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I read with interest the letter from McKenna and others describing the evolution of an algorithm to aid decision making in the withdrawal of life-sustaining medical devices.1 The briefly described scenario involving the development of cancer in a patient with a left ventricular assist device (LVAD) as a bridge to transplantation is familiar to us in cardiovascular medicine, as is the resulting need for decision making in the moment which often becomes the default position. While the occurrence of this comorbidity could not have been anticipated in this transplant candidate, …
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