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first instance of post-transplant ischemic infarction. He was
diagnosed with “Cardiac Allograft Coronary Artery Disease
with Recurrent Myocardial Infarctions”, that has resulted in the
weakening of the heart pumping function.

Mr. X has been repeatedly hospitalized for deteriorating
breathing difficulties due to heart failure in the recent months.
After the most recent episode of acute myocardial infarction,
he was found to be short of breath at rest, and his clinical
condition was getting worse.

Cardiac allograft coronary artery disease is usually
associated with persistent poor outcome and cardiac
re-transplantation is the only effective therapy in addition to
implantation of the left ventricular assist device (LVAD),
which is very expensive and not reimbursable in our country
for now.

Due to his poor compliance with the medical advice to
“refrain from smoking” etc., the heart transplantation team
decided not to carry out re-transplantation for Mr. X and came
to a consensus to offer end-of-life care to the patient and his
family.

Family meeting on end-of-life care was conducted
accordingly: the patient, his whole family, medical doctors,

107 年度•醫學倫理•人文醫學•心得 25