Doctors Operate on Joined Twins

Surgeons were laboring day and night Monday to separate conjoined twins in a complex operation that will mean certain death for one sister and the chance of life for the other.

The surgery, which the girls’ parents had fought unsuccessfully in court, was being carried out by a 20-person medical team at St. Mary’s Hospital in Manchester, where the girls were born Aug. 8. The infants were joined at the abdomen and shared vital organs, with a pair of legs protruding from each side.

Hospital officials declined to comment on the progress of the surgery, which entailed separating the fused spinal columns of the girls. The twins have been given the false names “Mary” and “Jodie” to protect their identities.

The hospital said that the operation was expected to last about 15 hours and that no progress reports would be issued until today.

“At this time, our thoughts are with the parents and the surgical team,” said hospital spokeswoman Yvonne King.

The parents, Roman Catholics from the Maltese island of Gozo, opposed the operation on religious grounds and asked that the girls’ fate be left to God. They said they could not elect to sacrifice one child for the other.

The moral dilemma--and the possibility of proceeding against the wishes of the parents--prompted an intense national debate and outpouring of sympathy. Whatever the outcome, the parents were destined to lose at least one of the girls.

Only Jodie was born with a functioning heart and lungs, and Mary has depended on her for oxygenated blood since birth. Mary also has suffered severe brain damage and is unable to eat on her own, while Jodie was diagnosed as being in good mental and physical health.

Doctors acknowledged that separation would kill Mary, but they said that, meanwhile, she was draining the life from her healthier sister. If they remained conjoined, both girls would die within six months, doctors said.

Britain’s Court of Appeal ruled in September that the healthy twin’s right to life outweighed that of the weak sister. Jodie had a right to defend herself, the court said.

“The sad fact is that Mary lives on borrowed time, all of it borrowed from her sister,” Lord Justice Alan Ward wrote in the ruling. “She is incapable of independent existence. She is designated for death.”

The judges gave the doctors the go-ahead and, having lost in two courts, the parents dropped their legal challenge. Judges also rejected an eleventh-hour appeal by Britain’s small antiabortion movement, Pro-Life Alliance, on Friday to take the case to the country’s highest court, the House of Lords.

The twins’ parents have spent most of the last three months at St. Mary’s Hospital and were there throughout Monday, accompanied by relatives. The hospital was surrounded by heavy security and the media. A handful of Catholic and antiabortion protesters stood vigil outside.

The parents have remained silent throughout the ordeal, although news reports over the weekend said they have agreed to give a paid interview to Granada TV in Britain and will use the money to care for Jodie as she undergoes further treatment.

As described in the court judgment, surgeons would have to shut off Mary’s blood supply, leading to instant death.

“Finally and eventually we have a major blood vessel, which is the continuation of Jodie’s aorta, which is bringing blood across to Mary, and similarly the vena cava, which is returning blood from Mary to Jodie. Those would need separating, dividing. It is at that point that we would expect that Mary would then die,” the ruling said, quoting an unidentified surgeon.

The doctors would have to separate the girls’ spinal columns and a shared bladder. They say Jodie will need further surgery to reconstruct some organs, including her rectum, sexual organs and lower abdomen. She also is expected to need skin grafts and possibly further surgery on her legs and pelvic bone.