Agonizing Over Botched Transplant

DURHAM, N.C. â€”  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 top hospitals in the U.S. 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, as Jesica remained near death this week from a transplant that all now agree was botched.

Officials at Duke University Hospital said Wednesday that 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 she would have died but for the life-support machines that have taken over for her. She 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 is deteriorating; the family said 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 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 Jesica is type O-positive. It is essential in such transplants that the blood type of the 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 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 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.

The transplant surgeon said in a statement released by the university Wednesday afternoon that he was told about the available heart and lungs and “assumed� that the organs were compatible.

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 said in the statement that he was “heartbroken about what happened to Jesica.�

“My focus has been on providing her with the heart and lungs she needs so she could lead a normal life,� he added.

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. The hospital has performed 20 heart-lung transplants since 1992 -- a small share of the thousands of organ transplants 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 executives 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 medical blunder brought sudden anguish to the Santillans, 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. She was given only six months to live at the time of the transplant.

Family ties 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.

Meanwhile, Jesica’s parents remained at the hospital, where doctors performed a scan to check for brain damage that she may have suffered since being put on life support. The family’s lawyer, Kurt Dixon, said late Wednesday that doctors had found no such evidence of brain damage.

Dixon also said 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 after 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.

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Times staff writer Benedict Carey in Los Angeles contributed to this report.