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Branding livers


An eminent surgeon made headline news in 2013 when he was found to have branded his initials on his patient’s liver. This week he made the news again as he pleaded guilty to assault. But is branding livers was really a big deal at all?

This doctor had been working as a transplant surgeon for over a decade. One of his old transplant patients went for another operation, and when the new surgeon opened the patient up, he noticed the initials ‘SB’ carved into the liver. This had been seared using argon gas.

There is no suggestion that this surgeon’s graffiti had led to harm of the patient, and no accusations of clinical incompetence or poor performance from the surgeon who, by all accounts, had an impressive record. But it still seems intrinsically ethically wrong.

Consent is certainly an issue. It seems as though the patient had no idea that this had happened. Should the surgeon have asked the patient’s permission, ‘I like to sign my livers after they’re in, do you mind if I put my initials in your body?’. That would sound ridiculous, perhaps because it is.

But in actual fact, we don’t consent patients to every miniscule step of surgery – they aren’t informed about every staple, every suture and every tool used. They are usually provided with an overview of the planned surgery and a summary of the main risks to them. So if this ‘signing’ is part of the surgeon’s routine practice, then he could regard it as just another minor detail of the operation that does not require specific consent.

However, what it does represent is an underlying arrogance. The patient is regarded as his masterpiece; the liver owned by the surgeon; and his work so fabulous that his name should forever be preserved inside the patient.

He has admitted to doing this to two patients, and we know from the court hearing that this was done in the presence of others. The fact that none of his colleagues had mentioned this earlier is alarming too. There must always have been other theatre staff there to see – scrub nurses, anaesthetists, junior doctors. Why did nobody speak up sooner?

When we talk about the changing nature of the doctor-patient relationship, this is exactly the kind of problem that we are all trying to move away from – where doctors see themselves above accountability and on a higher level of importance than the patient.

What is wrong with this case is not necessarily that the patient was harmed, it’s that the surgeon used the patient for his own gratification.

For this surgeon, it wasn’t about how the patient would feel, or whether the patient would consent. It was about arrogance and self-importance. And now it’s also about a criminal offence which was ‘an intentional application of unlawful force to a patient whilst anaesthetised’.

(image via

About the authors

  • Tessa Davis is a Consultant in Paediatric Emergency Medicine at the Royal London Hospital and a Senior Lecturer at Queen Mary University of London.


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