Cancer in a transplant kidney, is it the doctor’s fault?

[okarol]

Cancer in a transplant kidney, is it the doctor’s fault?
by AMY TUTEUR, MD | in PHYSICIAN | 4 responses

May you never be an interesting case.

That’s a cautionary proverb familiar to medical professionals. While it’s bad to get sick, it’s much worse to get sick with something uncommon or unusual. The more fascinating a case is for doctors, the more difficult it is for patients. Difficult to diagnose, difficult to treat, and often difficult to survive.

Kenneth Liew was doubly unfortunate. He was an interesting medical case and an interesting legal case. Now he’s dead and a jury is currently deliberating who, if anyone, is at fault.


Kenneth Liew was really, really unlucky. He was unlucky because he had serious kidney disease that necessitated debilitating dialysis treatments three times each week. He was unlucky because it took 10 years for a matching kidney to be found to give him in transplant. He was unlucky because after he received his kidney and after it was working well, an autopsy revealed that the kidney came from a woman who, though she died of a stroke, had unknowingly had uterine cancer as well. He was unlucky because there is not a single case like his in the whole world, so no one knew the odds that the cancer would be transmitted. He was unlucky because he died of cancer only seven months after receiving the transplant.

Despite being exhorted by her dying husband to forgive the doctor, Mr. Liew’s widow ignored his wishes and sued just about everyone she could think of including the doctor and New York University Medical Center where the transplant occurred. Eight years after Mr. Liew died, the jury has finally received the case.

First and foremost, this case has been a nightmare for Mr. Liew and his family. But secondarily, this case also represents a doctor’s worst nightmare. The doctor, transplant surgeon Thomas Diflo, lost a patient through a freak accident that no one could have known about or predicted and now he’s being blamed. I would feel sympathy for the doctor no matter what, but I am especially saddened because the doctor was one of my classmates in medical school.

Mrs. Liew is sure that somebody is to blame for something and that she deserves $3 million dollars in compensation, but it is not clear who is to blame or what they are to blame for:

· Did anyone know of the donor’s uterine cancer? Both sides agree that no one knew or could have known that the donor had uterine cancer.

· Was the patient informed that the donor had cancer? Both sides agree that the transplant surgeon informed the donor approximately 2 months after the he received the kidney.

· Should the kidney have been removed immediately thereafter? Both sides acknowledge that there was no way to predict the chances of Mr. Liew developing metastatic uterine cancer. There had literally never been a similar case in the history of medicine. Therefore, the doctor left the decision up to the patient, advising him that based upon what is known about transplants and cancer and based upon the fact that uterine cancer does not metastasize to the kidney, the chance that Mr. Liew would develop metastatic uterine cancer was low. Mr. Liew’s widow argues that the doctor should have advised that the kidney be removed immediately.

· Would removal of the kidney have made any difference? It’s unlikely. Whatever was transmitted to Mr. Liew from the donor kidney had already been transmitted.

· What caused Mr. Liew’s death? That’s not clear. Mr. Liew died of cancer, but the metastatic cancer was so poorly differentiated that no one can tell what type of organ it came from originally. It could have been uterine cancer transmitted by the kidney, but it also could have been cancer that developed spontaneously in Mr. Liew.

So if no one could have known about the uterine cancer in advance, if removing the kidney would not have made a difference and if it is not completely clear what kind of cancer killed Mr. Liew, why are Dr. Diflo and NYU being sued?

They are being sued because something bad happened and someone must be blamed. It wasn’t anyone’s fault; no one did anything wrong, but you can’t get any compensation for bad luck. Therefore someone, anyone, must be blamed and must be made to pay.

Amy Tuteur is an obstetrician-gynecologist who blogs at The Skeptical OB.

Submit a guest post and be heard.

http://www.kevinmd.com/blog/2010/07/cancer-transplant-kidney-doctors-fault.html

[KraigG]

For years after I got my kidney/pancreas, I used to worry if I had AIDS or not. This was back in 1990, and I wasn't quite sure what sort of life the donor had before he passed. Did he have a wild life right up to the time he died? Did he die in a car crash after a wild night of partying with women of questionable character?

I never knew who I got my organs from. You weren't allowed to know back then, and it was an issue for the first few years.

