Family of Donor Supports Heart Transplant : Comatose Man Was Costa Mesa Resident

The man whose heart was transplanted into a former staff physician at Hoag Memorial Hospital Presbyterian in Newport Beach on Wednesday was identified by authorities Friday as a 19-year-old Costa Mesa man.

Costa Mesa police identified him as Eleno Ullua Ramirez. He died Wednesday morning at Hoag after suffering severe brain injuries, apparently from a blow to the head. Ullua was found unconscious early Tuesday on a sidewalk outside a Costa Mesa convenience store.

Authorities initially were unable to identify the comatose man, who was declared brain dead Wednesday morning, 7 1/2 hours before his heart was removed and transplanted into the chest of Dr. Norton Humphreys, a 58-year-old Fountain Valley physician who was in critical condition at Hoag and awaiting a donor heart.

Ullua’s heart was taken for transplant without consent of relatives under a state law that allows the removal of an organ without the permission of the donor or his family if police have been unable to identify the donor after “diligently” attempting to do so for 24 hours.

However, family members said Friday that they were happy that Ullua’s heart was used to save another’s life.

“I think it was good what they did, taking my brother’s heart,” Ullua’s 28-year-old sister, Maria Celsa Torres, said Friday. “They saved another life.”

Ullua’s body was identified Friday by Torres at the county morgue, police said. According to police, his family came forward after hearing through a friend that an unidentified man matching Ullua’s description was on life support systems. Torres said her husband went to the hospital Thursday night but was unable to get any information because hospital officials told him the heart donor had not been identified.

The family also provided police with Ullua’s employment authorization card issued in January by the Immigration and Naturalization Service.

An investigation into Ullua’s death, which is being considered a possible homicide, is continuing, police said. Authorities have determined that he suffered a skull fracture, possibly from a heavy blow to the right side of his head. Hoag doctors found alcohol and cocaine in Ullua’s system. Further toxicological tests also are pending.

Humphreys, a Fountain Valley family practitioner who retired in 1980 because of degenerative heart disease, was in stable condition and resting comfortably Friday, a Hoag spokeswoman said.

Ethical questions have been raised about the use of the heart of an unidentified man 7 1/2 hours after he was declared brain dead in a hospital where a former member of the medical staff lay near death awaiting a new heart. Humphreys was at the top of the regional organ donor list to receive a heart.

But Dr. Aidan A. Raney, one of the two cardiac surgeons who performed the heart transplant, said Friday that he was surprised and disappointed by questions that have been raised by medical scholars.

“I have been involved with heart transplants since 1973 and have performed 77 of them, first at Stanford (University Medical Center in Palo Alto) and then at Sharp (Memorial Hospital in San Diego). In all that time I have been very cautious, and nobody has ever questioned my conduct or my ethics.”

But Raney acknowledged that he had never performed a transplant in which the determination that the unidentified donor was brain dead occurred about the same time as the 24-hour search period ended.

Raney said the timing “was pure coincidence.”

At 7 a.m. Tuesday, an unconscious Ullua arrived in Hoag’s emergency room, said Larry Ainsworth, the hospital’s executive vice president, who provided a chronology based on a review of hospital records and talks with those involved.

Dr. Oleg K. Chikovani, a neurosurgeon, performed a brain scan that showed that Ullua had a massive blood clot pressing against his brain.

Chikovani was out of town and could not be reached for comment Friday, but Dr. Laurence Jacobs, the other doctor who made the determination that Ullua was brain dead, said: “With this large blood clot there was virtually no chance that the patient could recover.

“But Dr. Chikovani decided to do surgery as a heroic effort to save the man’s life.”

This surgery began at 8:40 a.m. and ended at 10:20 a.m. Tuesday, Ainsworth said.

After surgery, Jacobs said a radioisotope flow study was done to see what kind of blood was circulating to and from the brain.

“There was no flow in and no flow out,” Jacobs said. “There was no circulation in the brain.”

An electroencephalogram also found no sign of electrical activity in the brain, Jacobs said.

At 11:40 a.m. Tuesday, Mary Jane Jones, a registered nurse who is Hoag’s transplant coordinator, called Costa Mesa police and asked them to launch a search to identify the man or contact his family because he was a potential heart transplant donor, Ainsworth said. He said he did not know how Jones learned of Ullua’s presence in the hospital.

At 1:20 p.m. Tuesday, a Costa Mesa police officer arrived at Hoag and took fingerprints of Ullua, Ainsworth said. He said the hospital decided to use the fingerprinting as the starting point for the 24-hour search period.

About the same time, Kathleen Dooley, Hoag’s vice president for risk management, telephoned Hoag attorney Robyn Meinhart and told her that the hospital had a potential organ donor who was unidentified. They discussed what steps Hoag had to take to legally authorize the use of the man’s organs, Ainsworth said.

To comply with California’s Uniform Anatomical Gift Act in this particular case, it was necessary for Hoag to establish that a “diligent search” to identify Ullua had been conducted by Costa Mesa police for 24 hours.

Ainsworth determined at 1:40 p.m. Wednesday that the brain-dead patient could not be identified, based on the fact that his fingerprints did not match any in law enforcement computer records and that no missing-person report had been filed matching his description.

Ainsworth noted that this was two hours after Chikovani and Jacobs declared the patient brain dead at 10:55 a.m. Wednesday.

“This determination was made by an independent private practice neurosurgeon and an independent private practice neurologist who were not part of the heart transplant team,” Ainsworth said. “They did this on their own timetable. It was not solicited by anyone.”

Jacobs, the neurologist, said: “The fact that Dr. Humphreys was waiting for a transplant did not influence my decision to declare the man brain dead.

“Even if a relative of mine had been waiting for a transplant, I would not have let that be a factor in my decision,” he said.

Raney, one of the cardiac transplant team leaders, said: “I am concerned that anyone would think that I had any control over the management of the care of a human being that could be a potential organ donor. I want to make it clear that I had absolutely nothing to do with that man’s care.”

Raney said Humphreys’ condition in the 24 hours before he underwent the heart transplant was not terminal.

To be sure, Humphreys, who had already suffered one heart attack during his five-week hospitalization in the intensive care unit at Hoag, probably could not have survived another one, Raney said. But he said that barring another heart attack, Humphreys would probably have been able to survive at least another month without the transplant.

During surgery beginning at 5:15 p.m. Wedensday to remove Ullua’s heart for transplant, a pathologist from the Orange County coroner’s office was present, officials said.

Also present was a representative from the Regional Organ Procurement Agency of Southern California, which approved of the procedure, a spokeswoman for the Los Angeles-based procurement agency said Friday.