2.1 - Alabo v. Magud-Logmao
2.1 - Alabo v. Magud-Logmao
2.1 - Alabo v. Magud-Logmao
* THIRD DIVISION.
666
669
or institution has exerted reasonable efforts to locate the
aforesaid guardian or relative. A copy of every such
authorization must be furnished the Secretary of Health.
670
shows disrespect to the dead, or wrongfully interferes with a
funeral shall be liable to the family of the deceased for damages,
material and moral. The organ retrieval performed by the
National Kidney Institute cannot be termed as “disrespect to the
dead.” Organ donation is allowed by law. A sterile medical
operation surely is not tantamount to grave robbery or mutilation.
PERALTA, J.:
This deals with the Petition for Review on Certiorari
under Rule 45 of the Rules of Court praying that the
Decision[1] of the
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[1] Penned by Associate Justice Marina L. Buzon, with Associate
Justices Aurora SantiagoLagman and Arcangelita RomillaLontok,
concurring; Rollo, pp. 7196.
671
Court of Appeals (CA), dated March 31, 2006, adjudging
petitioner liable for damages, and the Resolution[2] dated
November 22, 2006, denying petitioner’s motion for
reconsideration thereof, be reversed and set aside.
The CA’s narration of facts is accurate, to wit:
Plaintiffappellee Zenaida MagudLogmao is the mother
of deceased Arnelito Logmao. Defendantappellant Dr.
Filoteo Alano is the Executive Director of the National
Kidney Institute (NKI).
At around 9:50 in the evening of March 1, 1988, Arnelito
Logmao, then eighteen (18) years old, was brought to the
East Avenue Medical Center (EAMC) in Quezon City by
two sidewalk vendors, who allegedly saw the former fall
from the overpass near the Farmers’ Market in Cubao,
Quezon City. The patient’s data sheet identified the patient
as Angelito Lugmoso of Boni Avenue, Mandaluyong.
However, the clinical abstract prepared by Dr. Paterno F.
Cabrera, the surgical resident onduty at the Emergency
Room of EAMC, stated that the patient is Angelito
[Logmao]. Dr. Cabrera reported that [Logmao] was drowsy
with alcoholic breath, was conscious and coherent; that the
skull xray showed no fracture; that at around 4:00 o’clock
in the morning of March 2, 1988, [Logmao] developed
generalized seizures and was managed by the neuro
surgery resident onduty; that the condition of [Logmao]
progressively deteriorated and he was intubated and ambu
bagging support was provided; that admission to the
Intensive Care Unit (ICU) and mechanical ventilator
support became necessary, but there was no vacancy at the
ICU and all the ventilator units were being used by other
patients; that a resident physician of NKI, who was
rotating at EAMC, suggested that [Logmao] be transferred
to NKI; and that after arrangements were made, [Logmao]
was transferred to NKI at 10:10 in the morning.
At the NKI, the name Angelito [Logmao] was recorded
as Angelito Lugmoso. Lugmoso was immediately attended
to and given the necessary medical treatment. As Lugmoso
had no relatives around, Jennifer B. Misa, Transplant
Coordinator, was asked to locate his family by enlisting
police and media assistance. Dr. Enrique T. Ona, Chairman
of the Department of Surgery, observed that the severity
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[2] Id., at pp. 98101.
672
of the brain injury of Lugmoso manifested symptoms of
brain death. He requested the Laboratory Section to
conduct a tissue typing and tissue crossmatching
examination, so that should Lugmoso expire despite the
necessary medical care and management and he would be
found to be a suitable organ donor and his family would
consent to organ donation, the organs thus donated could
be detached and transplanted promptly to any compatible
beneficiary.
