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Sometimes you just gotta liver little

Today’s weird Guardian story is not directly political:

Surgeon admits marking his initials on the livers of two patients

A surgeon has pleaded guilty to marking his initials on the livers of two patients while performing transplant surgery.

In a hearing at Birmingham crown court on Wednesday, Simon Bramhall admitted two counts of assault by beating relating to incidents on 9 February and 21 August 2013. He pleaded not guilty to the more serious charges of assault occasioning actual bodily harm.

The renowned liver, spleen and pancreas surgeon used the gas argon, used to stop livers bleeding during operations and to highlight an area due to be worked on, to sign his initials into the patients’ organs. The marks left by argon are not thought to impair the organ’s function and usually disappear by themselves.

The 53-year-old was first suspended from his post as a consultant surgeon at Birmingham’s Queen Elizabeth hospital in 2013 after a colleague spotted the initials “SB” on an organ during follow-up surgery on one of Bramhall’s patients.

As one might expect, this is being treated as a crime:

Elizabeth Reid, of the Crown Prosecution Service, said Bramhall’s actions were an abuse of the trust placed in him by the patients.

“It was an intentional application of unlawful force to a patient whilst anaesthetised,” she said. “His acts in marking the livers of those patients, in a wholly unnecessary way, were deliberate and conscious acts on his part.”

But not everyone agrees.

Following reports of Bramhall’s suspension, his former patient Tracy Scriven told the Birmingham Mail that the surgeon should be immediately reinstated. “Even if he did put his initials on a transplanted liver, is it really that bad? I wouldn’t have cared if he did it to me. The man saved my life,” she said.

She has a point. As was discussed here yesterday there is a push (it’s called a “consultation” but no one is in any doubt what the desired answer is) for England to follow the example of Wales and institute a system in which unless a person objects in advance to their organs being donated after death their consent will be assumed.

Why, then, should Mr Bramhall not say that he assumed that his patients were OK with him putting his graffiti tag on their livers? They didn’t sign a form objecting, did they?

23 comments to Sometimes you just gotta liver little

  • Lee Moore

    Patient consent has nothing to do with it. The crime is damaging state property.

  • As the Banksy of liver transplants, are ones with his initials now worth more?

    Should organs be part of your estate?

    The value could come off Death tax…..

  • Someone I knew when she was in medical training would come home of an evening and sit down to dinner while announcing “We’ve reached Freda’s spleen” (Freda was the pet name her group gave to their corpse) and then do nothing for the appetites of the rest of us by describing the day’s dissections in some detail. However she did exert herself to verify that the lady who left her own corpse to this purpose knew she would be being used for student training: “I’d feel kind of bad if she’d thought she was going to be used for groundbreaking medical research, given our irreverent attitude.”

    I think the idea was for the students to get it out of their system while still students, and on the bodies of the departed, not living patients. 53-year-old Mr Bramhall may be a skilled surgeon but it sounds like he’s still at the student stage as regards other forms of maturity. 🙂 Of course, surgeons are fairly notorious for self-oriented dominating characters and I suppose signing your work is just an unusual (one assumes) example.

  • Mr Ed

    It’s a modern take on a mason’s mark, that’s all, the wonderful Tewkesbury Abbey abounds with them, and is nun the worse for it.

    However, timing is everything. If he marked the livers when they were between original owner and recipient, the liver tissue was not at that point comprising part of a real person’s body, (as opposed to being biologically a body part) and it might fall into a legal lacuna where the approprate charge might not be beating etc. but be criminal damage (against property) but whose property is a freestanding liver? The State may arrogate the right to use a stolen or harvested liver, but that is not the same as legal ownership, so whose property has been damaged? If it is not property ‘belonging to another’ it cannot be the subject of criminal damage.

    Clearly on transplantation, an organ is like a fixture in a house in England, but to the State, they are really fittings.

  • John K

    Frankly I think he’s a sick bastard.

    It takes a certain type of person to be able to carve up someone’s body. Surgeons are notorious for being arrogant, haughty, perhaps verging on the psychopathic. I think this fellow just proved the point.

    I don’t doubt that he was a competent surgeon, that’s not what is under discussion, rather he seems to have taken his belief in his own God like status just a bit too far. He probably really can’t see what he did wrong.

