DR. FILOTEO A. ALANO, Petitioner, vs. ZENAIDA MAGUD-LOGMAO, Respondent

G.R. No. 175540. April 7, 2014.
*
DR. FILOTEO A. ALANO, petitioner, vs. ZENAIDA MAGUD-
LOGMAO, respondent.
Civil Law; Damages; Organ Transplants; 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.—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.
Remedial Law; Evidence; Burden of Proof; Preponderance of
Evidence; In civil cases, it is a basic rule that the party making
allegations has the burden of proving them by a preponderance of
evidence.—It is respondent’s failure to adduce adequate evidence that
doomed this case. As stated in Otero v. Tan, 678 SCRA 583 (2012), “[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.” Here, there is to
proof that, indeed, the period of around 24 hours from the time
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* THIRD DIVISION.
666
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.
Civil Law; Damages; Organ Transplants; Internal organs of the
deceased were removed only after he had been declared brain dead;
thus, the emotional pain suffered by respondent due to the death of her
son cannot in any way be attributed to petitioner.—Finding petitioner
liable for damages is improper. It should be emphasized that the internal
organs of the deceased were removed only after he had been declared
brain dead; thus, the emotional pain suffered by respondent due to the
death of her son cannot in any way be attributed to petitioner. Neither
can the Court find evidence on record to show that respondent’s
emotional suffering at the sight of the pitiful state in which she found her
son’s lifeless body be categorically attributed to petitioner’s conduct.
LEONEN, J., Concurring Opinion:
Remedial Law; Civil Procedure; Appeals; Petition for Review on
Certiorari; View that as a general rule, only questions of law are to be
considered in a petition for review under Rule 45.—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.”
Civil Law; Quasi-Delicts; View that in order to be actionable, the act
should have been committed with the intention of injuring the plaintiff or
was committed recklessly or negligently or one which, even when done
with the proper care, held such high risk for injury to others that it will be
presumed by law to be actionable.—In cases involving quasi-delict and
torts, the plaintiff complains that the acts of a defendant caused him or
her injury. In order to be actionable, the act should have been committed
with the intention of injuring the plaintiff or was committed recklessly or
negligently or one which, even when done with the proper care, held
such high risk for injury to others that it will be presumed by law to be
actionable.
667
Same; Same; View on the elements of quasi-delicts.—The elements
of a quasi-delict are: (1) an act or omission; (2) the presence of fault or
negligence in the performance or non-performance of the act; (3) injury;
(4) a causal connection between the negligent act and the injury; and (5)
no pre-existing contractual relation. Jurisprudence, however, specifies
four (4) essential elements: “(1) duty; (2) breach; (3) injury; and (4)
proximate causation.”
Same; Same; Human Relations; View that Article 19 of the Civil
Code is the general rule which governs the conduct of human relations.
—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.
Same; Same; Damages; Organ Transplants; Doctrine of Informed
Consent; View that the Supreme Court ruled that liability may arise in
cases where the physician fails to obtain the consent of the patient
before performing any medical procedure.—The doctrine of informed
consent was introduced in this jurisdiction only very recently in Dr. Li v.
Spouses Soliman, 651 SCRA 32 (2011). 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 physician-patient 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
668
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 arrogate the decision on revelation to the
physician alone. Thus, respect for the patient’s right of self-determination
on particular therapy demands a standard set by law for physicians
rather than one which physicians may or may not impose upon
themselves.
Same; Same; Same; Same; View that 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.—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: SEC. 2. The authorization
referred to in section one of this Act must: be in writing; specify the
person or institution granted the authorization; the organ, part or parts to
be detached, the specific use or uses to which the organ, part or parts
are to be employed; and, signed by the grantor and two disinterested
witnesses. If the grantor is a minor or an incompetent person, the
authorization may be executed by his guardian with the approval of the
court; in default thereof, by the legitimate father or mother, in the order,
named. Married women may grant the authority referred to in section
one of this Act, without the consent of the husband. After the death of
the person, authority to use human organs or any portion or portions of
the human body for medical, surgical or scientific purposes may also be
granted by his nearest relative or guardian at the time of his death or in
the absence thereof, by the person or head of the hospital, or institution
having custody of the body of the deceased: Provided, however, That
the said person or head of the hospital
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.
Same; Same; Same; Same; View that 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.—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 vis-à-vis 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.
Same; Same; Negligence; Words and Phrases; View that
negligence has been defined by law as the failure to observe, for the
protection of the interests of another person, that degree of care,
precaution and vigilance which the circumstances justly demand,
whereby such other person suffers injury.—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
circumstances justly demand, whereby such other person suffers injury.”
Same; Same; Organ Donations; View that 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.—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: Article 309. Any person who
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.
Same; Damages; Exemplary Damages; View that since Zenaida
has not proven her claim to moral damages, she is also not entitled to
exemplary damages.—Since Zenaida has not proven her claim to moral
damages, she is also not entitled to exemplary damages. Article 2234 of
the Civil Code provides: Article 2234. While the amount of the exemplary
damages need not be proved, the plaintiff must show that he is entitled
to moral, temperate or compensatory damages before the court may
consider the question of whether or not exemplary damages should be
awarded.
Same; Same; Quasi-Delicts; Attorney’s Fees; View that since the
award of exemplary damages is not justified, there is no reason to award
attorney’s fees, in accordance with Article 2208 of the Civil Code.—
Since the award of exemplary damages is not justified, there is no
reason to award attorney’s fees, in accordance with Article 2208 of the
Civil Code, which allows the award of attorney’s fees only “when
exemplary damages are awarded.”
PETITION for review on certiorari of the decision and resolution of
the Court of Appeals.
The facts are stated in the opinion of the Court.
Pelaez, Gregorio, Gregorio & Lim for petitioner.
Manuel Mendoza for respondent.

