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Informed Consent Liver Donor Living Donor Protections

Brothers Sue UPMC Over Informed Consent

Two brothers who participated in a living liver donor transplant at University Pittsburgh Medical Center is suing the hospital and Dr. Marcos, former transplant chief, for “fail[ing] to give the brothers all of the information concerning the dangers of live liver transplantation.”

UPMC was involved in a scandal involving improper liver transplants, resulting in (among other things) the termination of Marcos, so it would be easy to dismiss this lawsuit, or its basis, the lack of Informed Consent, as an aberration or at the very least, relegated to a single transplant center. However, anecdotal evidence and at least one published study say different.

Housawi (2007) surveyed 203 transplant professionals at 119 cities and 35 countries* regarding the risks disseminated to prospective living donors during the Informed Consent process. While at least 77% claimed** to discuss hypertension and proteinuria, the worrisome prospect is that that 23% do not. Worse, 84% of those surveyed did not believe having a kidney removed increases the risk of cardiac disease despite the plethora of published evidence that any amount of renal insufficiency (drop in kidney function) is strongly correlated with cardiac issues.

Housawi’s inquiries were relegated to longer-term consequences of living donation and not the information dispensed about possible surgerical or short-term complications, which is what the UPMC lawsuit focuses more closely on. But story after story from living kidney and liver donors taking place on forums, message boards and mailing lists indicate that transplant centers are failing in that regard too. Nerve damage and hernias are most frequently reported, as well as gastic-intestinal blockage and damage, yet surgeons are neglecting to inform their prospective LDs of the possibility. Testicular swelling and sensitivity requiring surgical intervention occurs in approximately 10% of male LDs (more frequently in men who have undergone vasectomies), but men with the complication report months of haggling with their physicians over the cause and treatment of their issue, mostly because the medical professionals didn’t know it was a possible consequence of the surgery (!) It’s a reasonable assumption then, that prospective male LDs are not being asked if they have undergone vasectomies, nor warned of this potential complication.

There have been other lawsuits filed against transplant centers for a variety of living donor complications and deaths. Unfortunately, each and every one settled before they ever saw the light of a courtroom. This allows the transplant industry to continue their negligent behavior, complete with confidentiality agreement.

The complications incurred by the plaintiffs in the UPMC case are tragic. While nothing can be done to undo their pain or sense of betrayal and violation, they are in a position to improve how living donors everywhere are treated. A courtroom precedent can go a long way toward sending the message that living donors are deserving of respect, and being related to the recipient does not give the transplant industry license to decieve and abuse them.

*Most transplant professionals were from North America(45.1%) (USA 39.6%, Canada 4.0%, Mexico 1.5%),followed by Europe (31.7%) (UK 8.4%, Germany 6.4%, Belgium 2.5%, Netherlands 2.0%, Czech Republic 2.0%, Norway 2.0%, France 1.5%, Italy 1.0%, Sweden 1.0%, Switzerland 1.0%, Denmark 0.5%, Finland 0.5%, Northern Ireland 0.5%, Poland 0.5%, Serbia 0.5%, Spain 0.5%, Cyprus 0.5%, Scotland 0.5%), Asia (14.4%) (Saudi Arabia 8.4%, India 1.0%, Korea 1.0%, Lebanon 1.0%, United Arab Emirates 1.0%, China 0.5%, Thailand 0.5%, Kuwait 0.5%, Syria 0.5%), Australia (4.5%), South America (2.5%) (Brazil 1.5%, Argentina 1.0%) and Africa (2.0%) (Egypt 1.5%, Libya 0.5%).

**even the researchers acknowledge that there may be a difference between what survey participants report and their actual behavior.

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