  • Fraser Orr

    In regards to the organ crisis, there really is a simple solution — allow people to sell their organs. Of course you might restrict people from selling their irreplaceable organs, but what is wrong with selling a kidney or half a liver? After all if you do it a zero price you are a hero, so why not get paid for your services, you know like the doctor, the nurses, the guy who drives the ambulance, the guy who mops the floor, the guy who fills in the forms, etc. Transplant donors are the ONLY people who don’t get paid.

    And that is for live donation. Why can’t I have a future contract on my organs, so that they can have ’em when I am dead, but I can reap the benefits now?

    Or how about:

    Doctor: “I’m so sorry for your loss, would you consider organ donation?”
    Grieving Widow: “Sure, if you pay off my mortgage so I don’t have the worry anymore”

    Seems perfectly reasonable to me. Organ shortage? Gone in a jiffy.

    What this “survey” you mentioned is doing is exactly that, except that the state is keeping all the money/value generated. It is like that story of the guy who hooks up with a hot girl only to wake up in a bathtub of ice missing a kidney. The state is the hot girl, except that she isn’t hot, there is, god forbid, no hooking up to be had, and she doesn’t even give you a bathtub full of ice.

  • George Atkisson

    I foresee a slippery slope here. If assent can be assumed or implied without formal documentation in this regard, can the concept then be extended to male/female/xir interactions?

    “My partner was dead drunk and unresponsive. By established medical precedent, I then assumed consent for all my following actions.”

  • David

    Probably wasn’t room for “Kilroy was here” so he had to make do with just his initials.

  • Fraser:

    Let my estate sell my organs after I die. It can pay for the funeral at least.

  • Lee Moore

    Let my estate sell my organs after I die. It can pay for the funeral at least.

    It’s a nice thought. But it would take too long to get probate sorted out. In fact, for most sorts of transplants it’s essential that the donor still be alive. This is why it has been necessary to adjust the meaning of ‘dead” until it conforms to what is necessary for transplant purposes. It’s not just “consent’ that is malleable – even “death” must yield to the march of progress.

  • Fraser Orr

    @Lee Moore
    It’s not just “consent’ that is malleable – even “death” must yield to the march of progress.

    Which is why a futures contract seems ideal. The contract obtains my consent when I am able to give it, plus it can define what I mean by “death”. No doubt there would be various standard types of contracts with variable prices to that end.

    Either way it is better than the government just taking them by force, or facing families with impossible decisions at impossible times.

  • Mr Ed

    It’s a nice thought. But it would take too long to get probate sorted out.

    Probate (the process of getting authority to deal with an Estate) is hopelessly slow in England and Wales, and Scotland too from my experience. However, funeral expenses are the first call on the Estate so banks holding a deceased’s money will pay out on (genuine) funeral expenses without probate as there is no higher call on the deceased’s assets, so they cannot be held to have wrongly paid out of the Estate by any creditor or beneficiary of the Will/Intestacy.

    Of course, no one would have any doubt that they would be in safe hands if, after a car crash and perhaps a bit of head trauma, they ended up in an NHS hospital with idle transplant surgeons waiting for some offal to allocate, with perhaps a transplant ‘target’ to meet. There would be no temptation to hasten the accident victim away when so many others would benefit. Gemeinnutz geht vor Eigennutz and all that, not our way at all, much.

  • bobby b

    Ted Schuerzinger
    December 14, 2017 at 9:25 am

    “Let my estate sell my organs after I die.”

    It’s been pointed out that post-death is too late, but it would work to sell your own organs prior to your death. But it would be a tough contract to enforce. What happens when you are on the brink of death, and three sick people show up each with a contract — signed by you – granting them your liver? They’ll not likely be getting any refunds from you at that point. If you’re smart, you’ve already spent their payment.

    Perhaps a system where, on the signing of a contract, a surgeon makes a little incision and writes his initials on your organ? Like a lien filing for all to see?

    Like this surgeon did? 😈

  • Snorri Godhi

    Actually, there is a big difference between assuming consent for organ donation unless explicitly denied, and Dr Bramhall assuming consent for graffiti on transplanted livers unless explicitly denied:
    I cannot possibly benefit from surgeons putting their initials on my liver, whether i am the donor or the recipient; but i might benefit from a law on assuming consent for organ donations.

