A machine that makes it hard to die
Our latest special report by Toni Clarke and Debra Sherman examines how a new heart pump is revolutionizing heart failure treatment.
Dr Lynne Warner Stevenson, Professor of Medicine at Harvard Medical School, raises a fascinating ethical question about the device, made by Thoratec. “This is one of the ways our technology has moved ahead of our humanity,” she said. “We haven’t had enough experience yet about how to help people die naturally who have a ventricular assist device. And I can tell you, it is difficult to die with one of these things in place. The body does not give up easily when the blood flow is maintained.”
One big advantage: the knotty problem of deciding who, of the thousands of patients who need a heart transplant, actually gets one, has largely been obviated with the introduction of a robotic heart assist device that can be used in thousands of patients with end-stage heart failure.
“It relieves us of the very uncomfortable problem of distributive justice in terms of heart organs and removes what has always been quite a challenging ethical problem,” said Stevenson, who is also the director of Cardiomyopathy and Heart Failure at Brigham and Women’s Hospital in Boston.
Dick Cheney has one of the devices – known as a left ventricular assist device, or LVAD – and now thousands more patients are eligible. Earlier this year, Geri Norris, 63, of Massachusetts, was given an ultimatum: “The doctors said you have two options: an LVAD or two months to live.” She chose the LVAD.
LVADs take over the main pumping function of the heart, but patients must be connected, via a wire leading out of their abdomen, to a power source at all times – either to a wall socket, or to a set of rechargeable batteries. If electricity to a building is cut, and a patient’s batteries simultaneously die, there is an alternative: plug yourself into your car and go for a drive. It’s cumbersome, but it beats being dead. View a slideshow of patients living with the pump here.
“It’s a love-hate relationship you have with it,” said Norris. “I resent it, but it’s keeping me alive so you have to love it. I can now go up the stairs without standing at the bottom and saying, “My God they’re steep!”
The device costs about $100,000, while a heart transplant costs about $40,000, but transplant patients require more costly maintenance including drugs, noted Dr. Valluvan Jeevanandam, chief of cardiac and thoracic surgery at the University of Chicago Medical Center and an investigator for Thoratec’s clinical trials. The device, he said, “stacks up well to transplant in terms of costs.”
Thoratec’s main competitor is HeartWare International Inc, of Framingham, Massachusetts, which is developing a smaller device that some experts believe could, if approved as expected by early 2012, gain significant market share.
To view a multimedia PDF version of the story, click here.
Here’s how Thoratec’s device works: