Ethical considerations relating to different types of heart valve prosthetics

Abstract

With the increasing global population and average lifespan more people suffer from age associated diseases such as cardiovascular disease. In some cases the disease can be treated with novel medical devices such as pacemakers but for others transplantation remains the only viable option. This is often the case for patients with heart valve failure. However, there is a worldwide organ shortage for transplantation. This has led to the development of different types of heart valve prosthetics. Mechanical heart valves are durable but increase the risk of thromboembolism, resulting in patients needing to take lifelong anticoagulant therapy which has severe side effects. Patients with bioprosthetic heart valve prosthetics do not need to take anticoagulant therapy but risk repeated open-heart surgery because bioprosthetic heart valves are less durable. Tissue-engineered heart valves are newest to the market but have not yet reached their full potential and are therefore not yet frequently used. The development of these different types of heart valves has led to multiple different ethical discussions. Here, we will discuss which types of heart valves have given rise to which ethical considerations and whether these discussions have ceased or remain applicable with the development of new types of heart valve prosthetics. In particular we will try to gauge whether past and current ethical discussions regarding heart valve prosthetics will be applicable to the future regenerative tissue-engineered heart valves which are not yet commercially available.