Patients who refuse heart transplantation.

Abstract

Some terminally ill patients refuse proposed heart transplantation. Forty patients were offered this surgery; six (15%) declined. Candidates refusing surgery were likely to have a psychiatric diagnosis and heart disease longer than 1 year. Factors thought to influence the decision to refuse surgery included (1) depression, (2) ambivalence about surgery or survival, (3) previous negative experiences with surgery, (4) acceptance of the inevitability of death, (5) concerns about postoperative quality of life, (6) organic brain syndrome, and (7) denial of the severity of heart disease. Patient refusal of a heart transplant is often disconcerting for members of the transplant team.