Rise of the Machines: In an Era of Ventricular Assist Devices, Prolonging Life or Death?

Abstract

The past few decades witnessed the unprecedented "rise of the machines"; life-prolonging devices to support failing organs or as a form of organ replacement. Sophisticated machines provide us clinical milieu to intervene on sicker, dying patients, support the failing organ, prevent downward trajectory to multi-organ failure, and avert death. Hemodialysis has been in existence for several decades and has become the standard therapy for acute renal failure. Extracorporeal liver assist device replaces the detoxification function of the failing liver. Extracorporeal membrane oxygenator in cases of profound respiratory failure can replace the native lung function in the oxygenation of the venous blood and removal of carbon dioxide. The technology can also be used as a short-term heart-lung machine to keep the patient alive in the event of profound refractory cardiopulmonary collapse until the native heart and lung function returns. Ventricular assist devices (VADs) can completely replace the cardiac function in patients with end-stage heart failure and provide systemic flow. These innovative machines were developed under the assumption that they will improve survival, functional capacity, and quality of life in this cohort of patients. This case study focuses on the appropriate use of VADs as an alternative therapy for end-stage heart failure. This will explicate the ethical dilemma that concomitantly may arise with the use of these sophisticated organ replacement strategies when the goals of their placement are not met and just merely prolonging the dying process.