ventricular assist device candidacy

When medications and standard devices can no longer keep a failing heart going, one option is to add a mechanical pump — a ventricular assist device — that takes over much of the heart's work. VAD candidacy is the careful judgment of who is sick enough to need such a pump, yet well enough elsewhere to benefit from it.

Candidates are typically people with advanced, end-stage heart failure who remain severely limited despite optimal treatment. A device may be implanted as a bridge to transplant (supporting the patient while they wait for a donor heart), as destination therapy (a permanent solution for those not eligible for transplant), or as a bridge to recovery or decision. Assessment weighs the severity of heart failure against the function of other organs — kidneys, liver, lungs — as well as the right ventricle, bleeding and clotting risk, infection, nutrition, and a patient's ability to manage the device and its anticoagulation at home.

The evaluation is deliberately multidisciplinary, involving heart failure cardiologists, surgeons, nurses, and often social workers and psychologists, because a VAD demands lifelong commitment and carries real risks of bleeding, stroke, infection, and device problems. Candidacy is therefore not a yes-or-no checkbox but a balanced assessment of whether the likely benefit outweighs those burdens for a particular person.