Abstract
End-stage heart failure is associated with significant morbidity and mortality. Heart transplantation has the potential to offer areturn to daily activities for critically ill patients and is the gold standard therapy. However, heart transplantations are decreasing yearly with ahistoric low in Germany in 2017. By striking contrast, both waiting list numbers and waiting time have increased owing to alack of acceptable donor organs. Ventricular assist devices (VAD) represent areasonable therapeutic alternative for patients on heart transplantation waiting lists. Patients ineligible for transplantation may undergo VAD implantation as adestination therapy. However, the necessity for life-long anticoagulation must be weighed against bleeding complications in potential VAD candidates. VAD-dependent patients also face risks of driveline infections, in addition to restricted activities of daily living owing to limited battery capacities. Given Germany's low transplantation rate, VAD implantation may serve as amiddle ground. With the recent events in transplantation medicine, trust among the German population has declined. Transplant centers must ensure graft quality and ongoing care, define minimum caseload for accreditation, and implement specialty care units in heart failure. Furthermore, the legislation shift from extended consent to dissent solution has the potential to end donor organ shortage.
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