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Left Ventricular Assist Devices: When the Bridge to Transplantation Becomes the Destination

Broglio, Kathleen DNP, ANP-BC, ACHPN; Eichholz-Heller, Frances MSW, LMSW, ACHP-SW; Nakagawa, Shunichi MD

Journal of Hospice & Palliative Nursing: October 2015 - Volume 17 - Issue 5 - p 374–379
doi: 10.1097/NJH.0000000000000166
Ethics Series

Heart failure affects more than 5 million people in the United States. Left ventricular assist devices (LVADs), originally designed as a bridge to heart transplantation, are now implanted as either a bridge to transplantation or as a destination therapy for those individuals who are not transplant candidates. Left ventricular assist devices have improved survival and may improve the quality of life for many individuals. However, individuals who originally had LVADs implanted as a bridge to transplantation may be delisted because of changes in health status and, like those with LVADs as destination therapy, will live with this therapy until the end of life. Decision making can become more complicated when adverse effects or comorbid health conditions cause a significant decline in health status. Challenges related to informed consent, advance care planning, quality of life, and end-of-life care in this population will be discussed. Clinical interventions will be addressed to improve care in this growing population.

Kathleen Broglio, DNP, ANP-BC, ACHPN, is senior nurse practitioner, Adult Palliative Care Services, Columbia University Medical Center, New York.

Frances Eichholz-Heller, MSW, LMSW, ACHP-SW, is senior social worker, Adult Palliative Care Service, New York Presbyterian, Columbia University Medical Center, New York.

Shunichi Nakagawa, MD, is assistant professor, Adult Palliative Care Service, Department of Medicine, Columbia University Medical Center, New York.

Address correspondence to Kathleen Broglio, DNP, ANP-BC, ACHPN, Adult Palliative Care Services, Columbia University Medical Center, 601 West 168th St 37/38, New York, NY 10032 (

The authors have no conflicts of interest to disclose.

© 2015 by The Hospice and Palliative Nurses Association.