    Another difference is that donors and recipients have been given no prior warning that surgeons might put their initials on livers; but people have been given warning that their consent will be assumed unless explicitly denied.

    Having said that, i am 100% in favor of Fraser Orr’s proposals. Let me flesh it out a bit. (More fleshing-out is needed.)
    Every adult in the country gets a consent form in the mail once/year.
    In it, they can specify not only whether they consent to organ donation, but also the medical criterion by which they are to be considered dead for the purposes of organ donation.
    For people who do not return the consent form, no consent is assumed.
    People who consent to donate their organs get a check for an amount related to their age (the older the person, the smaller the refund, obviously) and the criterion by which they consent to be declared dead.
    Finally, if there is a medical condition that makes donation unfeasible, the check becomes smaller if some organs can still be salvaged, zero if no organs can be recycled.

    An important detail that needs fleshing out, is how far the government is allowed to go, to determine whether there are medical conditions preventing transplants.

  • bobby b

    You’d probably like the US system for opting in.

    Here, almost everyone over 16 gets a driver’s license.

    When you apply and when you renew, the form asks you to check a box for either opting in, or opting out, of organ donation.

    My license has a little red “donor” stamped in one corner.

    Most people check “yes.”

    I have no idea how this affects actual donation incidence, but I suspect our opt-in rate is high.

  • Julie near Chicago

    See Rob Fisher’s comment on this topic: https://www.samizdata.net/2017/12/samizdata-quote-of-the-day-967/#comment-742896

    I concur with Rob.

  • RRS

    And then, there is:

    “. . . him putting . . .”

    whatever happened to the gerund?

  • Organ donation is an interesting issue. Personally, I am against it for me; and I am against it generally on selling organs.

    Historically, both my personal organ protection policy and the general objection on selling has been down to risk of criminal theft of organs (as also mentioned by Fraser Orr at December 14, 2017 at 2:14 am).

    In addition, I am of the view that surgeons etc given an inch would (but for my age) take all one hundred and seventy five centimetres of me, including: hair, eyes, larynx, heart, lungs, liver, spleen, kidneys, bladder and pipework, intestine by the foot, skin by the square inch. Next year even more; cosmetic and (marginally) utilitarian as well as life-saving.

    However, the issue raised by Natalie, of the ‘signing’ Mr Bramhall, has raised new problems.

    I worry not a lot about the ‘signing’ – which is reported to do no harm to the transplant recipient nor to the organ transplanted. What this all indicates to me is likely some other perhaps general dispute within the hospital in which Mr Bramhill works – in which the skills of all as surgeons/doctors are less important than other issues (likely including internal politics).

    We already have the argument that (as for masons) the signing shows an explicit stamped guarantee of personal responsibility for the quality of the work, by the authoring artisan.

    So perhaps, not only must potential organ donors (and executors/relations) consider donation – but they must also consider the ‘ethics’ policies of the particular hospitals and particular doctors involved in both extraction and reuse of every single individual organ.

    No thank you (tl;dr or similar). I’ll just take the whole lot of me to my funeral and beyond!

    Best regards

  • I sneeze in threes

    “Can we have your liver then.”


  • Alisa

    I have no idea how this affects actual donation incidence, but I suspect our opt-in rate is high.

    I wonder how many of those opting in are fully aware that their organs would be harvested before they are clinically dead.

    What Nigel said.

  • Paul Marks

    No harm no foul – especially as no one could see the markings from the outside of the body and the markings would vanish in a while.

    As for harvesting organs without consent – bad.

  • Eric

    I cannot possibly benefit from surgeons putting their initials on my liver, whether i am the donor or the recipient; but i might benefit from a law on assuming consent for organ donations.

    You never know. Sometimes the signed copy is worth a lot more to collectors.

  • Lee

    In this situation I tend to work out how my broadly libertarian principles would react by imagining “what if it happened to me” I can say without fear nor favour that my biggest gripe after receiving a transplanted organ upon which the surgeon signed just their name would be “They didn’t sign the initials of the poor bugger who died giving it to me”