Introduction     Fast Fact #205 discusses left ventricular assist device (LVAD technology in general. This Fast Fact discusses important considerations at the time of LVAD deactivation in the context of end-of-life care. Fast Fact # 296 addresses palliative care issues regarding total artificial hearts.

Common scenarios leading to LVAD deactivation     Clinical situations leading to LVAD deactivation include catastrophic complications of the LVAD (e.g. stroke, sepsis and multiorgan failure); poor quality of life despite LVAD treatment (e.g. chronic infections, intolerance of or a decision to forego hemodialysis); and developing serious secondary comorbidities (e.g. cancer, dementia) (3,4). Most often the acuity of the medical situation will mean that the LVAD deactivation process will occur in the hospital, but LVAD deactivation at home or a free-standing hospice facility has been described in the published literature. As with other life-sustaining treatments, it is ethically permissible for patients or their surrogate decision makers to request withdrawal of a LVAD if the LVAD no longer is consistent with their goals of care or their evolving clinical situation.

Important process steps in deactivating LVADs 

• Since part of the device is implanted within the patient, turning off an LVAD in some ways it is akin to deactivating an implantable defibrillator. However, LVADs have an external power source and associated controlling unit which are removed from a patient, which is akin to removing a ventilator.
• The process regarding LVAD deactivation should be clearly outlined and understood by those who are participating. Any patient/family or professional ethical concerns should be addressed. Families and loved ones should have ample opportunities for visitation.  Family members’ presence can be based on patient preferences, and a description of what can be expected should be shared. Spiritual needs should be assessed and addressed if possible. Communicate to loved ones that just as much attention and care will be provided to the patient during the deactivation process (if not more), but the focus of medical interventions will be targeted on the patient’s comfort.
• DNR and DNI status should be confirmed and documented in the chart and orders, as well as the goals of care and overall medical plan of care.
• Survival after LVAD deactivation at the end-of-life ranges from a few minutes to a few days (5). Providers should carefully explain this variability to families as it can be upsetting if a patient lives longer or shorter than what family expects.
• Many patients will also be on other forms of life-sustaining treatments such as renal replacement therapy, vasopressors, tube feeds, implantable cardioverter-defibrillators (see Fast Fact #112), and mechanical ventilation that generally should be discontinued at the time of LVAD deactivation. Once the care goals are clear, it is usually best to make direct recommendations to the patient/family about the medical plan of care including what treatments should be stopped, as opposed to asking families treatment-by-treatment what they want done. Families should be reassured that patients can be kept comfortable without such treatments.
• All non-symptom-directed monitoring should be discontinued.

Practical LVAD deactivation tips 

• Much like a ventilator withdrawal at the end of life, clinicians should be prepared to prevent and treat the potentially rapid onset of dyspnea/labored respirations, agitation, or other signs of discomfort. Pharmacologic principles are similar to ventilator withdrawal – see Fast Fact #33 and Fast Fact #34.
• Work closely with the individuals in your institution responsible for LVAD management (e.g., LVAD nurse coordinators). There are many different LVAD models which have different deactivation steps. If the deactivation process is being done at home or a hospice facility, then make sure the hospice care team is coordinating with the appropriate LVAD nurse coordinators to ensure they are following the right deactivation steps for the specific LVAD model.
• Familiarity with the alarm functions of LVAD devices, and how to turn them off, is critical to prevent unsettling noises during what is hoped to be a peaceful process for patients and loved ones.
• Once the LVAD is deactivated, cardiovascular circulation may greatly diminish. This can precipitate a symptom flare from flash pulmonary edema leading to acute respiratory distress.  Therefore, clinicians should strongly consider bolusing with comfort medications prior to deactivation to ensure adequate circulation of the drugs. Due to diminished drug circulation, the time to peak effect of an opioid or benzodiazepine bolus may be delayed after LVAD discontinuation.

References 

1. Slaughter MS, Rogers JG, Milano CA, et al.  Advanced heart failure treated with continuous-flow left ventricular assist device. NEJM 2009; 361:2241-2251.
2. Panke JT, Ruiz G, Elliott T, et al.  Discontinuation of a left ventricular assist device in the home hospice setting. Journal of Pain and Symptom Management 52(2):313-317.
3. Zaidi D, Kirkpatrick JN, Fedson SE, et al.  Deactivation of left ventricular assist device at the end of life: narrative review and ethical framework.  JACC Heart Fail 2023; 11(11):1481-90.
4. Kelemen A, Groninger H, Yearwood EL, et al.  The experiences among bereaved family members after a left ventricular assist device (LVAD) deactivation. Heart & Lung 2024; 66:117-122.
5. Slaughter MS, Pagani FD, Rogers JG, et al. Clinical management of continuous-flow left ventricular assist devices in advanced heart failure. J Heart Lung Transplant. 2010; 29:S1-39.
6. Swetz KM, Freeman MR, AbouEzzeddine OF, et al. Palliative medicine consultation for preparedness planning in patients receiving left ventricular assist devices as destination therapy. Mayo Clin Proc. 2011; 86:493-500.
7. Swetz KM, Ottenberg AL, Freeman MR, Mueller PS. Palliative care and end-of-life issues in patients treated with left ventricular assist devices as destination therapy. Curr Heart Fail Rep. 2011; 8:212-218.
8. Brush S, Budge D, Alharethi R, et al.  End-of-life decision making and implementation in recipients of a destination left ventricular assist device. J Heart Lung Transplant. 2010; 29:1337-1341.

Authors’ Affiliations: Ohio State College of Medicine, Columbus, OH (EFG); Mayo Clinic, Rochester, MN (AJL, KMS).
Version History:  First published September 2013. Reviewed and update by Sean Marks in September 2015; reviewed and updated again in February 2026.
Conflicts of Interest: None to report.