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The risk of a live donor in transplant surgery

Before a patient has surgery, the doctors are required to obtain what is known as "informed consent." This is where they are supposed to explain to a patient the potential risks of the surgery or other procedure and the expected prognosis.

This allows the patient and his or her family to weigh the risks against the benefit. Only when the patient fully understands all of these factors, can their consent to the procedure be considered "informed."

But what happens when the surgery is elective and altruistic as in the case of an organ donor? What do they need to know before they can consent in an informed fashion to the surgery?

These questions were raised by a tragic death in an operating room during a liver transplant involving two men who were brothers-in-law. One man had liver disease, and needed a transplant. His brother-in-law agreed to be tested and was deemed a match.

During the procedure, surgical errors occurred, and the doctors could not control the bleeding around his liver. He died on the operating room table. The brother-in-law survived the transplant but would die within a year, due to the advanced nature of his liver disease.

Questions arose as to how well prepared the hospital was to deal with a medical emergency of the donor. Were they too focused on the transplant recipient? Did they adequately assess the donor's health prior to the surgery?

After the death, the transplant program was overhauled and processes were changed, including the addition of recipient survival data and "strengthened informed consent" forms. They also reduced the volume of live donor surgeries.

The widow hopes that changes brought about by her tragedy and lawsuit will better protect future donors.

Source: The Boston Globe, "Donor's death shatters family, stuns surgeons," Liz Kowalczyk, Feb. 2, 2014

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