An artificial heart may save your life. But it can also change you in surprising ways
- Written by Pat McConville, Lecturer in Ethics, Law, and Professionalism, School of Medicine, Deakin University
This week, doctors announced that an Australian man with severe heart failure had left hospital with an artificial heart that had kept him alive until he could receive a donor heart.
The patient, a man from New South Wales in his 40s, was not the world’s first person to receive this type of artificial heart. However, he is said to be the first with one to be discharged from hospital to wait for a heart transplant, which he’s since had.
I am a philosopher and bioethicist. I completed my PhD on artificial hearts – particularly how these implants can change people’s lives in profound ways.
Here’s what patients and their families need to consider.
What is an artificial heart?
Artificial hearts began to be developed in the 1960s, sponsored by the United States government and funded in a similar way to space and military programs.
In 1982, a man named Barney Clark received the Jarvik-7 total artificial heart. Doctors removed his failing biological heart and replaced it with a plastic and metal device to circulate blood to his lungs and around his body. He lived for 112 days before dying from multi-organ failure. He never left hospital.
In the 1980s and 1990s, medical device companies began to develop alternatives to total artificial hearts. These partial artificial hearts, known as ventricular assist devices, help out a biological heart by supplementing or replacing one of its two pumping chambers.
These are more straightforward and versatile than total artificial hearts, and can be used for earlier stages of heart failure.
Not all artificial hearts generate a pulse.
Artificial hearts with a pulse generally mimic the biological heart. They pump blood in the same way the heart beats, by filling with blood and squeezing to circulate blood in waves or pulses.
But some devices continuously push blood around the body instead of pulsing. So with these continuous-flow devices neither the patient nor their health team can detect a pulse.
In the US between 2014 and 2024, almost 30,000 patients received continuous-flow ventricular assist devices. In the same period, more than 310 total artificial hearts were implanted.
The total artificial hearts commercially available today are licensed exclusively as bridging therapies – to keep people alive until a donor heart becomes available – rather than permanent implants.
How about the device making news this week?
The device in the news – the BiVACOR Total Artificial Heart – was developed by a US-Australian collaboration. This device is innovative, mainly because it is the first continuous-flow device designed to replace the whole heart. Designers are also aiming for it to be the first total artificial heart suitable as a permanent transplant (known as destination therapy).
A reliable, durable and responsive total artificial heart is, in the words of Paul Jansz, the surgeon who implanted the device, “the Holy Grail”.
The BiVACOR’s clinical success so far gives us reason to be optimistic about an alternative to scarce donor hearts for responding to severe heart failure.
Transplants can change lives
However, patients do not just resume their old lives when they leave hospital with an artificial heart.
While the pumping component is inside their chest, there are also external components to manage and monitor. A thick tube perforates their abdomen and connects to an external controller unit and power supply, which the patient carries around in a bag. Controllers must be closely monitored, and batteries must be regularly recharged.
My research showed that even a perfectly safe and reliable total artificial heart could transform patients’ lives in at least three major areas.
1. Is it part of me? Do I trust it?
Patients must trust, tolerate and receive sensory feedback about how the device is working for it to feel like part of them. In the case of an artificial heart, this might mean the device feels responsive to exercise and the body’s needs.
But it may be difficult for artificial hearts to meet these criteria, especially for devices that do not generate a pulse.
Patients may also question whether their heart is located in their body, or in the controller unit. They may wonder if they even have a heart, particularly if they can’t feel a pulse.
2. Beeps and alarms
An artificial heart also changes how patients live their lives and navigate the world.
Interruptions from loud device alarms distract patients from their normal activities. And patients must switch between mains power and batteries when they wake in the night and need to visit the toilet.
3. Marking time
Our hearts may be our natural metronomes, marking time. So removing someone’s heart rhythm can confuse their sense of time.
The need for batteries to be recharged periodically can also reshape patients’ days.
Waiting around for a transplant heart, or the latest software update, may change patients’ perspectives on what months and years feel like.
We need to give patients the whole picture
Artificial hearts are remarkable devices with great promise. But patients and families also deserve to know how these extraordinary treatments might change how they feel about themselves and the world.
They need to know this before they sign up for them. Artificial hearts don’t just save lives – they also change them.
Authors: Pat McConville, Lecturer in Ethics, Law, and Professionalism, School of Medicine, Deakin University
