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Chapter 23 - One Way Out

Destination Therapy by Default

from Part VI - Human Guinea Pigs and Miracles

Published online by Cambridge University Press:  17 May 2025

By
Alice Chang  and
Denise M. Dudzinski
Edited by
Paul J. Ford  and
Denise M. Dudzinski
Paul J. Ford
Affiliation:
The Cleveland Clinic Foundation, Cleveland
Denise M. Dudzinski
Affiliation:
University of Washington School of Medicine, Seattle
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Summary

In this chapter of Complex Ethics Consultations: Cases that Haunt Us, the authors describe a patient in her twenties who had a left ventricular assist device implanted in an acute circumstance to save her life before completing a heart transplant evaluation. After being delayed for being placed on the transplant list because of nonadherence to appointment, the patient asked for the device to be shut off, which would result in her death. The authors reflect on better ways to support patients in these circumstances.

Keywords

hauntingclinical ethicsLVADdestination therapysurgerywithdrawal of therapynonadherencetransplantation

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Type
Chapter
Information
Complex Ethics Consultations
Cases that Haunt Us
 , pp. 181 - 186
Publisher: Cambridge University Press
Print publication year: 2025

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References

Rose, EA, Gelijins, AC, Moskowitz, AJ, et al. (REMATCH Study Group). Long-term mechanical left ventricular assistance for end-stage heart failure. N Engl J Med, 2001; 345: 1435–43.CrossRefGoogle Scholar
Rose, EA, Moskowitz, AJ, Packer, M, et al. The REMATCH trial: Rationale, design, and end points. Ann Thorac Surg, 1999; 67(3): 723–30.CrossRefGoogle ScholarPubMed
Lietz, K, Miller, LW. Will left-ventricular assist device therapy replace heart transplantation in the foreseeable future? Curr Opin Cardiol, 2005; 20: 132–7.Google ScholarPubMed
Dudzinski, D. Ethics guidelines for destination therapy. Ann Thorac Surg, 2006; 81: 1185–8.CrossRefGoogle ScholarPubMed
Owen, JE, Bonds, CL, Wellisch, DK. Psychiatric evaluations of heart transplant candidates: Predicting post-transplant hospitalization, rejection episodes, and survival. Psychosomat-ics, 2006; 47(3): 213–22.Google ScholarPubMed
Levenson, JL, Olbrisch, ME. Psychosocial evaluation of organ transplant candidates: A comparative survey of process, criteria, and outcomes in heart, liver, and kidney transplantation. Psychosomatics, 1993; 34(4): 314–23.CrossRefGoogle ScholarPubMed
De Geest, S, Dobbels, F, Fluri, C, et al. Adherence to the therapeutic regimen in heart, lung, and heart–lung transplant recipients. J Cardiovasc Nurs, 2005; 20(5S): S88–S98.CrossRefGoogle Scholar

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