Case #48
The Perfect Match

Case Goals
  • Conduct an empathetic and thorough conversation with the potential donor
  • Identify the core ethical issues in this situation
  • Handle confidentiality and communication appropriately
  • Navigate a difficult family interaction while maintaining ethical boundaries

    • Goals

  • Conduct an empathetic and thorough conversation with the potential donor
  • Identify the core ethical issues in this situation
  • Handle confidentiality and communication appropriately
  • Navigate a difficult family interaction while maintaining ethical boundaries
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    Welcome to this case. Here is the setup: You are a medical student on the transplant service. A 45-year-old man named Daniel Rivera is critically ill in the ICU with fulminant hepatic failure. His younger brother, Miguel Rivera, age 25, has been identified as a potential living liver donor and is a strong biological match. You have been asked to speak with Miguel to assess his understanding of the situation and confirm whether he is willing to proceed with the evaluation process. Are you ready to begin?

    Case Complete!

    High Yield points about this case:

    • Living organ donation always requires free, voluntary, informed consent from the donor. A competent person cannot be forced to donate for any reason.
    • In McFall v. Shimp (1978), a Pennsylvania court ruled that no person can be compelled to donate tissue or organs to save another person's life, establishing a legal precedent for bodily autonomy.
    • UNOS policy requires every living donor evaluation to include an independent donor advocate whose sole duty is to protect the donor's interests, separate from the recipient's medical team.
    • A living liver donor's remaining liver typically regenerates to near-normal size within 6 to 8 weeks after partial hepatectomy. The mortality risk for a living liver donor is approximately 0.1 to 0.5 percent, with additional risks including bile leak, infection, and blood clots.
    • A donor's refusal is protected health information. Physicians must not disclose the reason for a donor's withdrawal to the recipient or family without the donor's explicit permission.
    • Biological compatibility does not equal consent. Being a medical match for organ donation creates no legal or ethical obligation to donate.