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
_______________
[1] Penned by Associate Justice Marina L. Buzon, with Associate Justices Aurora
Santiago-Lagman and Arcangelita Romilla-Lontok, concurring; Rollo, pp. 71-96.
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:
Plaintiff-appellee Zenaida Magud-Logmao is the mother of
deceased Arnelito Logmao. Defendant-appellant 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 on-duty 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 x-ray
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 on-duty; 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
_______________
[2] Id., at pp. 98-101.
672
of the brain injury of Lugmoso manifested symptoms of brain
death. He requested the Laboratory Section to conduct a tissue
typing and tissue cross-matching 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, ABS-CBN 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
yielded no positive result and time being of the essence in the
success of organ transplantation, Dr. Ona requested Dr. Filoteo
A. Alano, Executive Director of NKI, to authorize the removal of
specific organs from the body of Lugmoso for transplantation
purposes. Dr. Ona likewise instructed Dr. Rose Marie Rosete-
Liquete to secure permission for the planned organ retrieval and
transplantation from the Medico-Legal Office of the National
Bureau of Investigation (NBI), on the assumption that the incident
which lead to the brain injury and death of Lugmoso was a
medico legal case.
On March 3, 1988, Dr. Alano issued to Dr. Ona a Memorandum,
which reads as follows:

This is in connection with the use of the human organs or any portion or
portions of the human body of the deceased patient, identified as a
certain Mr. Angelito Lugmoso who was brought to the National Kidney
Institute on March 2, 1988 from the East Avenue Medical Center.
As shown by the medical records, the said patient died on March 3, 1988
at 9:10 in the morning due to craniocerebral injury. Please make certain
that your Department has exerted all reasonable efforts to locate the
relatives or next of kin of the said deceased patient such as appeal
through the radios and television as well as through police and other
government agencies and that the NBI [Medico-Legal] Section has been
notified and is aware of the case.
If all the above has been complied with, in accordance with the
provisions of Republic Act No. 349 as amended and P.D. 856,
permission and/or authority is hereby given to the Department of Surgery
to retrieve and remove the kidneys, pancreas, liver and heart of the said
deceased patient and to transplant the said organs to any compatible
patient who maybe in need of said organs to live and survive.

A Certification dated March 10, 1988 was issued by Dr. Maximo
Reyes, Medico-Legal 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
that Dr. Liquete sought from him a second opinion for organ
retrieval for donation purposes even in the absence of consent
from the family of the deceased; and that he verbally agreed to
organ retrieval.
At 3:45 in the afternoon of March 3, 1988, a medical team,
composed of Dr. Enrique Ona, as principal surgeon, Drs. Manuel
Chua-Chiaco, Jr., Rose Marie Rosete-Liquete, Aurea Ambrosio,
Ludivino de Guzman, Mary Litonjua, Jaime Velasquez, Ricardo
Fernando, and Myrna Mendoza, removed the heart, kidneys,
pancreas, liver and spleen of Lugmoso. The medical team then
transplanted a kidney and the pancreas of Lugmoso to Lee Tan
Hoc and the other kidney of Lugmoso to Alexis Ambustan. The
transplant operation was completed at around 11:00 o’clock in the
evening of March 3, 1988.
On March 4, 1988, Dr. Antonio R. Paraiso, Head of the Cadaver
Organ Retrieval Effort (CORE) program of NKI, made
arrangements with La Funeraria Oro for the embalmment of the
cadaver of Lugmoso good for a period of fifteen (15) days to
afford NKI more time to continue searching for the relatives of the
latter. On the same day, Roberto Ortega, Funeral Consultant of
La Funeraria Oro, sent a request for autopsy to the NBI. The
Autopsy Report and Certification of Post-Mortem Examination
issued by the NBI stated that the cause of death of Lugmoso was
intracranial hemorrhage secondary to skull fracture.
On March 11, 1988, the NKI issued a press release announcing
its successful double organ transplantation. Aida Doromal, a
cousin of plaintiff, heard the news aired on television that the
donor was an eighteen (18) year old boy whose remains were at
La Funeraria Oro in Quezon City. As the name of the donor
sounded like Arnelito Logmao, Aida informed plaintiff of the news
report.
It appears that on March 3, 1988, Arlen Logmao, a brother of
Arnelito, who was then a resident of 17-C San Pedro Street,
Mandaluyong, reported to Police Station No. 5, Eastern Police
District, Mandaluyong that the latter did not return home after
seeing a movie in Cubao, Quezon City, as evidenced by a
Certification issued by said Station; and that the relatives of
Arnelito were likewise informed that the latter was missing. Upon
receiving the news from Aida, plaintiff and her other children went
to La Funeraria Oro, where they saw Arnelito inside a cheap
casket.
675
On April 29, 1988, plaintiff filed with the court a quo a complaint
for damages against Dr. Emmanuel Lenon, Taurean Protectors
Agency, represented by its Proprietor, Celso Santiago, National
Kidney Institute, represented by its Director, Dr. Filoteo A. Alano,
Jennifer Misa, Dr. Maximo Reyes, Dr. Enrique T. Ona, Dr. Manuel
Chua-Chiaco, Jr., Dr. Rose Marie O. Rosete-Liquete, Dr. Aurea Z.
Ambrosio, Dr. Ludivino de Guzman, Dr. Mary Litonjua, Dr. Jaime
Velasquez, Dr. Ricardo Fernando, Dr. Myrna Mendoza, Lee Tan
Koc, Alexis Ambustan, Dr. Antonio R. Paraiso, La Funeraria Oro,
Inc., represented by its President, German E. Ortega, Roberto
Ortega alias Bobby Ortega, Dr. Mariano B. Cueva, Jr., John Doe,
Peter Doe, and Alex Doe in connection with the death of her son
Arnelito. Plaintiff alleged that defendants conspired to remove the
organs of Arnelito while the latter was still alive and that they
concealed his true identity.
On January 17, 2000, the court a quo rendered judgment finding
only Dr. Filoteo Alano liable for damages to plaintiff and
dismissing the complaint against the other defendants for lack of
legal basis.[3]
After finding petitioner liable for a quasi-delict, the Regional Trial
Court of Quezon City (RTC) ordered petitioner to pay respondent
P188,740.90 as actual damages; P500,000.00 as moral
damages; P500,000.00 as exemplary damages; P300,000.00 as
attorney’s fees; and costs of suit. Petitioner appealed to the CA.
On March 31, 2006, the CA issued its Decision, the dispositive
portion of which reads as follows:

