$Unique_ID{BRK00830}
$Pretitle{}
$Title{Were Decisions About Artificial Heart Recipients Too Complicated?}
$Subject{special procedure procedures artificial heart surgery disease
atherosclerosis blocked arteries transplant candidates extraordinarily
expensive extend life complications blood clots}
$Volume{P-3}
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Copyright (c) 1991-92,1993   Tribune Media Services, Inc.


Were Decisions About Artificial Heart Recipients Too Complicated?


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QUESTION:  There is not much written on the artificial heart these days.  Were
the decisions about recipients too complicated, and what where they?  I am
sure a lot of your readers would be interested.

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ANSWER:  Since the first artificial heart was implanted in Barney Clark in
1983, medical professionals have had to consider a number of factors when
deciding who would get the benefit of medicine's latest technology.
Complicating the decision-making process was the high cost of the procedure
and the close scrutiny of the news media and the public.
     Here are some of the issues that were considered:

  *  Medical indications.  The drastic measure of replacing someone's own
heart with a mechanical device should be reserved for the patient who is about
to die from severe heart disease (usually atherosclerosis, or blocked
arteries) that has damaged the heart's ability to function.
     The artificial device is also useful for the patient waiting for a heart
transplant, especially since transplant candidates may deteriorate rapidly
from depending on their own weak, diseased heart before a donor heart is
found.
     Patients who have had open heart surgery and cannot be taken off the
heart-lung machine afterwards could also be saved with the artificial heart.
  *  The number of potential candidates.  Studies have shown that 17,000 to
35,000 patients under the age of 70 could be possible candidates each year for
the artificial heart!
  *  Cost.  Although using the artificial heart is extraordinarily expensive,
so is the cost of keeping a critically ill patient dying of heart disease
alive.
     Estimates put the cost for the first year of using the artificial heart
at around $150,000.  But the artificial heart was expected to extend life by
four years for the patient dying of heart disease, at an annual cost of
$28,000.  That same patient would run up bills of $22,000 in the last six
months of life.
     And if you compared the cost of the artificial heart to other procedures,
it didn't seem so outrageous:  a heart transplant costs around
$90,000 to $100,000 for the first year, a liver transplant $150,000 to
$200,000, and bone-marrow transplant for a leukemia patient more than
$100,000.
  *  Quality of life.  A number of complications--like blood clots--are
possible for artificial heart recipients.  Were the patient and family members
able to understand and accept these risks and limitations?
  *  Role of family.  The patient's family must be able to provide the
emotional support necessary for someone undergoing this procedure.  Could
family members cope with the intense coverage by the news media?
  *  Ethical issues.  Because of the public's failure to understand the
experimental nature of the new procedure, medical professionals had to be
prepared to explain the decisions and choices that were made.
     What if the patient chose to discontinue using the artificial heart and
to die?  How do you convince the public that the extraordinary cost of the
artificial heart does not rob other persons of medical resources?

     There is much that is positive about artificial heart surgery, and much
yet remains to be accomplished.  It will take study, funds, and the desire of
us all to see that the problems which exist today are solved, so that those
who truly need this miracle of medicine may have it available to them.

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The material contained here is "FOR INFORMATION ONLY" and should not replace
the counsel and advice of your personal physician.  Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.