Mechanical Circulatory Support in the New Era: An Overview

Kiran Shekar; Shaun D. Gregory; John F. Fraser


Crit Care. 2016;20(66) 

In This Article

Resource and Ethical Issues

The resource intensive nature of MCS therapies is a major barrier for their global uptake. Equally, developing, validating and clinically testing is a resource intense exercise as well. Industry, clinicians, researchers and policy makers will all have to work together in delivering these MCS devices, which can radically change the way we deal with a leading cause of death worldwide, i.e., cardiovascular disease. One of the most important ethical dilemmas faced by clinicians who are so invested in evidence-based medicine is the individual centric nature of MCS, in which 'one size doesn't fit all' and there will be a learning curve where patients will have to be offered these extraordinary therapies (especially the temporary MCS options as bridge to decision/recovery/device/transplant) outside the comfort zone of compelling favorable evidence from a randomized controlled trial. Equally it may be emotionally challenging for the staff involved to see their patients not get a positive outcome despite spending long periods of time in intensive care/hospital on various bridging MCS options and then not reach their ultimate goal of destination device or heart transplantation. Thus, MCS can raise significant ethical issues[43–45] in a world that is diverse from social, cultural and financial points of view. None of these factors should be a deterrent towards an ultimate goal of delivering temporary and longer term MCS devices.