WHEREFORE, the Decision appealed from is AFFIRMED, with
MODIFICATION by DELETING the award of P188,740.90 as actual
damages and REDUCING the award of moral damages to P250,000.00,
the award of exemplary damages to P200,000.00 and the award of
attorney’s fees to P100,000.00.
SO ORDERED.[4]
_______________
[3] Id., at pp. 73-79. (Citations omitted)
[4] Id., at p. 95. (Emphasis in the original)

676
Petitioner then elevated the matter to this Court via a petition for
review on certiorari, where the following issues are presented for
resolution:
A. WHETHER THE COURT OF APPEALS DISREGARDED
EXISTING JURISPRUDENCE PRONOUNCED BY THIS
HONORABLE SUPREME COURT IN HOLDING PETITIONER
DR. FILOTEO ALANO LIABLE FOR MORAL AND EXEMPLARY
DAMAGES AND ATTORNEY’S FEES DESPITE THE FACT
THAT THE ACT OF THE PETITIONER IS NOT THE
PROXIMATE CAUSE NOR IS THERE ANY FINDING THAT THE
ACT OF THE PETITIONER WAS THE PROXIMATE CAUSE OF
THE INJURY OR DAMAGE ALLEGEDLY SUSTAINED BY
RESPONDENT ZENAIDA MAGUD-LOGMAO.
B. WHETHER THE COURT OF APPEALS GRAVELY ERRED
IN REFUSING AND/OR FAILING TO DECLARE THAT
PETITIONER DR. ALANO ACTED IN GOOD FAITH AND
PURSUANT TO LAW WHEN HE ISSUED THE
AUTHORIZATION TO REMOVE AND RETRIEVE THE ORGANS
OF ANGELITO LUGMOSO (LATER IDENTIFIED TO BE IN FACT
ARNELITO LOGMAO) CONSIDERING THAT NO NEGLIGENCE
CAN BE ATTRIBUTED OR IMPUTED ON HIM IN HIS
PERFORMANCE OF AN ACT MANDATED BY LAW.
C. WHETHER THE COURT OF APPEALS GRAVELY ERRED
IN AWARDING RESPONDENT ZENAIDA MAGUD-LOGMAO
MORAL AND EXEMPLARY DAMAGES AND ATTORNEY’S
FEES THAT ARE NOT IN ACCORDANCE WITH AND ARE
CONTRARY TO ESTABLISHED JURISPRUDENCE.[5]
The first two issues boil down to the question of whether
respondent’s sufferings were brought about by petitioner’s alleged
negligence in granting authorization for the removal or retrieval of
the internal organs of respondent’s son who had been declared
brain dead.
Petitioner maintains that when he gave authorization for the
removal of some of the internal organs to be transplanted to other
patients, he did so in accordance with the letter of the
_______________
[5] Id., at pp. 408-409.
677
law, Republic Act (R.A.) No. 349, as amended by Presidential
Decree (P.D.) 856, i.e., giving his subordinates instructions to
exert all reasonable efforts to locate the relatives or next of kin of
respondent’s son. In fact, announcements were made through
radio and television, the assistance of police authorities was
sought, and the NBI Medico-Legal Section was notified. Thus,
petitioner insists that he should not be held responsible for any
damage allegedly suffered by respondent due to the death of her
son and the removal of her son’s internal organs for transplant
purposes.
The appellate court affirmed the trial court’s finding that there was
negligence on petitioner’s part when he failed to ensure that
reasonable time had elapsed to locate the relatives of the
deceased before giving the authorization to remove said
deceased’s internal organs for transplant purposes. However, a
close examination of the records of this case would reveal that
this case falls under one of the exceptions to the general rule that
factual findings of the trial court, when affirmed by the appellate
court, are binding on this Court. There are some important
circumstances that the lower courts failed to consider in
ascertaining whether it was the actions of petitioner that brought
about the sufferings of respondent.[6]
The Memorandum dated March 3, 1988 issued by petitioner,
stated thus:

relatives or next-of-kin of the said deceased patient, such as appeal
through the radios and television, as well as through police and other
government agencies and that the NBI [Medico-Legal] Section has been
_______________
[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
permission and/or authority is hereby given to the Department of Surgery
to retrieve and remove the kidneys, pancreas, liver and heart of the said
deceased patient and to transplant the said organs to any compatible
patient who maybe in need of said organs to live and survive.[7]

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
_______________
[7] Exhibits “19” and “33,” Records, p. 1019. (Emphasis supplied)

679
sought the opinion and approval of the Medico-Legal 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-
_______________
[8] G.R. No. 200134, August 15, 2012, 678 SCRA 583.
[9] Id., at p. 598.
680
ceased were removed only after he had been declared brain
dead; thus, the emotional pain suffered by respondent due to the
death of her son cannot in any way be attributed to petitioner.
Neither can the Court find evidence on record to show that
respondent’s emotional suffering at the sight of the pitiful state in
which she found her son’s lifeless body be categorically attributed
to petitioner’s conduct.
WHEREFORE, the petition is GRANTED. The Decision of the
Court of Appeals, dated March 31, 2006, is REVERSED and SET
ASIDE. The complaint against petitioner is hereby DISMISSED.
SO ORDERED.
Velasco, Jr., (Chairperson), Abad and Mendoza, JJ., concur.
Leonen, J., See Concurring Opinion.

