Texas surgeon accused of denying qualified patients liver transplants
Key Takeaways
A doctor is being investigated for manipulating patient records, effectively making some patients ineligible for liver transplants.
Historically, reports show that doctors have manipulated transplant waiting lists to both grant and deny patients eligibility.
Some manipulation tactics may be related to organ shortages in the US, which put patients and doctors in competition for organs.
The Memorial Hermann-Texas Medical Center suspended its liver and kidney transplant programs in early April while launching an investigation into one of its surgeons, 64-year-old J. Steve Bynon Jr., who has been accused of manipulating some patients’ medical records to deny them liver transplants. The medical center reported that Dr. Bynon Jr. made “inappropriate changes” to medical records that “effectively inactivated” some patients from being eligible to receive liver transplants.[]
According to his online bio, Dr. Bynon Jr. has performed over 800 liver transplants during his career. He has been the director of the Division of Immunology and Solid Organ Transplantation at UTHealth Houston’s McGovern Medical School since 2011.
In a statement to USA Today on April 12, representatives from the Memorial Hermann-Texas Medical Center said they “have been actively working with all impacted patients, families and caregivers from the liver and the kidney transplant programs," for the last two weeks.[]
“Our primary priority is ensuring continuity of compassionate care for patients who were on the transplant program lists at the hospital,” the statement continued. Representatives of the medical center added that transplant care coordinators are contacting patients in the suspended programs to look at further care options, including a "seamless” transition to another transplant program if needed.[]
Uneven organ supply and demand
The pending investigation may reveal flaws in Dr. Bynon Jr.’s practice and the medical center’s oversight of its transplant program, as well as uncover broader issues regarding transplant list manipulation in healthcare.
According to a report by the Organ Procurement and Transplantation Network/United Network for Organ Sharing (OPTN/UNOS), “[n]o studies have assessed the prevalence of waitlist manipulation,” but “there are numerous well-publicized reports and editorials highlighting alleged or potential purposeful manipulation of the allocation system.”[]
Among these reports are cases of doctors who have manipulated records to add ineligible patients to waiting lists, increasing the hospital’s chances of getting and holding on to an organ. These cases raise ethical dilemmas in the medical system, as doctors must balance their duty to individual patients with respect to the overall transplant system and patients at other hospitals.
Put simply, “[s]hortening wait times for some directly increases wait times for others,” OPTN/UNOS states. “The key ethical dilemma pertains to clinicians’ role in addressing their obligation to their patient with their obligation to the transplant system and society.”
Rather than demand that physicians ‘balance’ these obligations on their own, the network highlights the need for safeguards to “help ensure that all patients are treated equally.”
Safeguards should include taking both justice for individual patients and medical utility for transplant programs as a whole into consideration, the OPTN says. The network describes factors of justice as “fair consideration of candidates' circumstances and medical needs,” and factors of medical utility as efforts to “increase the number of transplants performed and the length of time patients and organs survive.” Evaluating patients according to these factors is necessary due to the fact that the supply of transplantable organs in the US is smaller than the number of patients in need of a transplant, the OPTN says.[]
In addition to the above, factors such as the patient’s blood type, height or weight, medical state, and size of the organ can influence a patient’s eligibility for a transplant. For live transplants, factors including medical urgency and distance from the donor hospital are also taken into consideration, the OPTN says.
What this means for you
A doctor is being investigated for manipulating patient records, effectively making some patients ineligible for liver transplants. Cases of waitlist manipulation, in addition to organ shortages in the US, highlight the importance of establishing safeguards for determining eligibility for organ transplants.