The device simply stopped. When he tried to restart it, nothing happened.
In the years between a warning and a withdrawal, dozens of patients in Britain received a mechanical heart device that NHS data had already marked as far more lethal than its alternative. Two of the country's leading transplant centres — Freeman Hospital in Newcastle and Harefield Hospital in London — continued implanting the Medtronic pump until the manufacturer pulled it from the market in 2021, three years after internal mortality figures had begun to speak plainly. The story of Greg Marshall, a 26-year-old who suffered a stroke, a device failure, and finally cardiac arrest, gives human weight to a question that institutions have yet to fully answer: when knowledge exists and action does not follow, who bears responsibility for the silence?
- NHS data from 2019 showed Medtronic device patients dying at two-and-a-half times the rate of those receiving the Abbott alternative — a gap too wide to be dismissed as statistical noise.
- While Royal Papworth voluntarily stopped using the device in early 2018 after reviewing trial data, Freeman and Harefield pressed on for years, leaving patients to receive an implant the numbers had already condemned.
- Greg Marshall was fitted with the device in 2019 — months after the NHS audit was complete — suffered a stroke, endured a catastrophic pump failure, and died in cardiac arrest in 2023 at the age of 26.
- His mother alleges the family was never told the full risks, and that the cardiologist overseeing his care failed to disclose a financial relationship with the device's manufacturer, Medtronic — a charge the doctor denies.
- The regulatory body responsible for approving the device, the MHRA, was never shown the NHS mortality data, leaving a critical gap between what hospitals knew and what oversight authorities were permitted to see.
- The device was only withdrawn when Medtronic itself acted on safety grounds in 2021, meaning institutional inertia — not regulatory intervention or hospital initiative — determined when the harm finally stopped.
Two of Britain's foremost transplant hospitals continued implanting a mechanical heart pump in critically ill patients for years after NHS data indicated it was killing people at more than twice the rate of a competing device. Freeman Hospital in Newcastle and Harefield Hospital in London kept using the Medtronic pump until mid-2021, despite warning signs that had surfaced as early as 2018.
The numbers were not ambiguous. A 2019 NHS audit found that 54 of 119 Medtronic patients had died within two years, against just 15 of 97 patients who received the Abbott pump. By the time the full dataset was assembled, covering October 2018 to June 2021, the mortality gap had widened further: 49 percent of Medtronic recipients died within three years, compared to 19 percent for Abbott. Royal Papworth Hospital in Cambridge had already drawn its own conclusion, voluntarily halting use of the Medtronic device in February 2018 after reviewing controlled trial results. Freeman and Harefield did not follow.
Greg Marshall was 26 years old when Freeman Hospital implanted the Medtronic device in 2019 — months after the audit was complete. A young man who had hoped to join the Royal Marines, he had suffered acute heart failure and placed his trust in the institution caring for him. The implant caused a stroke that left him partially paralysed and robbed him of clear speech. In July 2020, the device stopped entirely and could not be restarted. Surgeons declined to operate again, fearing another stroke. He was placed on a transplant waiting list and lived with the failed pump inside him until September 2023, when he died in cardiac arrest.
His mother, Tessa Marshall, said the family was never given a full account of the risks, and that a satisfied patient had been brought in to speak positively about the device before the surgery. She also alleged that the cardiologist responsible for Greg's care, Professor Stephan Schueler, had failed to disclose a financial relationship with Medtronic as required by the General Medical Council. Schueler denied the allegation, and both Freeman and Harefield maintained that their continued use of the device reflected legitimate clinical complexity rather than negligence.
The Medicines and Healthcare products Regulatory Agency, which approved the device, was never informed of the NHS mortality data. The pump remained in use until Medtronic withdrew it on safety grounds — including a fault that caused the device to stall or fail to restart after being switched off. The practice ended not because hospitals or regulators acted on what they knew, but because the manufacturer eventually acted on its own. For the families of those who died in the intervening years, that distinction is not a small one.
Two of Britain's most prominent transplant hospitals continued implanting a mechanical heart device in patients even after internal NHS data suggested it was killing people at two-and-a-half times the rate of a competing product. The Freeman Hospital in Newcastle and Harefield Hospital in London kept using the Medtronic pump through 2021, years after safety alarms had sounded and despite having access to mortality figures that should have prompted immediate action.
