Left ventricular assist devices and the slippery slope of ageism

The use of left ventricular assist devices is growing each year, as is the size of the United Network for Organ Sharing cardiac waiting pool. Notably, the geriatric waiting pool (age 65 and older), although small, is growing each year and this growth is predicted to increase as geriatric population projection curves soar. While left ventricular assist devices have clinically proven benefit, their use in geriatric patients raises ethical issues. Where these devices are currently not approved as destination therapy, their use must be reflected upon in conjunction with allograft transplantation. Age-based organ allocation policies could facilitate left ventricular assist devices as a bridge to nowhere for some geriatric patients. Specifically, the extended use of a left ventricular assist device by older patients could, in theory, put them in a position of not being able to get an allograft due to the fact that they have aged while on the waiting list. Unless these devices are approved as destination therapy, or age-based organ allocation policies contain exception clauses, an older person’s cardiac dilemma could be confounded as an assist device recipient. Without these measures one might argue the devices themselves should be subject to age-based allocation procedures. Is this the slippery slope of ageism?