Contemplating total artificial heart inactivation in cases of futility

Though currently an experimental technology, there is the potential for implantation of 100,000 total artificial replacement hearts each year in the United States once regulatory approvals are obtained. Although these devices are intended to lengthen life and improve its quality, clinical scenarios can emerge in which the device is no longer serving these goals and termination of life support, including inactivation of the implant, must be contemplated. Although the literature is replete with guidance on the withdrawal of non-implantable therapies, such as dialysis and artificial ventilation, there has been minimal discussion involving the deactivation of implanted therapies. Here, guidance is offered regarding the withdrawal of total artificial heart therapy.