Smith, R.G., Jaffe, C., Wild, J.C., Rose, D.S., Nelson, R.J., McClellan, D.M., Acuna, G.A., Edling, N.G., Harrington, N.K., Rabago, G., Tsen, A.C., Arzouman, D.A., Sethi, G.K. & Copeland, J.G. (1996) Cost analysis of the Novacor left ventricular assist system as an outpatient bridge to heart transplantation. American Association for Artificial Internal Organs Journal 42: M546-M549.

    Google Scholar 

  22. Baxton, M. (1995) Economic evaluation of therapies for end-stage heart failure. In: Lewis, T., Graham, T.R., eds., Mechanical circulatory support. Edward Arnold Press, Boston: 344–362.

    Google Scholar 

  23. Harper, A.M. & Baker, A.S. (1995) The UNOS OPTN waiting list: 1988–1995. Clinical Transplantation 1: 69–84.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of California-Los Angeles, USA

    Katrina A. Bramstedt

Authors
  1. Katrina A. Bramstedt
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

This paper was written by the author while in the Masters degree progrm at Loma Linda University (Dept. of Biomedical and Clinical Ethics), 11234 Anderson Street, Coleman Pavillion, Loma Linda, CA 92354, USA.

The author is currently an Ethies Fellow (pre-doctoral) in UCLA’s program in Biomedical and Research Ethics.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bramstedt, K.A. Left ventricular assist devices: An ethical analysis. SCI ENG ETHICS 5, 89–96 (1999). https://doi.org/10.1007/s11948-999-0060-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11948-999-0060-3

Keywords

Search

Navigation