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Malpractice case involving death of liver donor goes to trial

Lorraine Hawks, seen at her late husband’s crypt in Tampa, contends that he was led to believe his brother-in-law had a chance at a long life with the liver donation.
Lorraine Hawks, seen at her late husband’s crypt in Tampa, contends that he was led to believe his brother-in-law had a chance at a long life with the liver donation.(Brian Blanco for the boston globe/file 2014)

In 2010, Paul Hawks underwent surgery not because he needed it, but so he could donate most of his liver to a sick brother-in-law. The six-hour operation ended in tragedy when Hawks died on the operating room table at Lahey Hospital & Medical Center.

Despite Hawks’s altruistic donation, his brother-in-law, who had advanced cancer, died the next year.

Now, nine years later, a trial is underway in the medical malpractice lawsuit that resulted from Hawks’s death, a case that divided two families and exposed the potential ethical pitfalls in living organ donations. A key question is whether surgeons should have given Hawks more detailed information about the severity of his brother-in-law’s cancer and prognosis — and whether that knowledge would have changed his decision to undergo a risky surgery to remove 60 percent of his liver.

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Paul Hawks died while donating part of his liver to his brother-in-law.
Paul Hawks died while donating part of his liver to his brother-in-law.(Brian Blanco for the Boston Globe)

Hawks’s wife, Lorraine, testified Tuesday that lead surgeon Dr. Elizabeth Pomfret told her husband that his brother-in-law, Timothy Wilson, had a shot at a long life — if he received a liver donation.

“A good shot,’’ she said during her second day on the stand in Middlesex Superior Court in Lowell.

Hawks said she and her husband learned at some point that Wilson had cancer, but did not know that his cancer had advanced to stage three. Another expert witness called by attorney William Thompson, of the Boston law firm Lubin & Meyer, testified Monday that the five-year survival rate for stage three liver cancer is less than 20 percent.

Pomfret, who is now chief of transplant surgery at the University of Colorado School of Medicine, and the two other surgeons named in the case, Dr. Mohamed Akoad and Dr. Yee-Lee Cheah, listened quietly in the audience. Tuesday was the fourth day in the trial in the lawsuit filed by Lorraine Hawks against the three doctors.

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Thompson argued that Paul Hawks was not given enough information about whether the transplant would succeed. Thompson also called to the stand a medical ethicist and informed consent specialist from Boston University, who criticized the hospital’s process of obtaining Hawks’s consent for the surgery.

In previous testimony, Thompson aimed to prove that the donor advocate Lahey assigned to look out for Hawks’s interests was not truly independent from the transplant team, and that medical errors were made in his surgery, during which he lost excessive amounts of blood.

The defense is expected to call its witnesses in the next two days, and the 12-member jury could start deliberating next Thursday.

Hawks’s death was a calamity for Lahey, too. Transplant surgeons there ran the country’s busiest living liver donor program and had never lost a donor. Pomfret, a widely respected leader in the field, later told colleagues that she and the hospital had considered shutting down the renowned program.

On Tuesday, Lorraine Hawks, who lives in Tampa, described her husband, who was 56 when he died, as a cautious, reserved man who drove a Dodge truck and flew to Boston for his medical evaluations and surgery even though he hated flying. He could not stand to watch his wife, who was far more adventuresome, sky dive or hang glide. They had been married for 35 years.

Pomfret’s lawyer, Daniel Buoniconti, of the Boston law firm Foster & Eldridge, challenged her recollection about the case, saying that she did not mention details of Pomfret’s alleged comments during her pretrial testimony and that she was not part of the medical discussions between Pomfret and her husband.

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“You said Dr. Pomfret told your husband’’ that Wilson had liver cancer, Buoniconti said.

“I didn’t know how bad,’’ Hawks replied.

Wilson was married to Lorraine Hawks’s younger sister, Susie Wilson. Lorraine Hawks and her family had just finished Thanksgiving dinner in 2009 at the Cracker Barrel off Interstate 275 in North Tampa when her cellphone rang. Susie Wilson was calling, upset, from her home in New Hampshire because she had just found out that her husband, ill with end-stage liver disease, needed a transplant. Paul Hawks immediately volunteered to get tested.

Over the course of six months, Lahey doctors determined that Hawks was healthy enough to donate his liver, even though he was on the older side for donors.

But at the trial on Tuesday, Leonard Glantz, a retired professor of health law and ethics at Boston University, told the jury that he does not believe doctors sufficiently informed Hawks about Wilson’s medical situation. While doctors are obligated to clearly tell patients about the risks and benefits of any medical procedure, they need to be “especially careful’’ with living organ donors because they are not sick and “there is no physical benefit’’ to the major surgery they will undergo.

Tim Wilson (left) had both end-stage liver disease and liver cancer. Paul Hawks (right) was 56 at the time of the liver transplant at Lahey Clinic.
Tim Wilson (left) had both end-stage liver disease and liver cancer. Paul Hawks (right) was 56 at the time of the liver transplant at Lahey Clinic.

“It’s an act of charity,’’ Glantz said. “One of the key parts,’’ he said, “is that they have a realistic understanding of the benefits. What are the chances of saving another person’s life?’’

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In his cross-examination, Buoniconti called into question Glantz’s expertise. He said that Glantz is not a medical doctor and that, while he reviewed portions of Paul Hawks’s medical record, he did not read the entire record. Glantz also acknowledged that he had not reviewed Wilson’s medical record.

“You understand that medicine is not an exact science, and that complications can happen during surgery?’’ the lawyer asked.

“Yes,” Glantz replied. “I understand that.”


Liz Kowalczyk can be reached at kowalczyk@globe.com