Jennifer Misa verified on the same day, March 2, 1988,
from EAMC the identity of Lugmoso and, upon her request,
she was furnished by EAMC a copy of the patient’s date
sheet which bears the name Angelito Lugmoso, with
address at Boni Avenue, Mandaluyong. She then contacted
several radio and television stations to request for air time
for the purpose of locating the family of Angelito Lugmoso
of Boni Avenue, Mandaluyong, who was confined at NKI
for severe head injury after allegedly falling from the
Cubao overpass, as well as Police Station No. 5, Eastern
Police District, whose area of jurisdiction includes Boni
Avenue, Mandaluyong, for assistance in locating the
relatives of Angelito Lugmoso. Certifications were issued
by Channel 4, ABSCBN and GMA attesting that the
request made by the NKI on March 2, 1988 to air its appeal
to locate the family and relatives of Angelito Lugmoso of
Boni Avenue, Mandaluyong was accommodated. A
Certification was likewise issued by Police Station No. 5,
Eastern Police District, Mandaluyong attesting to the fact
that on March 2, 1988, at about 6:00 p.m., Jennifer Misa
requested for assistance to immediately locate the family
and relatives of Angelito Lugmoso and that she followed up
her request until March 9, 1988.
On March 3, 1988, at about 7:00 o’clock in the morning,
Dr. Ona was informed that Lugmoso had been pronounced
brain dead by Dr. Abdias V. Aquino, a neurologist, and by
Dr. Antonio Rafael, a neurosurgeon and attending
physician of Lugmoso, and that a repeat
electroencephalogram (EEG) was in progress to confirm the
diagnosis of brain death. Two hours later, Dr. Ona was
informed that the EEG recording exhibited a flat tracing,
thereby confirming that Lugmoso was brain dead. Upon
learning that Lugmoso was a suitable organ donor and that
some NKI patients awaiting organ donation had blood and
tissue types compatible with Lugmoso, Dr. Ona inquired
from Jennifer Misa whether the relatives of Lugmoso had
been located so that the necessary consent for organ
donation could be obtained. As the extensive search for the
relatives of Lugmoso
673
A Certification dated March 10, 1988 was issued by Dr.
Maximo Reyes, MedicoLegal Officer of the NBI, stating
that he received a telephone call from Dr. Liquete on
March 3, 1988 at 9:15 a.m. regarding the case of Lugmoso,
who was declared brain dead; that despite efforts to locate
the latter’s relatives, no one responded;
674
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[3] Id., at pp. 7379. (Citations omitted)
[4] Id., at p. 95. (Emphasis in the original)
676
677
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[6] E.Y. Industrial Sales, Inc. vs. Shen Dar Electricity and Machinery Co., Ltd.,
G.R. No. 184850, October 20, 2010, 634 SCRA 363.
678
A careful reading of the above shows that petitioner
instructed his subordinates to “make certain” that “all
reasonable efforts” are exerted to locate the patient’s next
of kin, even enumerating ways in which to ensure that
notices of the death of the patient would reach said
relatives. It also clearly stated that permission or
authorization to retrieve and remove the internal organs of
the deceased was being given ONLY IF the provisions of
the applicable law had been complied with. Such
instructions reveal that petitioner acted prudently by
directing his subordinates to exhaust all reasonable means
of locating the relatives of the deceased. He could not have
made his directives any clearer. He even specifically
mentioned that permission is only being granted IF
the Department of Surgery has complied with all the
requirements of the law. Verily, petitioner could not have
been faulted for having full confidence in the ability of the
doctors in the Department of Surgery to comprehend the
instructions, obeying all his directives, and acting only in
accordance with the requirements of the law.
Furthermore, as found by the lower courts from the
records of the case, the doctors and personnel of NKI
disseminated notices of the death of respondent’s son to the
media and sought the assistance of the appropriate police
authorities as early as March 2, 1988, even before
petitioner issued the Memorandum. Prior to performing the
procedure for retrieval of the deceased’s internal organs,
the doctors concerned also
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[7] Exhibits “19” and “33,” Records, p. 1019. (Emphasis supplied)
679
sought the opinion and approval of the MedicoLegal
Officer of the NBI.
Thus, there can be no cavil that petitioner employed
reasonable means to disseminate notifications intended to
reach the relatives of the deceased. The only question that
remains pertains to the sufficiency of time allowed for
notices to reach the relatives of the deceased.
If respondent failed to immediately receive notice of her
son’s death because the notices did not properly state the
name or identity of the deceased, fault cannot be laid at
petitioner’s door. The trial and appellate courts found that
it was the EAMC, who had the opportunity to ascertain the
name of the deceased, who recorded the wrong information
regarding the deceased’s identity to NKI. The NKI could
not have obtained the information about his name from the
patient, because as found by the lower courts, the deceased
was already unconscious by the time he was brought to the
NKI.
