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The implantation of an artificial heart on the assumption of a subsequent cardiac transplantation causes fundamental questions concerning the identity and the relationship between human and mechanical. Moreover, it also concerns the ethical challenge of the distinction between life and death when this operation is conducted on a patient in a coma, as in this case. Yet this is the incredible endeavor of highly specialized medical teams. Using the example of a long clinical and psychoanalytical experience in an intensive care and cardiac surgery unit, the author explores some of the phantastic and metapsychological stakes of the difficult psychological work that all protagonists of this process face.