Is this Patient REALLY Unrepresented? Hospital Must Make Diligent Inquiry.

In a series of articles on medical decision making for unrepresented patients, I emphasize the importance of first making sure that the patient really is unrepresented. That involves two important inquiries. First, does the patient really lack capacity? Even capacity for identifying a surrogate? Second, does the patient really have no friends or family to speak for her? How hard have we looked?

A new Simon & Schuster book illustrates the dangers of too quickly assuming that the patient is unrepresented. In The Organ Thieves: The Shocking Story of the First Heart Transplant in the Segregated South, surgeons performed one of the first heart transplants in the world (in 1968) when the donor patient (Bruce Tucker) was not yet dead and nobody had consented to donation.

Remarkably, among the donor patient’s final possessions was his brother's business card for a shoe repair shop only a few blocks from the hospital. Yet, nobody had called the patient's brother.