When prognosis is poor and transplantation is not feasible, what is the primary focus of care discussions with the family?

• A. Hospice or palliative care
• B. Aggressive revascularization
• C. Routine transplant evaluation
• D. Continuation of inotrope therapy without limits

Answer: (A)

When prognosis is poor and transplantation is not feasible, the discussions with the family should focus on comfort, symptom relief, and aligning care with the patient’s values and goals. This means prioritizing quality of life, easing distressing symptoms such as breathlessness, pain, fatigue, and edema, and planning care that supports the patient and family through the trajectory toward end of life. Involvement of palliative or hospice care helps formalize goals of care, establish desired place of care (home, hospital, or hospice facility), address advance directives and code status, and provide psychosocial and spiritual support for both patient and family.

Aggressive interventions like pursuing revascularization or ongoing transplant workups are not aligned with an end-stage prognosis when transplantation is not feasible, as they are unlikely to improve meaningful outcomes and can add burden. Continuing inotrope therapy without limits may extend life without improving quality, which often contradicts the aim of comfort-focused care. The emphasis is on clear, compassionate conversations that set realistic expectations, honor patient preferences, and ensure that the care plan centers on comfort and dignity.