Hoping for a miracle: supporting patients in transplantation and cardiac assist programs

Decision-making in the face of end-stage organ failure

“…However, the principles are similar given the high morbidity and mortality rate for patients on dialysis. This really should be seen as an end-of-life, or palliative, decision and patients counseled and supported as appropriate [9]. This becomes more complex as one considers the adverse event rate associated with VAD insertion, and the potential for the development of VAD-related complications potentially leading to change in candidacy for transplantation and destination therapy -possibly with a quality of life less than experienced previously [6 && ].…”

Improving End-of-Life Care for Ventricular Assist Devices (VAD) Patients: Paradox or Protocol?

“…However, early use of palliative care consultations for BTT patients may seem paradoxical since the goal of care is to survive until transplantation. The literature about this population is limited and yet what little scholarship has been conducted is significant, finding that early palliative care consultation-long before transplantation is no longer an option or a patient chooses to deactivate the device-can enhance the patient's quality of life for patients diagnosed with advanced heart failure (Bramstedt, 2008;Stuart, 2007). Experts recommend that palliative care be consulted at the time of diagnosis of a life-threatening disease to assist with planning for an uncertain future (Ferrell, 2005).…”