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
This court is now faced with the opportunity to confront the issues
concerning organ donation and transplantation for the first time
since the procedure was introduced in this country in 1983.
Before us is a petition for review under Rule 45 of the Rules of
Court, assailing the decision[2] of the Court of Appeals dated
March 31, 2006 and its resolution dated November 22, 2006 in
CA-G.R. CV No. 67399 entitled Zenaida Magud-Logmao v. Dr.
Emmanuel Lenon, et al. The appellate court affirmed the
decision[3] dated January 17, 2000 of the Regional Trial Court of
Quezon City, Branch 100, which found Dr. Filoteo A. Alano, then
the Executive Director of the National Kidney Institute, [4] liable for
damages to Zenaida Logmao.
The facts, as found by the lower courts, are as follows:
On March 1, 1988, at 9:50 p.m., Arnelito Logmao, 18 years old,
was brought to the East Avenue Medical Center in Quezon City
by two sidewalk vendors who allegedly saw him fall from the
overpass near Farmer’s Market, Cubao.[5] The security guards of
the hospital noted in their blotter that when he was admitted to the
hospital, he was drunk.[6] He gave his name as Arnelito Logmao
and his address as Boni Avenue, Mandaluyong.[7]
In the emergency room, Arnelito Logmao was conscious and was
interviewed by Dr. Paterno Cabrera, the duty resi-
_______________
nation.inquirer.net/99654/ph-beat-world-record-for-most-number-oforgan-donors-
in-one-hour> (visited April 3, 2014).
[2] Rollo, pp. 71-96, penned by Justice Marina L. Buzon and concurred in by
Justice Aurora Santiago-Lagman and Justice Arcangelita Romilla-Lontok.
[3] Id., at pp. 103-111, 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
dent physician.[8] The patient’s data sheet, prepared by Dr.
Cabrera, identified the patient as Angelito Lugmoso (and not
Arnelito Logmao) of Boni Avenue, Mandaluyong. [9] He was
subjected to an x-ray examination, but the examination did not
show him suffering from any skull fractures or head injuries.[10]
At around 4:00 a.m. on March 2, 1988, the patient developed
generalized seizures, and his condition progressively
deteriorated.[11] Admission to the Intensive Care Unit (ICU) and
mechanical ventilatory support became necessary, but there was
no vacancy at the East Avenue Medical Center ICU.[12] A
resident physician at National Kidney Institute, Dr. Emmanuel
Lenon, who was then conducting rounds at East Avenue Medical
Center, suggested that the patient be transferred to the National
Kidney Institute.[13] After arrangements were made, the patient
was transferred to the National Kidney Institute at 10:10 a.m. on
the same day.[14]
When the patient arrived at the National Kidney Institute, his
name was recorded as Angelito Lugmoso.[15] As the patient was
admitted without any relatives by his side, Jennifer B. Misa,
Transplant Coordinator, was asked to locate the patient’s family
by enlisting police and media assistance.[16] Dr. Enrique T. Ona,
Chairman of the Department of Surgery, observed that the
patient’s brain injury was so severe that it manifested symptoms
of brain death.[17] Upon his request, the Laboratory Section
conducted a tissue typing and tissue cross-
_______________
[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
matching examination on the patient.[18] The request was done
on the basis that if the deceased patient is found to be a suitable
organ donor and has his family’s consent, the organs could be
harvested and transplanted promptly to any of the compatible
beneficiaries.[19]
Jennifer Misa verified the identity of the patient with the East
Avenue Medical Center on the same day or March 2, 1988. [20]
Upon her request, the hospital furnished her a copy of the
patient’s data sheet which bore the name Angelito Lugmoso with
Boni Avenue, Mandaluyong, as his address.[21] She then
contacted several radio and television stations and requested for
airtime in her search for the family of Angelito Lugmoso.[22] Her
request was granted by Channel 4, ABS-CBN, and GMA. [23]
Police Station No. 5, Eastern Police District, Mandaluyong, issued
a certification attesting 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.[24]
On March 3, 1988 at about 7:00 a.m., Dr. Ona was informed that
the patient was pronounced brain dead by Dr. Abdias V. Aquino,
a neurologist, and Dr. Antonio Rafael, the attending physician of
the patient, and that another electroencephalogram (EEG) was in
progress to confirm the diagnosis.[25] At about 9:00 a.m., Dr. Ona
was informed that the EEG recording showed a flat tracing,
confirming that the patient was brain dead.[26]
_______________
[18] Id.
[19] Id.
[20] Id.
[21] Id.
[22] Id.
[23] Id.
[25] Id.
[26] Id.

684
Upon learning that the patient was a suitable organ donor and
that there were some National Kidney Institute patients who were
compatible donees, Dr. Ona inquired from Jennifer Misa whether
the patient’s relatives have been located so that the necessary
consent for organ donation could be obtained.[27]
Since no relatives of Angelito Lugmoso could be found despite
the ongoing search, Dr. Ona requested Dr. Filoteo A. Alano,
Executive Director of the National Kidney Institute, to authorize
the removal of specific organs from the body for transplantation
purposes.[28] Dr. Ona likewise requested Dr. Rose Marie Rosete-
Liquete to secure permission from the National Bureau of
Investigation’s Medico-Legal Office for organ retrieval and
transplantation, on the assumption that the incident which led to
the death of the patient was a medico-legal case.[29]
On March 3, 1988, Dr. Alano issued to Dr. Ona a memorandum
which states:

This is in connection with the use of the human organs or any portion or
portions of the human body of the deceased patient, identified as a
certain Mr. Angelito Lugmoso who was brought to the National Kidney
Institute on March 2, 1988 from the East Avenue Medical Center.
relatives or next of kin of the said deceased patient such as appeal
through the radios and television as well as through police and other
government agencies and that the NBI Medicolegal Section has been
permission and/or authority is hereby given to the
_______________
[27] Id.
[28] Id.
[29] Id.
685
Department of Surgery to retrieve and remove the kidneys, pancreas,
liver and heart of the said deceased patient and to transplant the said
organs to any compatible patient who maybe in need of said organs to
live and survive.[30] (Emphasis supplied)

Dr. Maximo Reyes, Medico-Legal 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
_______________
[31] Id., at pp. 76-77; CA Decision, pp. 6-7.
[33] Id.
[34] Id.
[35] Id.
[36] Id.