The warning signs emerged early. In 2018, the NHS flagged concerns about the device. By 2019, a preliminary audit painted a stark picture: of 119 patients fitted with the Medtronic pump, 54 had died within two years. Over the same period, only 15 of 97 patients who received an Abbott pump—the main alternative—had died. The difference was not marginal. When the full picture came into focus between October 2018 and June 2021, the numbers hardened into an indictment: 49 percent of Medtronic recipients died within three years, against 19 percent for Abbott recipients.
Yet Freeman and Harefield did not stop. Royal Papworth Hospital in Cambridge had voluntarily halted use of the Medtronic device in February 2018 after reviewing controlled trial data and choosing to switch to another pump. But the two larger centres pressed on. Harefield continued using Medtronic exclusively until early 2021. Freeman kept implanting the device until June 2021, when the manufacturer finally withdrew it from the market citing safety grounds—including a malfunction where the pumps would stall or fail to restart after being switched off. The regulatory authority, the Medicines and Healthcare products Regulatory Agency, never learned of the NHS mortality data during its approval process.
Greg Marshall became one face of this gap between knowledge and action. A fit, healthy young man with ambitions to join the Royal Marines, he suffered acute heart failure and was offered the Medtronic device by Freeman Hospital in 2019—months after the NHS audit was complete. He agreed to the surgery. The implant triggered a stroke that left him partially paralyzed and unable to speak clearly. Then, in July 2020, the device simply stopped. When he tried to restart it, nothing happened. He was rushed to hospital, but the pump could not be repaired and remained inside him. Doctors refused to perform another surgery, fearing another stroke. He was placed on a transplant waiting list and lived with the dead device in his chest. In September 2023, at age 26, he went into cardiac arrest and died.
Greg's mother, Tessa Marshall, said the family was never presented with long-term risks. A satisfied patient had even been brought in to speak about the device's benefits. She said the cardiologist responsible for his care, Professor Stephan Schueler, did not disclose his financial relationship with Medtronic, despite being required to do so by his regulator, the General Medical Council. Schueler denied the allegation, stating there was no financial incentive driving device selection. Both Freeman and Harefield defended their continued use of the pump as based on complex clinical judgment, saying there were no clear grounds at the time to believe Abbott's device was superior.
The gap between what the hospitals knew and what they did remains the central question. The NHS had the data. The hospitals had the data. Dozens of patients died at elevated rates while the device remained in use. Only when the manufacturer itself withdrew the product did the practice stop. By then, the damage was done—not just to Greg Marshall, but to the dozens of other families who had trusted their hospitals to protect them.
Citações Notáveis
I kick myself now, for not doing any more research— Tessa Marshall, Greg Marshall's mother
There was never a financial incentive nor any salary arrangements with Medtronic for me or anybody else in our team to choose one device over the other— Professor Stephan Schueler, cardiologist at Freeman Hospital
A Conversa do Hearth Outra perspectiva sobre a história
Why did these hospitals keep using a device when the numbers were so clearly worse?
That's the question no one has fully answered. They had the 2019 audit. They knew the mortality rates. But they called it a complex clinical decision and said there was no clear proof Abbott was better. That's a very different threshold than what the data seemed to show.
What about the financial relationships? Did that play a role?
The family believes it did. The cardiologist who treated Greg Marshall was a paid consultant for Medtronic, and they say he never disclosed that. He denies it influenced anything. But the appearance alone—that a doctor recommending a device is being paid by its maker—that's exactly why disclosure rules exist.
Greg's case sounds like a cascade of failures. The stroke, the device stopping, being refused another surgery.
It is. But what haunts his mother is that none of it had to happen. If the hospital had switched to Abbott like Royal Papworth did, or simply stopped using Medtronic when the data emerged, Greg would likely still be alive. Instead he got a device that failed, suffered a stroke, and died at 26.
The regulator didn't even know about the mortality data. How does that happen?
The NHS didn't tell them. The hospitals didn't tell them. The manufacturer didn't tell them until it withdrew the device on safety grounds. The regulator was approving a product based on incomplete information while patients were dying at twice the rate of alternatives.