In Reply We appreciate the thoughtful response to our work1 from Drs Nakada and Arakawa. We agree that the informed consent process should be robust and ongoing when discussing left ventricular assist device (LVAD) therapy with patients and their caregivers. We also wholeheartedly agree that discussions around dying with an LVAD—especially when patients are being implanted under the destination therapy (DT) indication—should be discussed prior to implant or as medical realities allow. However, going beyond stating this should occur, we believe the real challenge is how to have these conversations with patients and caregivers. This is true not just for LVADs but for all complicated technological therapies that alter the dying process.
McIlvennan CK, Allen LA, Matlock DD. Caregiver Perspectives on End-of-Life Experiences of Patients With Left Ventricular Assist Devices—Reply. JAMA Intern Med. 2016;176(8):1231-1232. doi:10.1001/jamainternmed.2016.3735