Life-sustaining medical devices at the end of life

Decision making around discontinuation of life-sustaining medical devices (LSMDs) at the end of life, is likely to become an increasingly common scenario within hospitals and hospices, as medical advances continue within an ageing population. Optimal end of life care planning should include practical considerations with regard to the device itself, as well as the emotional and legal decisions common to such situations. Within a cardiothoracic tertiary centre, our hospital specialist palliative care team was involved in the withdrawal of a left ventricular assist device (LVAD), in a complex patient who developed concomitant metastatic rectal cancer, while awaiting cardiac transplantation. The lack of a clear plan resulted in a rushed and unsatisfactory withdrawal, but prompted discussions with the cardiothoracic team and other teams using LSMDs.