Ultimately, it is respondent’s failure to adduce adequate
evidence that doomed this case. As stated in Otero v. Tan,
[8] “[i]n civil cases, it is a basic rule that the party making
allegations has the burden of proving them by a
preponderance of evidence. The parties must rely on the
strength of their own evidence and not upon the weakness
of the defense offered by their opponent.”[9] Here, there is
to proof that, indeed, the period of around 24 hours from
the time notices were disseminated, cannot be considered
as reasonable under the circumstances. They failed to
present any expert witness to prove that given the medical
technology and knowledge at that time in the 1980’s, the
doctors could or should have waited longer before
harvesting the internal organs for transplantation.
Verily, the Court cannot, in conscience, agree with the
lower court. Finding petitioner liable for damages is
improper. It should be emphasized that the internal organs
of the de
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[8] G.R. No. 200134, August 15, 2012, 678 SCRA 583.
[9] Id., at p. 598.
680
CONCURRING OPINION
“What you leave behind is not what is
engraved in stone monuments, but what is
woven in the lives of others.”
Pericles
LEONEN, J.:
On February 28, 2014, the Philippines broke the
Guinness World Record for the most number of people
signing up to be organ donors within an hour on a single
site. A total of 3,548 people trooped to the Polytechnic
University of the Philippines to pledge their organs as part
of the “I’m a Lifeline” campaign of the Philippine Network
for Organ Sharing under the Department of Health.[1]
_______________
[1] PH beat world record for most number of organ donors in one hour,
February 28, 2014, Philippine Daily Inquirer, <http://global
681
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nation.inquirer.net/99654/phbeatworldrecordformostnumberoforgan
donorsinonehour> (visited April 3, 2014).
[2] Rollo, pp. 7196, penned by Justice Marina L. Buzon and concurred
in by Justice Aurora SantiagoLagman and Justice Arcangelita Romilla
Lontok.
[3] Id., at pp. 103111, penned by Hon. Justice Mariano C. Del Castillo,
then the Presiding Judge of the Branch 100 of the Regional Trial Court of
Quezon City.
[4] This hospital is now known as the National Kidney and Transplant
Institute or NKTI.
[5] Rollo, p. 73; CA Decision, p. 3.
[6] Id., at p. 103; RTC Decision, p. 1.
[7] Id.
682
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[8] Id.
[9] Id., at p. 73; CA Decision, p. 3.
[10] Id.
[11] Id.
[12] Id.
[13] Id.
[14] Id.
[15] Id., at p. 74.
[16] Id.
[17] Id.
683
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[18] Id.
[19] Id.
[20] Id.
[21] Id.
[22] Id.
[23] Id.
[24] Id., at p. 75; CA Decision, p. 5.
[25] Id.
[26] Id.
684
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[27] Id.
[28] Id.
[29] Id.
685
Dr. Maximo Reyes, MedicoLegal Officer of the National
Bureau of Investigation, issued a certification dated March
10, 1988, stating that he received a telephone call from Dr.
Liquete on March 3, 1988 at 9:15 a.m. regarding the case.
[31] He certified that despite efforts to locate Angelito
Lugmoso’s relatives, no one responded. Dr. Liquete also
sought from Dr. Reyes a second opinion on organ donation
even in the absence of consent from the family of the
deceased patient, and Dr. Reyes verbally agreed to the
organ retrieval.[32]
On March 3, 1988 at 3:45 p.m., a medical team led by
Dr. Ona removed the heart, kidneys, pancreas, liver, and
spleen of the deceased patient.[33] The medical team then
transplanted a kidney and the pancreas to Lee Tan Koc
and the other kidney to Alexis Ambustan.[34] The
transplant operation was completed around 11:00 p.m. on
the same day.[35]
On March 4, 1988, Dr. Antonio R. Paraiso, Head of the
Cadaver Organ Retrieval Effort (CORE) program of the
National Kidney Institute, made arrangements with La
Funeraria Oro for the embalming of the cadaver for up to
15 days to give the National Kidney Institute more time to
continue searching for the relatives of the deceased patient.
