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Bad news continues for transplant patient

After doctors' errors and two heart-lung transplants, the teen is left with brain damage.

©Associated Press
February 22, 2003

DURHAM, N.C. -- Jesica Santillan, the 17-year-old girl who underwent a second heart-lung transplant after the first was botched, was found to have severe and perhaps irreversible brain damage Friday.

The girl's chief benefactor said doctors told Jesica's family the girl might be brain dead and tests would be performed today. But a hospital spokesman said Jesica hadn't been declared brain dead and no tests were planned.

Mack Mahoney blamed the grim turn on Duke University Medical Center, saying image-conscious doctors hesitated to take the blame for the first, bungled operation and lost precious time in the hunt for a new set of organs.

"If she dies, they murdered her," said Mahoney, a North Carolina building contractor who started a charity in Jesica's name.

In her first transplant Feb. 7, the Mexican teenager was mistakenly given a heart and lungs from a donor with the wrong blood type. Her body rejected the organs, and she was on life support by the time a matching donor was found and a second transplant performed Thursday morning.

Though the new organs were performing well, tests early Friday showed Jesica's brain was swollen and bleeding, said Dr. Karen Frush, the hospital's medical director of children's services. She said Jesica also was hooked to dialysis machines because of damage to her kidneys.

"Yesterday after the transplant, we were all very hopeful," Frush said. But now, "the swelling in her brain is severe, severe to the point we fear it's irreversible."

Doctors told Jesica's family they would test her brain-wave function today, Mahoney said. But Duke spokesman Richard Puff denied that.

"Jesica has not been diagnosed as brain dead," he said. "The time frame to declare brain death may take up to 24 hours."

Earlier, Mahoney had said doctors told the family to prepare for a decision to remove the girl from life support. But her mother, Magdalena Santillan, refused to think about it, he said.

"She won't even discuss last rites because it's like giving up," Mahoney said.

Frush said there was no sure way to tell when the brain damage occurred. But Mahoney said doctors told the family it was because of the time Jesica was connected to life support.

"Life support ruins kidneys, it ruins brains, it ruins all the organs of the body," he said. "What they done is played with that little girl's life, trying to make a decision on whether they was going to fess up. They were putting their bottom line before a little girl's life.

"I'm mad. I'm enraged. I'm horrified," Mahoney said. "It's a horrifying thing. You take your child to what you considered to be the best institution in the world for a particular kind of surgery and you get this."

Dr. William Fulkerson, hospital chief executive, denied the hospital had delayed the search for new organs and pointed out the second set was found in a matter of days. The second transplant came 13 days after the first.

"I think we have been honest and forthcoming with Jesica's family about her medical care every step of the way, and we have accepted the responsibility publicly," Fulkerson said.

Earlier Friday, as Jesica was wheeled out of her room in intensive care to have a brain scan, she had a blue ventilator hose and other tubes attached to her body, and her head was covered with surgical tissues. Her eyes were swollen so much they appeared to be open.

Her mother, Magdalena, stood nearby, sobbing.

Jesica had a heart deformity that kept her lungs from getting oxygen into her blood. Relatives have said her family paid a smuggler to bring them from their small town near Guadalajara to the United States so she could get medical care. She waited three years for organs to become available.

In the first operation, Dr. James Jaggers implanted organs from a donor with type A blood, rather than Jesica's O-positive, a mistake Duke officials said was not discovered until the surgery was almost over.

Fulkerson said Jaggers wrongly assumed compatibility had been confirmed when he was offered the organs, and later failed to double-check that assumption, a violation of the hospital's procedures.

Duke officials explained the error in detail in a letter sent Friday to the United Network for Organ Sharing, which matches patients with donated organs.

The letter was signed by Fulkerson and Dr. Duane Davis, surgical director of Duke's lung transplant program.

They said Jaggers declined the organs for one patient who was not ready for transplant and asked Carolina Donor Services, an organ procurement organization, whether they were available for Jesica.

CDS officials checked the data and called back, offering the organs to Davis, who declined because they were the wrong size for his patient.

The organs were then offered to Jaggers for Jesica, the letter said.

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