686
transplantation.[37] Aida Doromal, a relative of Arnelito’s mother,
Zenaida Logmao, saw the news on television that the donor was
an 18-year-old boy whose remains were laid at La Funeraria Oro
in Quezon City.[38] Since the name of the donor sounded like
Arnelito Logmao, Aida informed Zenaida.[39] Upon receiving the
news from Aida, Zenaida and her other children went to La
Funeraria Oro where they were able to retrieve Arnelito’s body.
[40]
On April 29, 1988, Zenaida filed with the Regional Trial Court a
complaint for damages against Dr. Lenon, Taurean Protectors
Agency, National Kidney Institute, Jennifer Misa, Dr. Alano, Dr.
Reyes, Dr. Ona, Dr. Liquete, the entire medical team that
conducted the transplant, Lee Tan Koc, Alexis Ambustan, Dr.
Paraiso, La Funeraria Oro, Dr. Mariano B. Cueva, Jr., John Doe,
Peter Doe, and Alex Doe in connection with the death of her son,
Arnelito.[41] She alleged that all of them conspired to remove the
organs of Arnelito when he was still alive and that they concealed
his true identity.[42]
On January 17, 2000, the Regional Trial Court rendered
judgment[43] dismissing the complaint against all defendants but
finding Dr. Alano liable for damages. The trial court found Dr.
Alano negligent under Article 2176 of the Civil Code for
authorizing the retrieval of the deceased patient’s organs without
first exerting reasonable efforts to locate his relatives, in direct
violation of the law. According to the trial court:
x x x. In the natural course of things, a search or inquiry of anything
requires at least two days of probing and seeking to be actually
considered as having made said earnest efforts.
_______________
[38] Id.
[39] Id.
[40] Id.
[41] Id., at pp. 78-79.
[43] Id., at pp. 103-111.

687
But a one-day campaign, especially with regard to a subject matter as
important as a person’s disposal into the afterlife certainly warrants a
longer time for investigation. Indeed, what is “reasonable” is a relative
term, dependent on the attendant circumstances of the case (Philippine
Law Dictionary, citing Katague vs. Lagana, CV 70164, March 7, 1986).
Here, what was involved was the detachment of the vital organs of
plaintiff’s 18-year[-]old son from his body without her knowledge and
consent, and which act was upon the authority issued by defendant Dr.
Alano as head of the hospital. The matter at hand was of a very sensitive
nature that an inquiry of less than one day cannot be deemed as
sufficient and reasonable to exculpate him from liability. x x x.[44]
(Emphasis supplied)
Dr. Alano appealed[45] the ruling with the Court of Appeals.
On March 31, 2006, the Court of Appeals rendered its decision [46]
affirming the ruling of the Regional Trial Court with modifications.
The appellate court deleted the award for actual damages
representing the expenses for autopsy fees, and wake and
funeral services, since Arnelito’s family would have still incurred
those expenses even if no organ retrieval was done on the body.
[47] It also deleted the award of compensatory damages of
P50,000.00 per organ retrieved since it was not shown that Dr.
Alano was the recipient of the organ transplants or that he
received any consideration from the transplant patients. [48]
Finally, it affirmed the award of damages but reduced moral
damages from P500,000.00 to P250,000.00, exemplary damages
from P500,000.00 to P200,000.00, and attorney’s fees from
P300,000.00 to P100,000.00.[49]
_______________
[44] Id., at p. 106; RTC Decision, p. 4.
[45] Id., at pp. 112-144.
[46] Id., at pp. 71-96.
[48] Id.
[49] Id., at pp. 93-95; CA Decision, pp. 23-25.

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.
_______________
[50] Id., at pp. 401-459, 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. Leonardo-
De Castro, First Division].
689
The elements of a quasi-delict
In cases involving quasi-delict and torts, the plaintiff complains
that the acts of a defendant caused him or her injury. In order to
be actionable, the act should have been committed with the
intention of injuring the plaintiff or was committed recklessly or
negligently or one which, even when done with the proper care,
held such high risk for injury to others that it will be presumed by
law to be actionable.
The lower courts are all in agreement that Dr. Alano’s
participation in the organ retrieval constituted a quasi-delict under
Article 2176 of the Civil Code for which he should be liable for
damages.
This conclusion is erroneous.
Article 2176 may not be the proper legal basis for the cause of
action. This article defines a quasi-delict as:
Article 2176. Whoever by act or omission causes damage to another,
there being fault or negligence, is obliged to pay for the damage done.
Such fault or negligence, if there is no pre-existing contractual relation
between the parties, is called a quasi-delict and is governed by the
provisions of this Chapter.