[36]
On March 11, 1988, the National Kidney Institute
issued a press release announcing its first successful
double organ
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[30] Id., at p. 76; CA Decision, p. 6.
[31] Id., at pp. 7677; CA Decision, pp. 67.
[32] Id., at p. 77; CA Decision, p. 7.
[33] Id.
[34] Id.
[35] Id.
[36] Id.
686
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[37] Id., at p. 78; CA Decision, p. 8.
[38] Id.
[39] Id.
[40] Id.
[41] Id., at pp. 7879.
[42] Id., at p. 79; CA Decision, p. 9.
[43] Id., at pp. 103111.
687
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[44] Id., at p. 106; RTC Decision, p. 4.
[45] Id., at pp. 112144.
[46] Id., at pp. 7196.
[47] Id., at p. 92; CA Decision, p. 22.
[48] Id.
[49] Id., at pp. 9395; CA Decision, pp. 2325.
688
Dr. Alano now comes before this court via a petition for
review on certiorari. He argues[50] that there was no legal
basis for the Court of Appeals to hold him liable for
damages since there was no finding that he was the
proximate cause of the injury or damage sustained by
Zenaida. He also argues that he acted in good faith and
pursuant to law when he issued the authorization for the
organ retrieval.
Thus, the issue before this court is whether Dr. Alano
should be held liable for his alleged negligence in
authorizing the removal and retrieval of Arnelito’s internal
organs without Zenaida’s consent.
I agree with the ponencia that Dr. Alano should not be
found liable, but I take this opportunity to further expound
on the issues presented to this court.
As a general rule, only questions of law are to be
considered in a petition for review under Rule 45. There
are, however, recognized exceptions to the rule, one of
which is when “the Court of Appeals fails to notice certain
relevant facts which, if properly considered, will justify a
different conclusion x x x.”[51]
Dr. Alano’s acts were not reckless, negligent or
unreasonable. It was not his acts that caused the alleged
injury to the deceased patient’s relatives. Considering the
circumstances that he had to face, the search he ordered for
the deceased patient’s relatives were all that ordinary
prudence required. His retrieval of the deceased patient’s
organs was done legally and after allowing a reasonable
time to lapse. The conclusions of the trial court and the
appellate court were, therefore, correctly reversed and set
aside.
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[50] Id., at pp. 401459, Memorandum for the petitioner.
[51] Spouses Alcazar v. Evelyn Arante, G.R. No. 177042, December 10,
2012, 687 SCRA 507, 516 [Per J. Peralta, Third Division], citing Vallacar
Transit, Inc. v. Catubig, G.R. No. 175512, May 30, 2011, 649 SCRA 281,
294 [Per J. LeonardoDe Castro, First Division].
689
The elements of a quasidelict are: (1) an act or omission;
(2) the presence of fault or negligence in the performance or
nonperformance of the act; (3) injury; (4) a causal
connection between the negligent act and the injury; and
(5) no preexisting contractual relation. Jurisprudence,
however, specifies four (4) essential elements: “(1) duty; (2)
breach; (3) injury; and (4) proximate causation.”[52]
As a general rule, any act or omission coming under the
purview of Article 2176 gives rise to a cause of action under
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[52] Garcia, Jr. v. Salvador, 547 Phil. 463, 470; 518 SCRA 568, 575
(2007) [Per J. YnaresSantiago, Third Division]; Lucas v. Tuaño, 604 Phil.
98, 121; 586 SCRA 173, 199200 (2009) [Per J. ChicoNazario, Third
Division].
690
Article 2176 is not an allencompassing enumeration of
all actionable wrongs which can give rise to the liability for
damages. Under the Civil Code, acts done in violation of
Articles 19, 20, and 21 will also give rise to damages. The
provisions state as follows:
Article 19. Every person must, in the exercise of his rights and
in the performance of his duties, act with justice, give everyone
his due, and observe honesty and good faith.
Article 20. Every person who, contrary to law, willfully or
negligently causes damage to another, shall indemnify the latter
for the same.
Article 21. Any person who willfully causes loss or injury to
another in a manner that is contrary to morals, good customs, or
public policy shall compensate the latter for the damage.
