How Should Mechanical Circulatory Support Be Deactivated for Patients With Depression at the End of Life?

Mechanical circulatory support (MCS) is an increasingly frequent treatment option for managing end-stage heart failure. Devices are implanted either as destination therapy or as bridge to transplant. Patients undergoing this treatment can experience significant symptoms of depression in addition to stresses associated with chronic illness. After implantation, some patients may decide that the burdens of an MCS device outweigh the benefits. Physician asked to assist in deactivating MCS devices in the face of depression must ensure appropriate assessment, informed consent, and multidisciplinary involvement to minimize suffering and maximize patient quality of life.