Implantable left ventricular assist device bridge-to-transplantation: natural selection, or is this the natural selection?.

The use of the implantable left ventricular assist device (LVAD) for patients before a heart transplant is evolving and becoming more common. Almost all U.S. cardiac transplant programs have an implantable LVAD, either the HeartMate (Thoratec, Oakland, California) or Novacor (World Heart, Ottawa, Canada). With better technology, more predictable clinical results and greater widespread acceptance, the role of these devices has changed from something you “have to do” to save the patient’s life to the provocative subject of the article in this issue of the Journal by Aaronson et al. (1) is this something you “should do” to ensure optimal utilization of scarce donor hearts?