Baksh v. Court of Appeals[53] elaborates on the distinctions:
x x x. Quasidelict, known in Spanish legal treatises as culpa
aquiliana, is a civil law concept while torts is an AngloAmerican
or common law concept. Torts is much broader than culpa
aquiliana because it includes not only negligence, but
international criminal acts as well such as assault and battery,
false imprisonment and deceit. In the general scheme of the
Philippine legal system envisioned by the Commission responsible
for drafting the New Civil Code, inten
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[53] G.R. No. 97336, February 19, 1993, 219 SCRA 115 [Per J. Davide, Third
Division].
691
Yuchengco v. Manila Chronicle Publishing
Corporation[55] further elaborates on tort based on the
concept of abuse of right:
_______________
[54] Id., at pp. 127128, citing Report of the Code Commission, pp. 161162, and
A.M. TOLENTINO, COMMENTARIES AND JURISPRUDENCE ON THE CIVIL CODE OF THE
692
693
Article 19 is the general rule which governs the conduct
of human relations. By itself, it is not the basis of an
actionable tort. Article 19 describes the degree of care
required so that an actionable tort may arise when it is
alleged together with Article 20 or Article 21.
Article 20 concerns violations of existing law as basis for
an injury. It allows recovery should the act have been
willful or negligent. Willful may refer to the intention to do
the act and the desire to achieve the outcome which is
considered by the plaintiff in tort action as injurious.
Negligence may refer to a situation where the act was
consciously done but without intending the result which
the plaintiff considers as injurious.
Article 21, on the other hand, concerns injuries that may
be caused by acts which are not necessarily proscribed by
law. This article requires that the act be willful, that is,
that there
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[65] Id., at pp. 402403, citing GF Equity, Inc. v. Valenzona, 501 Phil.
153, 164; 462 SCRA 466, 479480 (2005) [Per J. CarpioMorales, Third
Division]; Globe Mackay Cable and Radio Corporation v. Court of Appeals,
257 Phil. 783; 176 SCRA 778 (1989) [Per J. Cortes, Third Division];
Manuel v. People, 512 Phil. 818, 847; 476 SCRA 461, 491492 (2005) [Per
J. Callejo, Sr., Second Division].
694
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[57] Entitled “AN ACT TO LEGALIZE PERMISSIONS TO USE HUMAN ORGANS OR
695
The doctrine of informed consent
The doctrine of informed consent was introduced in this
jurisdiction only very recently in Dr. Li v. Spouses Soliman.
[59] This court ruled that liability may arise in cases where
the physician fails to obtain the consent of the patient
before performing any medical procedure, thus:
The doctrine of informed consent within the context of
physicianpatient relationships goes far back into English
common law. As early as 1767, doctors were charged with
the tort of “battery” (i.e., an unauthorized physical contact
with a patient) if they had not gained the consent of their
patients prior to performing a surgery or procedure. In the
United States, the seminal case was Schoendorff v. Society
of New York Hospital which involved unwanted treatment
performed by a doctor. Justice Benjamin Cardozo’s oft
quoted opinion upheld the basic right of a patient to give
consent to any medical procedure or treatment: “Every
human being of adult years and sound mind has a right to
determine what shall be done with his own body; and a
surgeon who performs an operation without his patient’s
consent, commits an assault, for which he is liable in
damages.” From a purely ethical norm, informed consent
evolved into a general principle of law that a
physician has a duty to disclose what a reasonably
prudent physician in the medical community in the
exercise of reasonable care would disclose to his
patient as to whatever grave risks of injury might be
incurred from a proposed course of treatment, so
that a patient, exercising ordinary care for his own
welfare, and faced with a choice of undergoing the
proposed treatment, or alternative treatment, or
none at all, may intelligently exercise his judgment
by reasonably balancing the probable risks against
the probable benefits.
Subsequently, in Canterbury v. Spence[,] the court
observed that the duty to disclose should not be limited to
medical usage as to
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[59] G.R. No. 165279, June 7, 2011, 651 SCRA 32 [Per J. Villarama, En
Banc, CJ. Corona, JJ. Perez and Abad, concurring; JJ. Brion, Nachura,
LeonardoDe Castro, Bersamin, and Mendoza, concurring in the result;
JJ. Carpio, CarpioMorales, Velasco, Peralta, and Sereno, dissenting].