The elements of a quasi-delict are: (1) an act or omission; (2) the
presence of fault or negligence in the performance or non-
performance of the act; (3) injury; (4) a causal connection
between the negligent act and the injury; and (5) no pre-existing
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
_______________
[52] Garcia, Jr. v. Salvador, 547 Phil. 463, 470; 518 SCRA 568, 575 (2007) [Per
J. Ynares-Santiago, Third Division]; Lucas v. Tuaño, 604 Phil. 98, 121; 586
SCRA 173, 199-200 (2009) [Per J. Chico-Nazario, Third Division].
690
quasi-delict. This, in turn, gives the basis for a claim of damages.
Verily, Article 1157 of the Civil Code provides as follows:
Article 1157. Obligations arise from:
(1) Law;
(2) Contracts;
(3) Quasi-contracts;
(4) Acts or omissions punished by law; and
(5) Quasi-delicts. (Emphasis supplied)

Article 2176 is not an all-encompassing 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. Quasi-delict, known in Spanish legal treatises as culpa
aquiliana, is a civil law concept while torts is an Anglo-American 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-
_______________
[53] G.R. No. 97336, February 19, 1993, 219 SCRA 115 [Per J. Davide, Third Division].

691
tional and malicious acts, with certain exceptions, are to be governed by
the Revised Penal Code while negligent acts or omissions are to be
covered by Article 2176 of the Civil Code. In between these opposite
spectrums are injurious acts which, in the absence of Article 21, would
have been beyond redress. Thus, Article 21 fills that vacuum. It is even
postulated that together with Articles 19 and 20 of the Civil Code, Article
21 has greatly broadened the scope of the law on civil wrongs; it has
become much more supple and adaptable than the Anglo-American law
on torts.[54] (Emphasis supplied)

Yuchengco v. Manila Chronicle Publishing Corporation[55]
further elaborates on tort based on the concept of abuse of right:

The principle of abuse of rights as enshrined in Article 19 of the Civil
Code provides:
Art. 19. Every person must, in the exercise of his rights and in the
This provision of law sets standards which must be observed in the
exercise of one’s rights as well as in the performance of its duties, to wit:
to act with justice; give everyone his due; and observe honesty and good
faith.
In Globe Mackay Cable and Radio Corporation v. Court of Appeals, it
was elucidated that while Article 19 “lays down a rule of conduct for the
government of human relations and for the maintenance of social order,
it does not provide a remedy for its violation. Generally, an action for
damages under either Article 20 or Article 21 would be proper.” The
Court said:
_______________
[54] Id., at pp. 127-128, citing Report of the Code Commission, pp. 161-162, and A.M.
Tolentino, Commentaries and Jurisprudence on the Civil Code of the Philippines 72 (Vol. 1,
1985).
[55] G.R. No. 184315, November 28, 2011, 661 SCRA 392 [Per J. Peralta, Special Third
Division].
692
One of the more notable innovations of the New Civil Code is the
codification of “some basic principles that are to be observed for the
rightful relationship between human beings and for the stability of the
social order.” [REPORT ON THE CODE COMMISSION ON THE
PROPOSED CIVIL CODE OF THE PHILIPPINES, p. 39]. The framers of
the Code, seeking to remedy the defect of the old Code which merely
stated the effects of the law, but failed to draw out its spirit, incorporated
certain fundamental precepts which were “designed to indicate certain
norms that spring from the fountain of good conscience” and which were
also meant to serve as “guides for human conduct [that] should run as
golden threads through society, to the end that law may approach its
supreme ideal, which is the sway and dominance of justice.” (Id.)
Foremost among these principles is that pronounced in Article 19 which
provides:
Art. 19. Every person must, in the exercise of his rights and in the
This article, known to contain what is commonly referred to as the
principle of abuse of rights, sets certain standards which must be
observed not only in the exercise of one’s rights, but also in the
performance of one’s duties. These standards are the following: to act
with justice; to give everyone his due; and to observe honesty and good
faith. The law, therefore, recognizes a primordial limitation on all rights;
that in their exercise, the norms of human conduct set forth in Article 19
must be observed. A right, though by itself legal because recognized or
granted by law as such, may nevertheless become the source of some
illegality. When a right is exercised in a manner which does not conform
with the norms enshrined in Article 19 and results in damage to another,
a legal wrong is thereby committed for which the wrongdoer must be
held responsible. But while Article 19 lays down a rule of conduct for the
government of
693
human relations and for the maintenance of social order, it does not
provide a remedy for its violation. Generally, an action for damages
under either Article 20 or Article 21 would be proper.
Corollarily, Article 20 provides that “every person who, contrary to law,
willfully or negligently causes damage to another shall indemnify the
latter for the same.” It speaks of the general sanctions of all other
provisions of law which do not especially provide for its own sanction.
When a right is exercised in a manner which does not conform to the
standards set forth in the said provision and results in damage to
another, a legal wrong is thereby committed for which the wrongdoer
must be responsible. Thus, if the provision does not provide a remedy
for its violation, an action for damages under either Article 20 or Article
21 of the Civil Code would be proper.[56] (Emphasis supplied)

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
_______________
[65] Id., at pp. 402-403, citing GF Equity, Inc. v. Valenzona, 501 Phil. 153, 164;
462 SCRA 466, 479-480 (2005) [Per J. Carpio-Morales, 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, 491-492 (2005) [Per J. Callejo, Sr., Second Division].
694
was an intention to do the act and a desire to achieve the
outcome. In cases under Article 21, the legal issues revolve
around whether such outcome should be considered a legal injury
on the part of the plaintiff or whether the commission of the act
was done in violation of the standards of care required in Article
19.
Article 2176 covers situations where an injury happens through an
act or omission of the defendant. When it involves a positive act,
the intention to commit the outcome is irrelevant. The act itself
must not be a breach of an existing law or a pre-existing
contractual obligation. What will be considered is whether there is
“fault or negligence” attending the commission of the act which
necessarily leads to the outcome considered as injurious by the
plaintiff. The required degree of diligence will then be assessed in
relation to the circumstances of each and every case.
Article 2176 should not have been the basis for the cause of
action in this case. Rather, it should have been Article 20, which
is applicable when there is a violation of law.
The law that is applicable is the third paragraph of Section 2 of
Republic Act No. 349,[57] as amended by Republic Act No. 1056,
[58] which provides for a way to determine substituted informed
consent for deceased patients for purposes of organ donation.
_______________
[57] Entitled “An Act to Legalize Permissions to Use Human Organs or Any
Portion or Portions of the Human Body for Medical, Surgical, or Scientific
Purposes, Under Certain Conditions,” approved on May 17, 1949. This law has
since been superseded by Republic Act No. 7170 or “The Organ Donation Act of
1991,” approved on January 7, 1992. Section 9 of Republic Act No. 7170 now
specifically provides that the search for the donor’s relatives must be done within
48 hours.
[58] Entitled “An Act to Amend Republic Act Numbered Three Hundred and Forty-
Nine, Entitled ‘An Act to Legalize Permissions to Use Human Organs or Any
Portion or Portions of the Human Body for Medical, Surgical, or Scientific
Purposes, Under Certain Conditions,’” approved on June 12, 1954.
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 physician-
patient 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
_______________
[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, Leonardo-De
Castro, Bersamin, and Mendoza, concurring in the result; JJ. Carpio, Carpio-
Morales, Velasco, Peralta, and Sereno, dissenting].
696
arrogate the decision on revelation to the physician alone. Thus,
respect for the patient’s right of self-determination 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:

SEC. 2. The authorization referred to in section one of this Act must:
be in writing; specify the person or institution granted the authorization;
the organ, part or parts to be detached, the specific use or uses to which
the organ, part or parts are to be employed; and, signed by the grantor
and two disinterested witnesses.
If the grantor is a minor or an incompetent person, the authorization may
be executed by his guardian with the approval of the court; in default
thereof, by the legitimate father or mother, in the order, named. Married
women may grant the authority referred to in section one of this Act,
without the consent of the husband.
After the death of the person, authority to use human organs or any
portion or portions of the human body for medical, surgical or scientific
purposes may also be granted by his nearest relative or guardian at the
time of his death or in the absence thereof, by the person or head of the
hospital, or institution having custody of the body of the deceased:
Provided, however, That the said person or head
_______________
[60] Id., at pp. 56-57, 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
of the hospital 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. (Emphasis supplied)

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 vis-à-vis 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
cumstances justly demand, whereby such other person suffers
injury.”[61]
In Picart v. Smith,[62] the test for negligence is as follows:

The test by which to determine the existence of negligence in a
particular case may be stated as follows: Did the defendant in doing the
alleged negligent act use that reasonable care and caution which an
ordinarily prudent person would have used in the same situation? If not,
then he is guilty of negligence. The law here in effect adopts the
standard supposed to be supplied by the imaginary conduct of the
discreet paterfamilias of the Roman law. The existence of negligence in
a given case is not determined by reference to the personal judgment of
the actor in the situation before him. The law considers what would be
reckless, blameworthy, or negligent in the man of ordinary intelligence
and prudence and determines liability by that.
The question as to what would constitute the conduct of a prudent man
in a given situation must of course be always determined in the light of
human experience and in view of the facts involved in the particular
case. Abstract speculation cannot here be of much value but this much
can be profitably said: Reasonable men govern their conduct by the
circumstances which are before them or known to them. They are not,
and are not supposed to be, omniscient of the future. Hence they can be
expected to take care only when there is something before them to
suggest or warn of danger. Could a prudent man, in the case under
consideration, foresee harm as a result of the course actually pursued?
If so, it was the duty of the actor to take precautions to guard against that
harm. Reasonable foresight of harm, followed by the ignoring of the
suggestion born of this prevision, is always necessary before negligence
can be held to exist. Stated in these terms, the proper criterion for
determining the existence of negligence in a given case is this: Conduct
is said to be negligent when a prudent man in the position of the
tortfeasor would have foreseen that an effect harmful to another was
sufficiently
_______________
[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
probable to warrant his foregoing the conduct or guarding against its
consequences.[63] (Emphasis supplied)

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
_______________
[63] Id., at p. 813.
[64] Rollo, p. 106; RTC Decision, p. 4.
[65] Id., at pp. 323-324; TSN, October 2, 1995, pp. 35-36.
700
the search for the deceased patient’s relatives before he
authorized the organ retrieval.
What the lower courts failed to consider was that this was an
unusual situation wherein time was of the essence. Organ
retrieval must always take into account the viability of the organs.
As explained by Dr. Ona in his testimony before the trial court:

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. 375-379; TSN, October 2, 1995, pp. 87-91.
[67] D. W. McKeown, R. S. Bonser, and J. A. Kellum, Management of the
heartbeating brain-dead organ donor, British Journal of Anaesthesia 108 (S1):
i96-i107 (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.
938-942 (2011).
[69] Id., at p. 939.
702
cardiac transplants. There is also a study [70] that shows that
“[t]here are clear data that both [brain death] and prolonged [brain
death duration] result in [kidney] graft damage, and successful
organ retrieval after [brain death] definitely relies on intensive
donor management.”[71]
Upon a showing by the Transplant Coordinator that the deceased
patient’s relatives could not be found despite all her efforts in
locating them, Dr. Alano exercised his professional judgment and
ordered the retrieval bearing in mind the short length of time the
organs could be viable after the declaration of brain death. He
exercised all the reasonable care and caution that an ordinarily
prudent man would have exercised in the same situation.
Dr. Alano, therefore, should not have been found to be negligent.
He did not violate Article 20 of the Civil Code because he
complied with all his duties in Republic Act No. 349, as amended.

