The Artificial Heart Juggernaut In May 1985 a panel of experts urged the National Institutes of Health to resume funding to develop a totally implantable permanent artificial heart: Fully implantable ventricular assist systems, in which an auxiliary pump takes over the function of the diseased ventricle, may be beneficial for some patients; for other patients, bilateral functional replacement or a total artificial heart will be necessary. Therefore, the mission of the NHLBI (National Heart, Lung and Blood Institute) program should include the fully implantable total artificial heart.1 Based on that recommendation, in January 1988 the government awarded grants worth more than $22 million to four research groups. Then in May, the NIH abruptly announced that it would suspend the program as of September 30. But two months later there was yet another shift in policy; bowing to congressional pressure, NIH restored the funding. To understand the ebbs and flows in government policy regarding the artificial heart, it is necessary to review recent medical developments and changing assessments of the device. Failed Promises The 1985 report was issued in the flush of excitement and publicity surrounding the implantation of Jarvik-7 pneumatic artificial hearts on a permanent basis in four patients--William Schroeder, Murray Haydon, and Jack Burcham in Louisville, KY, and Leif Stenberg in Stockholm--since November 1984. Three were still alive. (The first permanent recipient, Barney Clark, lived 112 days after his December 1981 operation.) Schroeder had suffered a stroke but was living with his wife in a specifically equipped apartment across the street from the hospital after six months on the Jarvik-7. Haydon was experiencing respiratory problems but was stroke-free after three months on the device, and Stenberg appeared to be recovering well a month after his implant. Only the case of Burcham, who died ten days after his April 1985 operation, was a clear failure. His surgeon, William C. DeVries, acknowledged that the device may have shortened Burcham's life. Four years later, however, reports in the lay press and medical journals have contributed to a widespread perception that the Jarvik heart and artificial hearts in general are unacceptable as permanent devices. The misgivings about the Jarvik-7 are evident in the difficulty DeVries, who performed four of the five permanent implants, has had in finding volunteers for another such operation. None has been done since April 1985. While the increasing age limit for heart transplants has had much to do with this, DeVries himself has said that negative news reports about the artificial heart have led to reduced patient referrals. In the afterglow of Schroeder's implant, DeVries received 100 inquiries a week. By early 1988 they were down to one every other week.(2) The negative news accounts concerned the difficult lives of Schroeder, Haydon, Burcham and Stenberg. Schroeder lived 620 days on the Jarvik heart, but in that time he suffered four strokes and chronic infections that sapped his strength and left him severely impaired, both mentally and physically. Near the end, believing their husband and father had been through enough, Schroeder's family asked that no more heroic measures be taken to extend his life (The Courier-Journal, (Louisville, KY), 8 August 1988, 1A). Haydon lived more than a year, but spent most of that time in the intensive care unit attached to a respirator that assisted his breathing. He also suffered a minor stroke and infections. Stenberg probably gained the highest quality of life of all the permanent recipients. In the months after his implant, he was able to live outside the hospital during the day, dine out at restaurants and walk the streets of Stockholm. But that all came to an end when he suffered a massive stroke after four months on the artificial heart. The stroke convinced Stenberg's surgeon, Dr. …