696
arrogate the decision on revelation to the physician alone.
Thus, respect for the patient’s right of selfdetermination
on particular therapy demands a standard set by law for
physicians rather than one which physicians may or may
not impose upon themselves. x x x.[60]
Those who consent to using their organs upon their
death for the benefit of another can make their consent
known prior to their death by following the requirements of
the law. Should a patient die prior to making his or her
informed consent known, the law provides a list of persons
who may consent on his or her behalf, that is, “substituted”
informed consent.
Since the incident in this case occurred in 1988,
Republic Act No. 349, as amended by Republic Act No.
1056, is the law that applies. Section 2 of the law states
that:
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[60] Id., at pp. 5657, citing Schoendorff v. Society of New York Hospital, 105
N.E. 92, 93 (N.Y. 1914); Black’s Law Dictionary, Fifth Edition, p. 701, citing Ze
Barth v. Swedish Hospital Medical Center, 81 Wash.2d 12, 499 P.2d 1, 8;
Canterbury v. Spence, 464 F.2d 772 C.A.D.C., 1972.
697
Under this law, consent to organ retrieval after the
patient’s death may be given first and foremost by the
patient’s nearest relative or guardian at the time of death.
It is only in the event that these relatives cannot be
contacted despite reasonable efforts that the head of the
hospital or institution having custody of the body may give
consent for organ retrieval on behalf of the patient. Failing
this, liability for damages arises.
Considering that Republic Act No. 349, as amended,
does not provide a remedy in case of violation, an
application of the doctrine of informed consent visàvis
Article 20 of the Civil Code may give rise to an action for
damages. In this case, Dr. Alano must first be shown to
have acted willfully and negligently to the damage and
prejudice of Zenaida.
Petitioner did not willfully
or negligently, in a manner
contrary to law, authoriz
the retrieval of the organs
Dr. Alano did not violate the provisions of the law
willfully or negligently. In accordance with the
requirements of the third paragraph of Section 2 of
Republic Act No. 349, as amended, he caused the discharge
of “reasonable efforts” to locate the relatives, allowed for a
reasonable time to pass, and harvested the organs with
care and prudence.
Negligence has been defined by law as “[t]he failure to
observe, for the protection of the interests of another
person, that degree of care, precaution and vigilance which
the cir
698
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[61] United States v. Barias, 23 Phil. 434, 437 (1912) [Per J. Carson, En Banc],
citing Judge Cooley in his work on Torts, 3rd ed., 1324.
[62] 37 Phil. 809 (1918) [Per J. Street, En Banc].
699
As correctly found by the majority, Zenaida failed to
prove that Dr. Alano did not exercise the reasonable care
and caution of an ordinarily prudent person.
In compliance with the duty reposed on him by the law,
Dr. Alano, as the Executive Director of the National Kidney
Institute, directed Jennifer B. Misa, Transplant
Coordinator, to locate Arnelito’s relatives. Radio
announcements over Radyo ng Bayan and DZMM Radio,
televised notices on Channels 2, 7, 9, and 13, and a police
blotter in the Eastern Police District No. 5, Mandaluyong,
were done on March 2, 1988, with a published
advertisement also appearing on the People’s Journal on
March 20, 1988.[64] Assistance was also sought from the
National Bureau of Investigation. These findings were, in
fact, adopted by the trial court. Dr. Enrique T. Ona also
testified that the search for the deceased patient’s relatives
continued even after the organ retrieval, thus:
Q: After the retrieval of the organs from the patient and the
transplantation of the organs to Mr. Ambustan and Tan [K]oc Lee, did
the hospital stop in its effort to locate the family of the patient, Mr.
Witness?
A: Since this patient is a John Doe and even after we had retrieved the
organs and transplanted it to the 2 recipients, I was also made aware
that no relatives could still be located. Specific instruction were
[sic] given to the transplant coordinator to continue looking
for the relatives.[65] (Emphasis supplied)
The trial court and the appellate court, however, took
exception to the period of time taken by Dr. Alano in
conducting
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[63] Id., at p. 813.
