The development of the total artificial heart (TAH) as a support before cardiac transplantation and as a possible permanent prosthesis has generated intense debate. The social commitment to TAH research entails immense health care costs because of the cost of the implant itself and also because of the large number of patients whose interests impel the research. The deployment of the pre-transplant TAH during the current shortage of donor hearts means that the TAH creates its own incentive as a way to compete in an expanded pool of donor heart candidates. Policies to address the orderly deployment and costs of the pretransplant TAH are needed. Research design and current pre-transplant clinical applications require careful consideration of planning for the termination of TAH support for severely injured but not brain dead patients.
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The authors gratefully acknowledge the assistance of Stephen Toulmin, Carol Stocking, and Diane Puklin in reviewing this manuscript. This work was supported by grants from the Henry J. Kaiser Family Foundation, the Andrew W. Mellon Foundation, and the National Fund for Medical Education. Dr. Miles is a Henry J. Kaiser Family Foundation Scholar in General Internal Medicine. The views expressed in this work are those of the authors alone and do not necessarily reflect the views of the University of Chicago or the supporting foundations.