An interesting medical dilemma(House spoilers)...

[Faqa]

Like the title says, I took this dilemma from an episode of House M.D, so Beware of Spoiler(he bites).

(You are, obviously, the lead doctor on this case)

You have a romantic couple. One of them has serious liver failure, and requires a liver within six hours. You can't get a transplant in that time, of course, especially considering she's otherwise ill.

Her partner volunteers to donate. Great, right? Except the partner's oblivious to the fact that the patient was planning to end the relationship before this whole thing went down.

Give this information out, you mess with your patient's chance for life. But is witholding it ethical? Would the partner be within their rights to withdraw the liver over this?

It seemed a pretty messy dilemma to me. Thought I'd get SDN input.

[Elheru Aran]

Do the transplant; IIRC partial livers can be donated. They can deal with their own personal shit after she gets better; the doctor's job is to heal/fix/cure, not work the case in such a way to accommodate one or the other's wishes.

[Faqa]

Do the transplant; IIRC partial livers can be donated. They can deal with their own personal shit after she gets better; the doctor's job is to heal/fix/cure, not work the case in such a way to accommodate one or the other's wishes.

True, but consider that the donor is essentially donating under false pretenses here.

[Elheru Aran]

Do the transplant; IIRC partial livers can be donated. They can deal with their own personal shit after she gets better; the doctor's job is to heal/fix/cure, not work the case in such a way to accommodate one or the other's wishes.

True, but consider that the donor is essentially donating under false pretenses here.

That's not the impression I get from your post here.

Her partner volunteers to donate. Great, right? Except the partner's oblivious to the fact that the patient was planning to end the relationship before this whole thing went down.

Sounds more like it's the *patient* who wouldn't want the transplant... if the partner didn't want to donate, that's his business. If he does though, it's the doctor's job to do the transplant; their personal lives aren't any business of his/hers.

[Faqa]

Sounds more like it's the *patient* who wouldn't want the transplant... if the partner didn't want to donate, that's his business. If he does though, it's the doctor's job to do the transplant; their personal lives aren't any business of his/hers.

Partner thinks they're donating to a loving partner. Turns out they're donating to someone who's planning to break it off. That makes no difference?

[Lord Zentei]

The doctor has taken an oath to treat his patients. He is obligated to follow up on any chance that allows this to be done. That takes priority over any incidental considerations. This is particularly the case since death is a greater negative utility than an organ donation (since as already stated, he can survive on a partial liver).

[Lord Zentei]

Whoops, bit of a GHETTO here:

But is witholding it ethical?

The personal relationships of the couple is not really any of the doctor's business in any case.

Would the partner be within their rights to withdraw the liver over this?

Off-hand I'd say yes; you are never really obligated to donate an organ; it depends perhaps on whether concent had already been signed with all legal requirements satisfied. In that case it might be breach of contract.

[Alyeska]

Interesting thought. The act of the donation could very well keep the couple together. Thats a pretty big act of love there.

[wolveraptor]

Sounds more like it's the *patient* who wouldn't want the transplant...

She's going to die in 6 hours. You'd have to be a Jehovah's Witness-style moron to not want a liver from someone, even a soon-to-be-ex.

[Patrick Degan]

Not the doctor's problem. The soon-to-be exes can live with the breakup, but the patient will die without the liver.

[Pezzoni]

A life, versus someone being pissed off and hurt? In any situation, I'd do the transplant witholding the knowledge, and this is only exacerbated by the fact that a doctor has taken a vow to save life; not to get involved in patients love lives.

I am correct in thinking that the donor will suffer no long-term ill effect, as the liver can regrow, am I not?

[mr friendly guy]

This is one of those situations where either way leads to negative consequences (assuming the partner withholds the liver after finding out about the plan break up). As with all things we weigh the pros vs cons.

Pros for not telling him

1) she gets the life saving transplant

2) it is not the doctor's right to go around telling people details of his patients private lifes (which are not related to the medical issue at hand, and not to non-professionals in the field), which violates patient confidentiality anyway.

Cons for not telling him

1) he makes his decision under false pretenses

Sucks to be that guy donating, but under the circumstances not telling him seems the way to go.

Of course you could encourage the woman to tell the partner herself, in a round about way.

I am interested to see whether people think this dilemna would change if we find out that the liver failure was self inflicted, say from alcoholism despite repeat warnings by doctors to stop drinking.