by John M. Curtis
(310) 204-8700

Copyright February 26, 2003
All Rights Reserved.

hen 17-year-old undocumented Mexican immigrant Jesica Santillan received a miraculous heart-lung transplant on Feb. 7, her family and Duke University Medical Center had high hopes for her recovery. Great expectations turned quickly into her worst nightmare as her body rejected transplanted organs soon after surgery, leaving her clinging to life support. In what amounted to a fatal error, lead surgeon Dr. James Jaggers failed to match "Type A-positive" organs to Jesica's "Type O-positive" blood, causing catastrophic rejection. Stunning the transplant community, Duke procured a new set of organs and repeated the rare procedure for the second time on Feb. 20. Two days later Jesica was dead. "The family is clearly very relieved and happy," said Kurt Dixon, an attorney representing the family, given false hopes that Jesica really had a fighting chance—in reality, her prognosis was bleak.

     Once Jesica's body rejected the errant organs, her life was on a short rope. Waiting two weeks between surgeries guaranteed—less than a miracle—that the teenager was doomed, yet Duke persisted to redo the operation. "She has a number of hurdles to overcome," said Dr. Duane Davis, lead surgeon on Jesica's second transplant, telling the media that she had a fighting chance. Jesica's deterioration began before the end of the first surgery. Despite her grave prognosis, Duke feverishly pursued another set of organs, performing the second operation not to give Jesica a new lease on life but to reduce its legal exposure and undo damage to the medical center's reputation. "Our hopes and prayers are that she will overcome all of them," said Davis, knowing full well that her chances of survival were remote. Redoing the operation was nothing more than an elaborate publicity stunt.

     No one blames Jesica's family for taking dramatic measures to save her life. But her doctors knew Jesica's condition following the first surgery prohibited a second transplant. Jesica deteriorated rapidly for two-week period following for her first transplant on Feb 7. By the time Duke procured the right organs, Jesica sustained irreversible damage to her internal organs and brain. Rather than admitting failure, Duke performed the second transplant not to save Jesica's life but to salvage its damaged reputation. Eighty-thousand helpless patients await vital organ transplants in the U.S. Less than one percent receive heart-lung transplants. Only 55 were performed in 2001-2002, with only 43% surviving beyond three years. When Duke decided to give Jesica the correct organs, it was already too late both for Jesica and another qualified transplant recipient whose life might have been saved.

     Organ matching and blood-typing is the most elementary step prior to transplant surgery. Two outside agencies, involved in procuring Jesica's original organs, identified them as "Type A-positive." Yet Duke's head surgeon failed to perform the most basic prerequisite before jumping into surgery—a simple blood-typing procedure. "This has been a very difficult and heart-wrenching time for many people here at Duke," said hospital CEO Dr. William Fulkerson, announcing new safeguards to prevent future incidents. Fulkerson indicated that Jesica's lead surgeon James Jaggers was "devastated by the events," yet Fulkerson hasn't explained why Duke performed the second operation when Jesica had little chance of survival. Stubborn medical facts clearly indicated she was not a candidate for a second operation. Two days after the second surgery, Jessica was brain dead and disconnected from life-support.

     While it's good PR that Duke repeated the transplant, it didn't increase Jesica's chance of survival. With six other heart-lung patients in Jesica's category desperately awaiting organ donations, Duke's decision to give them to Jesica for a second transplant no doubt cost more lives. No one really knows how Duke obtained "Type-A" organs, given the extreme scarcity of donors. Nationwide, there are 59 regional organ-procurement centers, all of which share a common database for possible matches. Priority is typically given on the basis of urgency, but more importantly, qualified patients who stand to benefit. In Jesica's case, her deteriorated state should have disqualified her from a second transplant. No matter how it benefited Duke's damage control strategy, it wasn't going to save Jesica's life. Losing two rare sets of organs cost more than Jesica's tragic life.

     Duke Medical Center must fully account for how it mismatched organs before Jesica's original transplant on Feb. 7. Duke personnel must also explain how they were able to obtain the correct organs and decide to repeat the procedure knowing that Jesica's medical condition precluded her from a second transplant. If her prognosis was indeed unfavorable on Feb. 20, no second operation should have been performed. No matter how Duke felt about the first transplant, only medical necessity should have determined Jesica's suitability for another transplant. Without any likely benefits, the only reason for repeating the operation was to undo colossal damage to Duke's reputation. Raising the public's and family's expectations when no hope existed cannot pass unnoticed. Medical institutions must stick to the facts and not allow worries about liability or disastrous public relations to dictate their actions.

About the Author

John M. Curtis writes politically neutral commentary analyzing spin in national and global news. He's editor OnlineColumnist.com and author of Dodging The Bullet and Operation Charisma.

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