Was the decision to halt liver transplant surgery in Hong Kong ethically sound or a violation of patient and family rights?
Shekhar Kumta questions whether the family of a seriously ill man who was denied a donor liver that carried a very small risk of cancer was able to make an informed choice
Last week, a surgical team at Queen Mary Hospital halted a liver transplant operation midway after a cancerous tumour was discovered in the donor's kidney. The decision was ethically questionable. The explanation that proceeding with the surgery would have deprived the patient of the chance of a "better liver" in the near future is unpersuasive.
The donor was discovered to have a renal carcinoma - a 1.5cm tumour was found at the time of harvesting the kidney for transplantation to another recipient.
The risk that this tumour might have spread to the donor's other organs is real but extremely small, given the size of the tumour in the kidney. To discard a perfectly healthy liver that a patient desperately needed for survival and to abandon a liver transplant procedure halfway through - exposing the patient to an immediate risk of dying - in the hope that he might be able to get a "better" donor liver later does not make clinical sense.
Continuing with the transplant could have saved the patient's life even though there was a theoretical possibility that he might develop metastatic cancer in the liver in the future.
The reasoning put forward by Queen Mary Hospital is analogous to telling a patient: "I can save your life immediately with a drug but I would rather not do so, because it might cause serious side effects sometime in the future." The patient's likely reaction is easy to imagine.
A patient requiring a liver transplant must have seriously degraded liver function. The trauma of major surgery adds further metabolic stress.
Autonomy requires doctors to be honest and transparent with patients so that they can make informed choices