There is no causal connection
between the alleged negligent
act and the damage suffered by
respondent
The trial court, by using the codal definition of a quasi-delict,
identified the act or omission as that of authorizing the retrieval of
the deceased patient’s organs without seeking permission from
his relatives; the presence of negligence as the failure to exert
reasonable efforts in searching for the deceased patient’s
relatives; and the damage pertaining to Zenaida’s discovery of her
son’s lifeless body “mangled, robbed
_______________
[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. 12-13 (2011).
[71] Id., at p. 13.
703
of its vital organs and x x x sewn up like x x x a rag doll.”[72] The
court also found no pre-existing contractual relation.
The trial court is mistaken. Clearly, there is no causal connection
between the alleged negligent act of Dr. Alano and the damage
suffered by Zenaida.
First, Zenaida alleged before the trial court that the damage
she suffered was the loss of her son’s life. The trial court,
however, conceded that “the extent of Logmao’s injuries were
such that the possibility of survival would have been highly
improbable, if not impossible x x x.”[73] It then concluded that
there was still damage suffered by Zenaida, in that her son’s
lifeless body was “mangled, robbed of its vital organs and x x x
sewn up like some rag doll, without her knowledge, much more
her consent.”[74] The Court of Appeals agreed, stating that “the
pain and anguish of a mother in seeing the lifeless body of her
son like a slaughtered pig in the funeral parlor x x x is more than
one can take.”[75]
The “pain and anguish”[76] of Zenaida indeed may have
resulted from the loss of her son. However, Dr. Alano or any of his
subordinates did not cause the loss of her son’s life. Even if Dr.
Alano did not order the organ retrieval, Zenaida would still find the
body of her son lifeless.
It was, therefore, erroneous to impute the emotional suffering
of Zenaida as being caused by Dr. Alano’s failure to exert
reasonable efforts to locate her before ordering the organ
retrieval.
Second, the failure to locate Zenaida to secure her permission
for the organ retrieval was not caused by Dr. Alano.
The records show that the difficulty in locating Zenaida
stemmed from the erroneous information found on the de-
_______________
[72] Rollo, p. 107; RTC Decision, p. 5.
[73] Id.
[74] Id.
[75] Id., at pp. 93-94.
[76] Id., at p. 93.
704
ceased’s patient data sheet, which indicated his name as Angelito
Lugmoso, not Arnelito Logmao. It was the staff of East Avenue
Medical Center, not Dr. Alano and the staff of the National Kidney
Institute, which provided the erroneous information on the patient
data sheet.
It can be conceded that there was a duty on the part of the
National Kidney Institute to verify the information on the patient
data sheet with the patient himself. However, when Arnelito was
transferred from East Avenue Medical Center to the National
Kidney Institute, he was already “intubated and ambu-bagging
support was provided x x x.”[77] This means that he would not
have been coherent enough or even conscious enough to be able
to answer any query by the medical staff. The staff of the National
Kidney Institute would have had no choice but to rely on the
information provided to them by East Avenue Medical Center
considering the urgency of Arnelito’s situation.
The erroneous information on the patient data sheet was
eventually the cause of the failure of the Transplant Coordinator
to locate Zenaida. The radio and television announcements,
together with the newspaper advertisements, were rendered futile
by the fact that they were simply looking for the wrong person.
Even if the Transplant Coordinator spent more than 24 hours
looking for the deceased patient’s relatives, it was doubtful
whether they could have been found, considering that they were
looking for the relatives of Angelito Lugmoso, not Arnelito
Logmao.

Respondent should not
be awarded damages
Moral damages were awarded by the lower courts on the basis
that it was Dr. Alano’s alleged negligence which caused the
emotional suffering of Zenaida. This is erroneous.
_______________
[77] Id., at p. 73.
705
The pertinent provisions of the Civil Code on moral damages are:
Article 2217. Moral damages include physical suffering, mental
anguish, fright, serious anxiety, besmirched reputation, wounded
feelings, moral shock, social humiliation, and similar injury. Though
incapable of pecuniary computation, moral damages may be recovered if
they are the proximate result of the defendant’s wrongful act or omission.
Article 2219. Moral damages may be recovered in the following and
analogous cases:
(1) A criminal offense resulting in physical injuries;
(2) Quasi-delicts causing physical injuries;
(3) Seduction, abduction, rape, or other lascivious acts;
(4) Adultery or concubinage;
(5) Illegal or arbitrary detention or arrest;
(6) Illegal search;
(7) Libel, slander or any other form of defamation;
(8) Malicious prosecution;
(9) Acts mentioned in Article 309;
(10) Acts and actions referred to in Articles 21, 26, 27, 28, 29, 30, 32,
34, and 35.
The parents of the female seduced, abducted, raped, or abused,
referred to in No. 3 of this article, may also recover moral damages.
The spouse, descendants, ascendants, and brothers and sisters may
bring the action mentioned in No. 9 of this article, in the order named.

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 quasi-delict
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
Article 309. Any person who 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.
Since Zenaida has not proven her claim to moral damages, she is
also not entitled to exemplary damages.
Article 2234 of the Civil Code provides:
Article 2234. While the amount of the exemplary damages need not be
proved, the plaintiff must show that he is entitled to moral, temperate or
compensatory damages before the court may consider the question of
whether or not exemplary damages should be awarded. x x x.
Since the award of exemplary damages is not justified, there is no
reason to award attorney’s fees, in accordance with Article 2208
of the Civil Code, which allows the award of attorney’s fees only
“when exemplary damages are awarded.”
ACCORDINGLY, I CONCUR and vote to GRANT the petition.
Petition granted, judgment reversed and set aside.
Notes.—Section 1, Rule 131 of the Rules of Court defines
“burden of proof” as “the duty of a party to present evidence on
the facts in issue necessary to establish his claim or defense by
the amount of evidence required by law.” (De Leon vs. Bank of
the Philippine Islands, 710 SCRA 443 [2013])
He who alleges has the burden of proving his allegation by
preponderance of evidence or greater weight of credible
evidence. (Dela Llana vs. Biong, 711 SCRA 522 [2013])
——o0o——

DR. FILOTEO A. ALANO, Petitioner, vs. ZENAIDA MAGUD-LOGMAO, Respondent

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G.R. No. 175540. April 7, 2014.

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