The Washington Post
He lies in a Louisville, Ky., hospital bed, a middle-aged man about whom almost nothing personal is known except the most intimate details of his health. He was — and perhaps still is — about to die.
Last Monday, surgeons at Jewish Hospital removed his diseased heart and replaced it with a man-made pump constructed of hard plastic and titanium. It was the first fully implantable artificial heart ever put inside a human being.
He has shown improvement every day, surgeon Robert Dowling said Friday. Hes interacting with doctors and nurses through his gestures, and the device is functioning flawlessly.
the mans long-term prospects remain far from clear, his doctors have been surprised by his early progress, and have even speculated that he may eventually be able to leave the hospital and return to some semblance of a normal life.
In the meantime, however, medicines latest attempt to tackle one of the most difficult technological challenges ever attempted is remarkable for yet another reason — its absence of controversy.
Experimental treatments involving the desperately ill often pose many complex ethical questions, particularly when the object of the treatment is to cheat death in spectacular fashion.
The first artificial heart implants in the 1980s proved so controversial and fraught with ethical pitfalls that the field was all but abandoned for 15 years. Many observers speculated those problems — coupled with advances in treating heart disease, improvements in the outcomes of transplants, and the development of highly effective partial heart pumps — might preclude any future attempts to develop a full artificial heart.
While some of those questions and potential ethical traps remain, even some of the harshest critics of earlier efforts acknowledge that so far, Abiomed Inc., the Danvers, Mass., company that developed the AbioCor device, appears to have learned well from the mistakes of the past.
One of the ethical issues that I would have flagged would have been hubris, and they are not guilty, said University of Pennsylvania medical sociologist Renee Fox, an expert on the ethics of organ replacement and transplantation. They are not only prudent, but very candid.
Abiomed waited until new technology enabled its AbioCor heart to be fully enclosed inside the patients chest, lessening the chance of infection and eliminating the need to be tethered to a power source through an open wound.
The company wrote a 13-page consent agreement, spelling out 14 separate potentially fatal risks associated with the implant, everything from liver failure to tissue damage caused by an overheated device.
It set up an Independent Patient Advocacy Council to provide each patient with a knowledgeable mentor, and funded the council with an irrevocable blind trust, leaving the four initial members to add additional advocates as they saw fit.
No council member, surgeon or anyone else connected with the clinical aspects of the experiment is allowed to hold stock in Abiomed. No one from Abiomed is allowed to meddle with the council. No one in the media was allowed to know the name of any council member except chairwoman Elizabeth Haavik Morreim of the University of Tennessees College of Medicine.
Abiomed briefed reporters on the company and the device in April and discussed the Louisville surgery at a July 4 news conference. But it refused to divulge the patients name or discuss his background except as it related to his medical condition.
And to further dampen publicity it has cautioned repeatedly that no matter how well the patients recovery has appeared to be going, the man was so sick — with diabetes, kidney failure, hypertension and overall weakness — that he could die at any time.
Abiomed Vice President Ed Berger said the company extensively studied the 1980s cases of Barney Clark and William Schroeder, who received Jarvik 7 artificial hearts powered through wires and tubes inserted through incisions in the skin and connected to a noisy, bedside console the size of a refrigerator.
The publics initial euphoria gave way to distress as the two patients contracted infections and illness before dying. Many wondered whether the implant had simply prolonged the mens suffering.
The extension of life without improving the quality of life is an empty goal, Berger said. Abiomed took a very, very long time to wait for big technological developments and then apply them to the device.
Electronics miniaturization shrunk the console to the size of a telephone beeper. The transcutaneous energy transmission system, or TETS, enabled electricity to flow from an external battery pack to electrodes mounted inside a patients abdomen.
Neither advance improved the hearts function, but that wasnt the idea. They learned that you should not implant an artificial heart that is not totally implantable and totally forgettable, said ethics specialist George Annas of the Boston University School of Public Health. The Jarvik 7 console was extremely loud, and you could never get away from it. You could never live a normal life.
Abiomeds formula for success was modest. Patients would be chosen only if they had been rejected for transplant and were judged to have an 80 percent chance of dying within 30 days. With AbioCor, the company hoped to double the lifespan.
Can a person in such a situation give an adequately free and informed consent? asked medical ethicist Robert Veatch of Georgetown Universitys Kennedy Institute of Ethics. I call this a coercively attractive offer — you die in 30 days, or you take this offer and get 60 days. The offer may be irresistible, but that doesnt necessarily make it immoral. I am not troubled as long as patients know the trade-offs.
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