## Facts

- Kathleen Hart, age seven, suffered severe kidney disease; without a prompt transplant, death was reasonably probable.
- Kathleen’s kidneys had been removed, and she was maintained on regular dialysis pending transplantation.
- Margaret Hart, Kathleen’s identical twin, was medically determined to be an ideal living kidney donor; the procedure was an isograft with highly favorable compatibility.
- Physicians concluded that a parental kidney would likely require lifelong immunosuppressive therapy for Kathleen with serious side effects, while a twin-to-twin transplant would avoid or substantially reduce that need.
- The parents sought to consent to surgery for both children, but the physicians and hospital refused to proceed without a judicial declaration of legal authority to consent for the minors.
- The court appointed separate guardians ad litem for each child; both supported the transplant after reviewing the medical evidence and the children’s welfare.
- The court questioned Margaret, who showed age-appropriate understanding and expressed a clear desire to donate to help save her sister’s life.

## Issues

1. Whether parents may lawfully consent to a kidney transplant in which one minor child donates a kidney to her minor sibling.
2. Whether a court of equity may authorize such a procedure for minors through substituted judgment and declare that consent by parents and guardians ad litem is legally sufficient.
3. What conditions must be met before a court may authorize serious, non-therapeutic surgery on a healthy minor donor for the primary medical benefit of another person.

## Decision

- The court granted declaratory relief authorizing the kidney transplant and declaring that the parents and guardians ad litem could validly consent on behalf of both minors.
- The court held that it had inherent equitable power, applied through substituted judgment, to authorize the procedure for minors lacking legal capacity.
- The court found the circumstances met a stringent standard: urgent need, most favorable probability of success, and a clear duty to protect the welfare of the children.
- The court concluded the transplant served the best interests of both Kathleen (as recipient) and Margaret (as donor), given the medical record, the reduced immunologic risk from an isograft, and the limited donor risk.

## Legal Principles

- A court of equity may act for persons who cannot legally act for themselves and may authorize medical decisions under substituted judgment when necessary to protect their welfare.
- Equity power to approve extraordinary medical intervention must be exercised cautiously and only in rare instances; the need must be urgent, the likelihood of success highly favorable, and the duty clear.
- Parental consent to medical care has limits where a healthy child would undergo non-therapeutic surgery for another’s benefit; independent representation (guardians ad litem) and judicial review are key safeguards.
- Authorization may be appropriate where: (1) the recipient faces imminent death or grave harm without transplantation; (2) the procedure offers high probability of success; (3) risks to the minor donor are medically acceptable; and (4) the court finds the arrangement serves the welfare of both minors.

## Conclusion

The court permitted a minor-to-minor kidney transplant between identical twins by declaring that parents and guardians ad litem could consent, using substituted judgment and a strict, fact-specific equitable review centered on urgent medical necessity, high likelihood of success, and the welfare of both children.


Hart v. Brown, 29 Conn. Supp. 368, 289 A.2d 386 (Conn. Super. Ct. 1972)