Compassionate Deactivation Of Ventricular Assist Devices In Pediatric Patients.

Compassionate Deactivation Of Ventricular Assist Devices In Pediatric Patients.

Hollander SA; Axelrod DM; Bernstein D; Cohen H; Sourkes B; Reddy S; Magnus D; Rosenthal DN; Kaufman BD

The Journal Of Heart And Lung Transplantation

2016

Pediatrics; Expert Consensus Statement; Destination Therapy; End Of Life Care; Respiratory System; Advanced Heart-disease; Implantable Electronic Devices; Mechanical Circulatory Support; Transplantation; Mechanical Support; Cardiac & Cardiovascular Systems; United States; Patients Nearing End; Quality Of Life; Palliative Care; Surgery; Ventricular Assist; Requesting Withdrawal; Sustaining Treatment

Mechanical Support; Palliative Care; Pediatrics; Quality Of Life; Ventricular Assist

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.

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May 2016 List