Transplant Gone Wrong

DURHAM, N.C.–Jesica Santillan’s longshot journey seemed headed for a triumphal finish.
The ailing 17-year-old Mexican girl, ferried across a dangerous border by desperate parents, had made it to one of the United States’ top hospitals to receive a new heart and lungs to replace her own failing organs.
There were all the makings of the now-familiar medical-miracle narrative: the youthful patient, hopeful parents, big-hearted American sponsor and crack medical team tackling a rare and difficult operation.
But instead of celebration there was finger pointing this week, as Jesica remained near death from a transplant that all now agree was botched.
Officials at Duke University Hospital said Wednesday they were still reviewing how Jesica received a new heart and lungs with a different blood type than hers, which prompted her body to reject the organs and begin to fail altogether.
Since the Feb. 7 operation, she has suffered a seizure and would have died but for the life-support machines that have taken over for her own system. Jesica remained in critical condition Wednesday as her family and doctors raced to locate a replacement heart and lungs.
The family’s lawyer said the girl’s condition was deteriorating; the family had said that she is expected to survive only a few days more.
”She’s still critical, still on the donor list. We’re still hopeful that we’ll be able to find organs,” said Richard Puff, a hospital spokesman.
As the search for replacement organs continued, Duke officials faced reports that the doctors who performed the transplant had been told at several points that the organs were blood type A-positive, while Jessica is type O. It is essential in such transplants that the blood type of such organs match that of the recipient.
Earlier in the week, Duke officials apologized and announced new procedures to prevent future mistakes, requiring that more than one medical staffer confirm a blood type match. Previously, only the surgeon made that check.
According to two agencies involved in locating the organs and relaying word to Duke, the physicians should have known that the organs were type A-positive.
The organs had been offered by the New England Organ Bank, which passed along word to Duke of their availability through Carolina Donor Services, a North Carolina agency.
A spokeswoman for Carolina Donor Services said that information relayed to the Duke surgeons indicated that the available organs were type A-positive. At the time, Duke surgeons had two A-positive patients awaiting heart-lung transplants, but the New England organs were rejected in these cases for other medical reasons.
A Duke doctor said the team wanted the organs for a third patient, who turned out to be Jesica.
Duke physicians flew to Boston to obtain the organs and were informed of the donor’s blood type, according to a statement by the New England Organ Bank released Tuesday night.
Puff declined to comment on the agencies’ statements. But he said Duke doctors believed at the time of the surgery that the organs were compatible.
”They were incorrect,” he said.
The trouble appeared almost immediately after the transplant. The surgeon, James Jaggers, told Jesica’s parents after the surgery that ”an error had been made,” said family friend Mack Mahoney. Jaggers was not available for comment.
Heart-lung transplants are rare; only 28 were performed nationwide during the first 11 months of last year.
Publicity about the case has been an embarrassment for Duke, a respected transplant center whose hospital lobby boasts a display of national news magazine covers that have featured Duke in their stories.
The hospital has performed 20 heart-lung transplants since 1992–a small share of the thousands of organ transplants that have been done there. Duke’s prompt admission of its error is expected to help the institution retain its reputation.
”In every crisis like this there is a conflict between the legal advice the institution gets and the PR advice,” said Paul Holmes, publisher of the Holmes Report, a public relations industry newsletter based in New York. ”The lawyers are telling you not to admit anything because you might want to deny it later in court. But that is lousy public relations.”
When executive or administrators stonewall after a crisis, as medical institutions have done in past transplant mistakes, it’s not lost on the public, Holmes said.
”The public perceives, and I think correctly, that the best way to judge a company or an institution’s values is to watch what it does in a crisis. People know that bad things happen to good companies,” he added.
The transplant blunder brought sudden anguish to the Santillan family, who three years ago paid a smuggler $5,000 to shepherd them into the country so they could seek a transplant unavailable to them in Mexico.
Jesica had long suffered from cardiomyopathy–a condition that left her with an overgrown heart and defective lungs.
Family connections drew the Santillans to North Carolina, where they learned about Duke. Mahoney, a North Carolina contractor, helped lead a volunteer effort to raise money for the transplant expenses. His group built houses using donated labor, then sold them on the market to raise money.
Meanwhile, Jesica’s parents remained at the hospital, where doctors performed a scan to check for brain damage that she may have suffered since she went on life support.
The family’s lawyer, Kurt Dixon, said late Wednesday that he had learned of a potential donor in Southern California–a 12-year-old girl with the same blood type as Jesica who was on life support following a car accident.
It was far from certain, however, that these organs would go to Jesica, who remains on a national list of patients awaiting transplant.
Dixon, a medical malpractice specialist, declined to discuss who was to blame for the error.
”We’re focused on getting that girl some organs,” he said.