Later, Kayla suffered sepsis and peritonitis from a perforated gastric ulcer and required a liver transplant. Sam managed to rush through the tests to see if he was a compatible donor and offered a lobe of his liver for transplantation. The transplant surgery was successful.
However, Kayla developed new symptoms a few months later and House realized by looking at Sam that he was suffering from hepatitis and that he must have known that this would disqualify him as a donor and therefore he probably paid someone at the lab to hide it. However, hepatitis wasn't the problem. Sam was also suffering from an undiagnosed hepatoma, which had also been transplanted into Kayla. Since Kayla was immunocompromised from the anti-rejection drugs, the hepatoma grew faster inside her than it did in Sam. Ironically, this discovery saved Sam's life as the hepatoma was still asymptomatic in him.
Sam's hepatoma was successfully treated, but it meant that Kayla was unlikely to survive. Sam tried to convince Kayla to go to Mexico to get a black market liver, but Robert Chase convinced her that she would never survive the surgery and that she should use her remaining time to stay with her daughters.
After Kayla died, Chase was doing a follow up examination on Sam. Sam noted that he and Kayla's daughters had to move due to lack of money. Chase then falsely claimed that he had been drunk when Kayla came back for her test results and he had missed asking her a question that would have diagnosed her ulcer in time to be treated, goading Sam into starting a lawsuit. In fact, Chase was distracted as he had just heard his father had died of cancer that Chase knew nothing about.