Current VAD technology has enabled patients to be safely discharged from hospital, awaiting transplantation in the setting of their home. The results of recent studies have proven that patients on LVADs as destination therapy fare better than their medical counterparts and enjoy a higher quality of life. The lessons learned thus far in the outpatient management of LVADs has convinced the medical and non-medical communities that this form of therapy is more than feasible in addressing the epidemic of heart failure. Newer devices are on the horizon. It is inevitable that more patients will be visible in the streets and workplace as the modifications in size and application become more user friendly. It will be our responsibility, as the guardians of this technology, to use it wisely and provide the support that is necessary for this special population of people.