Abstract
This is the report of a case that required clinical ethical evaluation due to family relations that became strained when a donor candidate was selected for adult-to-adult living donor liver transplantation (LDLT). A 40-year-old woman was transferred to our hospital because of drug-induced severe hepatitis. She suffered from hepatic encephalopathy grade III. On admission, her prothrombin time was 19%, and her total bilirubin was 26.6 mg/dl. Her condition deteriorated, and adult-to-adult LDLT was explained to her family members as the ultimate treatment of choice. The only donor candidate was her father who was divorced from her mother. He opted for the operation, but his common-law wife opposed his decision. After consulting a lawyer through the ethics committee, the operation was performed in respect for his will and interpersonal relationships among the family members deteriorated. The patient died from liver failure after several months. In cases of intractable severe acute liver failure involving conscious disorders, it is better for donor candidates to freely decide their will. At the same time, however, time limitations create psychological pressure when means of treatment and transplantation are explained to the donor's family as final medical measures because LDLT may offer the only chance of patient survival. It must be understood that these psychological pressures extend beyond the donor to his or her family members and all concerned should be offered psychosocial support, regardless of the decision of the donor candidate.
