Liver transplants from live donors are under increased scrutiny in the United States after the death of a previously healthy 57 year old man who donated a portion of his liver to save an ailing brother from fatal liver failure.
The man, Michael Hurewitz, a former reporter on the New York Post and the Times Union of Albany, volunteered to have a portion of his liver removed and transplanted into his brother, 54 year old Adam Hurewitz, a doctor. The operation and postoperative care were performed at Mt Sinai Hospital in New York, a leader in the field of liver transplants from live patients. Over 100 such procedures have been done at Mt Sinai since 1998—more than at any other hospital in the United States—and until the death of Michael Hurewitz no deaths at Mt Sinai were directly and publicly attributed to the procedure.
Three days after the operation the donor became ill, first developing nausea, hiccups, and tachycardia and then vomiting blood and subsequently aspirating and choking on it. An autopsy found large amounts of blood in the stomach and a bacterial infection, Clostridium perfringens. State investigators found Mt Sinai liable for inadequate postoperative care and in particular faulted the hospital for insufficient supervision of inexperienced resident doctors.
For much of the time Mr Hurewitz was cared for by a single, poorly supervised intern who was responsible for 34 critically ill patients in the transplant unit. The surgeon who did the transplantation, Dr Charles Miller, failed to visit the patient after the procedure, and no senior member of the surgical team had made any postoperative chart notes.
The case has parallels to that of 18 year old Libby Zion, who died within a day of admission to New York Hospital with fever of unknown origin. The landmark 1981 case went to the Supreme Court and resulted in the Bell Commission and a revision of state laws requiring increased supervision of junior doctors and decreased working hours for interns and residents in New York state.
In the current case an investigation by New York state health commissioner Antonio Novello found 18 deficiencies in the care received by Mr Hurewitz and fined Mt Sinai $48000 (£34000; €54000), in addition to suspending the hospital from performing liver transplantations from live donors for six months. The commissioner also wants the hospital to institute a formal plan of corrective action.
Meanwhile the investigation is being broadened to include three more patients, including one who died after receiving a cadaveric transplant and two who complained of faulty care at Mt Sinai Hospital.