[malaka]

That case, albeit as reported by one who might be thought to favor the doctors, sounds like bull**** to me.  If I'm on that jury and these are the facts, I know exactly what to award:  ZERO.  Lady, your husband wasn't a picture of health to begin with.  The doctor can't dissect the kidney to be transplanted before he put it in your husband. 

There's more to this than reported, however, as she needs a doc or two to testify that the standard of care was somehow breached.  I'm surprised that they found such docs.  Especially given the seeming uncertainty about the actual cause of death.  Maybe the years of drug treatment made him develop his own cancer. 

This did happen in the early years of AIDS. I know of one such case at a university medical center and in those days, organs weren't tested for HIV.  At the time, such tests may not have existed so the only screen was "no gays, no transfusions, no Haiti tourists" as donors

[fearless]

Looks like mine will be the unpopular view, but:  I think the doctor was faultless up until the time he told the patient that the chances of him contracting cancer were "low".  With all the unknowns which were described, and the very known fact that immunosuppressants encourage cancer, the kidney should have been removed so that if cancer showed up it could be treated effectively.  When a doctor says "the chances are low" that's very reassuring to a patient.  And a patient who is so grateful to have a new kidney will hear that as "there is no chance at all".  Certainly the doctor's assessment influenced the patient's decision.  The doc should have said "we don't know what the risk of you developing cancer is because we've never had this happen." 

That doesn't mean i support $3million in damages though.  There is a more reasonable amount that would send a message to other docs to be conservative when approaching unknowns.
I wonder how accurate this article is in describing what actually happened.
 

[RichardMEL]

Here's what I think.

Assuming the facts are as reported I think that the wife should not have sued. Hell her husband asked her to forgive the doctor - clearly he had come to terms with his lot in life. Further, saying you have a low risk of cancer is being informative and docs are required to say that. It's like with the biopisies I've had they tell you up front there's a low chance we could hit an artery and you could bleed and blah blah. That's clalled informed consent. Heavens the poor man waited ***TEN*** years for a kidney. I think all of us would take that chance of a more normal life.

They only found out later she(donor) had this cancer.. if they had waited to do the PM the kidney prob would not be viable - and we do nbot know that just because she had that condition that it would be passed on through the tx.

I read this and am reminded of my own transplant adventure (still going!) wherein I was told, as I was waiting outside the OR, that the kidney may be banged up a bit and may not be in great condition and while the docs would decide when they looked at it, I had the choice there and then to say no. That was the point of final consent. I will admit I did think about it for a small amount of time but really, for me, the choice came down to taking a chance and having faith in the surgical team to make an informed decision when they looked at the actual organ. I put my faith in them.

A year later and so far so good. I'll say this right now if Danny falls over tomorrow and I am back on D in a few months or whatever.. the LAST thing I would do is blame any of the tx people, docs etc. That's LIFE. We have a chronic and terrible condition and these people have our best interests at heart. We take the chance of something better (also knowing that staying on D has just as many risks) and I for one value fully the year I have had so far of relative freedom in so many ways.

It is a sad fact that these days some people in certain parts of the world will sue over just about anything because I think there is some kind of sense of entitlement. I wait for the day when some kid has a bad date and sues the other party for emotional distress or something.

Finally, suing "just about anyone she could think of"  will NOT bring her husband back. It will not wipe away the pan of all they endured together. I think the victim in all this had the right set of values to accept it and forgive - clearly he felt the doctor did his best and had the patients best interests at heart.

You get cases like this and you can understand why some don't want to become medical professionals (and similar related fields) when they could face stuff like this for trying to do the best they can at their jobs and help people....

[MooseMom]

If these are all of the facts...if this is the truth, the whole truth and nothing but the truth, then the widow certainly has the right to sue (and her attorney gets paid, I'm sure), but I think she will lose.  The doctor in question did not act unreasonably or negligently.

[jbeany]

It was a transplant, not a cure.  Anyone who thinks there aren't huge risks that come with the procedure is living in fairy land.  Does this man's outcome stink?  Yes.  But those are the risks.  I've had people ask me if I planned to sue because of my multitude of complications.  I can't ever figure out for what - I knew the risks when I signed the consent form.  And if my sister had tried to sue if I hadn't made it, I'd have come back to haunt her. 

[Katonsdad]

I liken this to me sueing my parents because I got diabetes which caused my heart problems and
my kidney problems .  Well they are gone now , so lets see I guess my moms sister might be a good target for
my lawsuit as she was around when I was born.


Katonsdad