2018 Volume 6 Pages 38-47
Implanting a VAD (Implantable Ventricular Assist Device) is a preliminary procedure for transition to a heart transplant. In Japan, the waiting period for heart transplant is lengthening because of the lack of donor hearts. Patients who receive an implanted VAD frequently require DT (destination therapy) and approach the end-of-life because of complications. Therefore, when performing VAD implants, it is necessary for physicians to explain not only the risks and benefits of the operation and heart transplantation but also the importance of deciding about an approach to the end-of-life stage, prior to obtaining informed consent.
We conducted an inventory survey of 64 representative authorized institutions and obtained responses from 44 such institutions (68.8% response rate). 17 institutions (38.6%) have established advanced directives regarding the kind of medical care required when performing an implanted VAD procedure. Among the 17 institutions, 12 institutions (70.6%) prepare advances directives before performing an implanted VAD procedure. The decision to determine the terminal phase was made by the physician (14 institutions : 31.8%), the team physician and other health care practitioners (31 institutions : 70.5%), or the hospital ethics committee (12 institutions : 27.3%).
The findings confirm that appropriate directives for obtaining informed consent and end-of life decisions may be difficult to apply.
