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A heart and lungs with the wrong blood type are transplanted in the 17-year-old. Doctors say it's unlikely another donor will be found.
February 19, 2003
DURHAM, N.C. -- A 17-year-old girl lay near death Tuesday after mistakenly receiving a heart and lung transplant from a donor with the wrong blood type, and hospital officials held out little hope of finding a new set of organs in time.
Jesica Santillan's condition steadily deteriorated after the surgery Feb. 7. She suffered a heart attack Feb. 10 and a seizure on Sunday, and was in critical condition with a machine keeping her heart and lungs going.
"Right now my daughter is between life and death. She could die at any moment," her mother, Magdalena Santillan, said in Spanish through an interpreter. "My daughter needs a transplant of a heart and lungs to survive. It's the only hope that we have because the doctors made an error."
A family friend said the girl has only a few days left.
The girl has type O-positive blood but was given organs from a donor with type-A blood during the operation at Duke University Hospital. Because of the mismatch, antibodies in her blood attacked the organs as foreign objects.
Hospital spokesman Richard Puff said he could not specify how the mistake was made. But he said that the hospital staff believed the organs were compatible and that compatibility had been confirmed.
Puff said the girl is a candidate for another transplant and "we remain hopeful that will happen." But he said the hospital can do little to improve her odds.
"We're going through the usual system of transplant agencies. That's all we can do," he said.
Jesica remained on the national waiting list kept by the United Network for Organ Sharing.
"Unfortunately, there are very few organs available," spokeswoman Anne Paschke said. The organs not only have to be the right blood type, they have to be the right size to fit into the girl's chest cavity.
Mack Mahoney, the family friend, said Jesica is small for her age -- 5-foot-2 and 85 pounds -- and any donated organs would probably come from a child.
Heart and lung transplants are rare for teenagers: In the first 11 months of last year, there were four nationwide for children between ages 11 and 17, UNOS' records show. The previous year, there were four.
"We have a good chance of saving this child's life if we find a donor in the next couple of days," Mahoney said.
In the meantime, he said, the life-support apparatus was hurting Jesica, raising the danger of bleeding, stroke and kidney damage.
Jesica, who is from a small town near Guadalajara, Mexico, needed the transplant because a heart deformity kept her lungs from getting oxygen into her blood. Mahoney said she would have died within six months without a transplant.
Two groups involved in the transplant have provided clues to how the mistake might have occurred.
According to Carolina Donor Services, on Feb. 7, the New England Organ Bank said it had a heart and lungs from a Type A donor who, according to a national database, matched two Type A patients at Duke. The Carolina group notified Duke, but surgeons there declined the organs, because for reasons other than blood type they were not suitable for the patients in the database.
But one of the Duke surgeons, whose name was not revealed by the Carolina group, requested the heart and lungs for a third patient, Jesica.
The New England Organ Bank issued a statement saying it had correctly identified the donor as Type A and had given the information to Duke twice before the organs were removed from the donor and again when Duke surgeons arrived in New England to perform the surgery to remove them. The bank would not say where this surgery occurred.
As the surgeons flew back to North Carolina with the heart and lungs, Jesica's transplant surgeon began removing her organs. Time was short because heart-lung combinations deteriorate quickly, and doctors wanted to implant the new organs as soon as they arrived at Duke.
The operation went smoothly until routine tests performed near its completion revealed Jesica and the organ donor did not have matching blood types and Jesica was beginning to reject the organs, said Dr. William Fulkerson, the hospital's chief executive.
Mahoney said her surgeon, Dr. James Jaggers, told the family about the mistake immediately after the surgery, and listed Jesica for another transplant. But he also said medicines might control the rejection, Mahoney said. They did not.
Mahoney, a businessman who created a foundation to help pay for Jesica's treatment, said the surgeon told him and Jesica's parents that because he had removed Jesica's heart and lungs shortly before the donor heart and lungs were brought to the hospital, he had no choice but to sew the donor organs into her.
Jaggers was not available for interviews, a Duke spokesman said.
Fulkerson said he could not discuss the details of Jesica's case, but said chest surgeons at Duke told him it was standard procedure to take out the recipient's organs before the donor organs arrived, in order to save time -- even if the organs were being brought in by helicopter or ambulance.
Hearts and lungs are good for only about six hours, even on ice, and surgeons are racing against the clock.
Once the recipient's organs come out, they cannot be put back in, Fulkerson said. For one thing, they are so damaged as to be almost useless, or the person would not need a transplant.
Mahoney said: "The family is horrified, terrified, grieving. The mother has cried until she can't cry anymore. She's either at her daughter's bedside or in the chapel with the priest. She still holds out faith the somebody will help her, that somebody who loses a little one will give Jesica the gift of life and not bury the organs with the child."
People who know of a potential donor can make contact through a Web site, www.4jhc.org.
Fulkerson said the hospital was investigating how the mistake happened and whether staff members should be disciplined. He said the hospital will add new confirmation requirements to ensure organ compatibility.
Organ network spokesman Bob Spieldenner said he knows of two similar cases in the past decade, both at Oregon Health Sciences University, now called Oregon Health and Science University.
In 1991, the hospital put a heart with the wrong blood type into a patient, but discovered the error. It gave him another heart and he survived. Three years later, surgeons opened the chest of a 15-year-old boy for a heart transplant, but discovered the organ was the wrong blood type and closed him up. The boy died 10 days later.
The Santillans moved to North Carolina nearly three years ago from Tamazula.
Mahoney got involved after he read news reports of the girl's ailment and her family's lack of money. He and his wife joined community efforts to raise money to pay for her medical care, and Jesica's parents gave Mahoney power of attorney for their daughter.
"I've been trying to save this girl's life," Mahoney said. "It's been a fight all the way."
Relatives said the girl's mother asked Mexican doctors about the possibility of an organ transplant in Mexico but was told it would be a long wait.
"The last we heard, she was getting much better, she wasn't fainting anymore," the girl's aunt, Ramona Santillan, said in an interview in Tamazula, 275 miles west of Mexico City.
"At that point my sister didn't want the operation anymore," she said. "But then the doctors told her they had a heart that would help her. Only it wasn't true."
-- Information from the New York Times was used in this report.