Ethical Issues in the Deactivation of Total Artificial Heart Support – A Systematic Review

Abstract

"Introduction: In the context of a relatively constant heart donation rate, the effort to satisfy the needs, has led to the development of mechanical devices that can replace the cardiac function. Estimating an annual potential of 100,000 artificial heart implants in the United States alone, there is an increased interest in these devices, which is why it is appropriate to explore the situations where its inactivation may be ethically appropriate. Method: We performed a systematic review, which includes all the studies regarding the dilemma of artificial hearts inactivation from the beginning until 2020, published in PubMed, Embase and Scopus. The searched keywords were “totally artificial heart and ethics”; the duplicate studies and those referring to other cardiac support devices were excluded. Results: Following the selection, 12 articles were included in the review. The conflict between the principle of discontinuity and the prohibition generated by the indispensability of the artificial heart was emphasized. The decision to inactivate the support dependent on the patient’s declared level of happiness or clinical evolution over time was reviewed. The dilemma of self-inactivation of artificial cardiac support as suicide versus the acceptance of death caused by the underlying heart condition, as well as the impact of total removal of the native heart were included in the ethical analysis. Conclusions: Requests for withdrawal of TAH support are not uncommon among patients, their discontinuation being ethically acceptable when it does not serve the patient’s interests, even though they may still be capable to prolong their life. "