Ethical Considerations Informed Consent Liver Donor Living Donor Risks

Living Liver Donor Deaths are “Inevitable”

According to transplant surgeons and bioethicists at The Cleveland Clinic, it is.

The first line of Miller, et al’s newly published study, “Preparing for the Inevitable: the death of a living liver donor”, reads:


Living donor liver transplantation (LDLT) is associated with a low but finite and well documented risk of donor morbidity and mortality, therefore organizations and individuals involved in this activity must accept the fact that donor death is as a question of “when, not if”.


(And they’re not wrong, as I wrote about last November when I got my hands (eyes?) on Abecassis et al’s most recent paper. )


Truth be told, I appreciate the authors’ candor. Some scholarly titles are exercises in mental gymnastics, but not this one. And rather than beat around the proverbial bush in their abstract, relying on euphemisms or technical jargon, they get right to the point:

If you take a chunks of livers from living people, eventually you’re going to kill and/or maim some of them. So you and your center better prepare yourselves.


What troubles me however, or what question comes to mind, is how transplant centers will address these facts to prospective liver donors. Informed consent requires an operator (aka surgeon, the person performing the treatment or procedure) to disclose to a patient the advantages/disadvantages, pros/cons, upside/risks to a specific treatment. Within that general framework of “patient education” is a lot of room to maneuver – stadium size, in fact  – which has lead transplant centers to omit or minimize or otherwise bend the truth.


For example:

“We’ve never lost a donor” as opposed to the historical national statistics.


“No greater risk than the general population” when people approved as living donors are much healthier than the general population.


So now that the transplant industry has confirmed and agreed that 40% of live liver donors will experience physical complications, and a certain percentage will die as a result of the procedure, how will they disperse that information? Will they use a variation of my prior sentence, or will they behave like one particular transplant center and blame the high profile death of a living liver donor on a lobster dinner?



Miller, C., Smith, M., Fujiki, M., Uso, T., & Quintini, C. (2013). Preparing for the inevitable: The death of a living liver donor Liver Transplantation DOI: 10.1002/lt.23637

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