The Total Artificial Heart: Termination Planning for TAH Patients
Termination Planning for TAH Patients
The decision to terminate a TAH resembles the decision to discontinue other life-sustaining treatments like respirators or dialysis. It should be based on the patients preferences. Though TAH termination necessarily entails death, this is not, as some suggest, suicide, an analogy that has been rejected in reference to other refusals of life-sustaining therapy by terminally ill persons. Despite improvements in equipment and medical management, TAH implantation will be a hazardous therapy Some TAH recipients will die after an extended course of multiple organ failure similar to that of critically ill intensive care unit patients. Bridge recipients may well experience complications that will render transplantation impossible. These complications and this manner of dying may be anticipated and should be addressed with patients.
Physicians and patients should prepare for two possibilities: that competent patients who are doing well may wish to stop the TAH, and that patients who are no longer competent may have issued advance instructions for care when they can no longer speak on their own behalf. The dialysis experience, where nearly a fourth of the patients die after elective discontinuation of therapy, often independent of new setbacks, suggests the magnitude of the need for TAH termination planning. canadianneighborpharmacy.com
Many forces will make planning for these eventualities difficult. The immediacy of death after ending TAH support will demand steadfastness and sensitivity on the part of participants in such decisions. Physicians will need to recognize that the decision to terminate a TAH research trial lies primarily with the patient. Finally, termination decisions will occur in the public arena that is both fascinated by and unsophisticated about these decisions. Intense scrutiny by the media and partially informed legal authorities may mean that the termination of a TAH may adversely affect the possibility of future TAH research or bridge deployment.