9

In an episode of the medical drama 'House', a patient needing a liver transplant is offered a live donation from her girlfriend. During the episode there's a continual argument over the ethics of whether they should tell the donor that the patient was about to break up with her prior to the hospital admission. I am wondering whether the doctor and patient, both strongly believing that the donor would withdraw consent if she knew, would be liable to lawsuit or even committed a crime by hiding this information? Would the doctors be obliged to tell the donor or even be allowed if they wanted to as it is not sensitive medical information?

1 Answer 1

14

The primary question is whether remaining silent would constitute a breech of medical ethics. The pertinent ethical principle is AMA Opinion 2.15 One of the requirements is that the donor be assigned an advocate team whose interest is the donor, not the patient, and these should generally be distinct individuals in order to avoid conflict of interest. Assuming that the donor's team is aware of this fact, they have a duty to disclose it, since it materially affects the donor's willingness to donate the organ. The ethical opinion does not specifically address "patient breaking up with a directed donor", but there is a general obligation to share information, and it would probably be found to be a breach of medical ethics to suppress relevant non-medical information. The ethics of directed donation from live donors is not well-developed.

I will mention that

Potential donors must be informed that they may withdraw from donation at any time before undergoing the operation and that, should this occur, the health care team is committed to protect the potential donor from pressures to reveal the reasons for withdrawal. If the potential donor withdraws, the health care team should report simply that the individual was unsuitable for donation. From the outset, all involved parties must agree that the reasons why any potential donor does not donate will remain confidential for the potential donor’s protection. In situations of paired, domino, or chain donation withdrawal must still be permitted. Physicians should make special efforts to present a clear and comprehensive description of the commitment being made by the donor and the implications for other parties to the paired donation during the informed consent process.

Neither team can tell the patient that the reason the girlfriend withdrew was because they ratted him out (anyhow, we can suppose she said something to him on her own).

The hospital knows this fact, and has both a duty to the patient to solve a medical problem but also to the donor to be sure that the consent is informed. The hospital would be suppressing a fact relevant to the donor's willingness to undergo the operation, which is a breach of duty. This fact is not protected by HIPAA, or any other California statute, so does not supersede the obligation to reveal relevant facts.

5
  • 1
    In the episode its revealed the donor actually knew this information all along. If we ignore that fact because the doctors weren't aware she already knew, what repercussions could doctor house, who actively took step to hide this information and the other doctor's who just said nothing face for this?
    – Ethan
    Aug 8, 2023 at 21:25
  • 4
    In lieu of a strong professional requirement to disclose, repercussions would be via a lawsuit from the donor, for having withheld material information. But since she knew, she couldn't sue. It seems that the show finessed the issue of the donor's advocacy team.
    – user6726
    Aug 8, 2023 at 22:04
  • 1
    Is the reality that easy? I presume that both the donor team and the primary physicians would have been informed of the decision to break up in the context of providing medical care, and at least in Germany, such information would also fall under special laws protecting medical confidentiality. I am not sure if the obligation to support the donor in their decision generally outweighs the patient’s right to confidentiality, but of course there will not be case law on this specific situation.
    – Narusan
    Aug 9, 2023 at 14:15
  • 2
    Would you be obliged to reveal the patient‘s sexuality / religion / ethnic background in cases where donors would not be willing to donate to specific minorities? The resource you link discusses sharing medical information about the procedure that could influence the donor’s willingness to donate, but nowhere is personal information provided by the patient in confidentiality mentioned.. Indeed, it even says explicitly „physicians must ensure utmost respect for the privacy and confidentiality of donors and recipients“
    – Narusan
    Aug 9, 2023 at 14:30
  • 2
    s/breech/breach/
    – shoover
    Aug 9, 2023 at 16:38

You must log in to answer this question.

Not the answer you're looking for? Browse other questions tagged .