[64] Rollo, p. 106; RTC Decision, p. 4.
[65] Id., at pp. 323324; TSN, October 2, 1995, pp. 3536.
700
Q: Does the time have any factor also with respect to the viability of
these organs, Mr. Witness[?]
A: Yes, sir.
Q: Will you please explain this, Mr. Witness?
A: When we remove the organs say, the kidney from the
cadaver we put that into [a] special solution for preservation
and ideally we would like to transplant that kidney within 24
hours although oftentimes we extend it to 48 hours and even
stretching it to 72 hours, sir.
Court: I just want to clarify this issue.
Q: Is there any particular reason why the retrieval of the organs have
to be done even when the patient is not yet dead, as what we know
heart beating [sic] stops but even at that stage when classified as
brain dead, why the rush to open it up, is there any particular reason
or could it refer perhaps to the successful operation maybe for the
organs to fit well to the rec[i]pient?
A: Yes, Your Honor. The viability of the organ as I mentioned
earlier the kidney is viable for several hours, as I mentioned 24
hours, 48 hours up to 72 hours but for the liver, Your [Honor],
during that time in 1988 the liver can be preserved only for
about 6 to 8 hours and for the heart it should be connected for
4 hours, Your Honor.
Q: So, in this particular case, the kidney, how many hours more or
less?
701
A: At that time it was stretched into 24 hours, Your Honor and the
pa[n]creas maybe 4 hours so that it is the leng[th] of time when the
organs most likely to be viable after that most likely did not function
anymore [sic].
Q: But you do retrieval also to those dead on arrival, is that not?
A: In this particular case, Your Honor, it is possible for example the
dead on arrival is brought to the emergency room, the preparation of
the operating room and the getting of [sic] the consent it will take
time, Your Honor, so in this particular case, Your Honor there is no
more heart beat that cannot be viable anymore[.][66] (Emphasis
supplied)
This testimony is supported by several studies, which
tend to show that the viability of organs in an organ
donation may depend on the length of time between the
declaration of brain death and organ retrieval.
One study shows that widespread physiological changes
occur during brain death. “In addition to acute changes,
which if untreated lead to rapid deterioration and cardiac
arrest (even if ventilation is continued), there are ongoing
generalized inflammatory and hormonal changes
associated with brain death which adversely affect donor
organ function and propensity to rejection.”[67] Another
study[68] shows that the time period between declaration of
brain death and organ retrieval was a “significant
predictive factor”[69] in recipient mortality for
_______________
[66] Id., at pp. 375379; TSN, October 2, 1995, pp. 8791.
[67] D. W. McKeown, R. S. Bonser, and J. A. Kellum, Management of
the heartbeating braindead organ donor, British Journal of Anaesthesia
108 (S1): i96i107 (2012).
[68] S. Ramjug, N. Hussain, and N. Yonan, Prolonged time between
donor brain death and organ retrieval results in an increased risk of
mortality in cardiac transplant recipients, Interactive CardioVascular and
Thoracic Surgery 12, pp. 938942 (2011).
[69] Id., at p. 939.
702
_______________
[70] K. Kunert, S. Weiß, K. Kotsch, and J. Pratschke, Prolonged brain
death duration — does it improve graft quality?, Transplant International
2010 European Society for Organ Transplantation 24, pp. 1213 (2011).
[71] Id., at p. 13.
703
_______________
[72] Rollo, p. 107; RTC Decision, p. 5.
[73] Id.
[74] Id.
[75] Id., at pp. 9394.
[76] Id., at p. 93.
704
_______________
[77] Id., at p. 73.
705
It has already been established that Zenaida’s emotional
suffering was not caused by the acts of Dr. Alano. He also
did not commit any act in violation of Articles 19, 20 or 21
of the Civil Code. This is also not a case wherein the
alleged quasidelict resulted in physical injuries. The lower
courts are also in agreement that Dr. Alano did not cause
the death of Zenaida’s son. Neither is this case analogous to
any of the situations mentioned in the provision. Contrary
to the ruling of the trial court, this situation is also not
covered by Article 309 of the Civil Code, which states:
706
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