A Second Chance at Life for Gravely Ill Teenager

A 17-year-old girl who was left near death after a botched heart and lung transplant at Duke University Hospital in Durham, N.C., received replacement organs early Thursday in an operation that offered a coveted second chance for both patient and doctor.

Jesica Santillan, whose parents smuggled her from Mexico three years ago in hopes of replacing her defective heart and lungs, remained in critical condition after the four-hour procedure. The operation was made possible when a heart and lungs became available overnight, even as time appeared to be running out for Jesica. The donor was not identified.

In a two-week span, Jesica underwent a rare and complicated procedure twice.

“The family is clearly very relieved, happy,” said Kurt Dixon, an attorney representing the family. “It’s a very extensive surgery, so they’re worried. But it’s a huge weight off of them.”

Jesica was left gravely ill after a Feb. 7 operation in which she received organs that were of a different blood type than her own. As a result, her body rejected the replacement heart and lungs almost immediately, forcing doctors in recent days to place her on life support.

The ordeal has resulted in damage to other organs, and doctors warned that even though Thursday’s transplant went as expected, Jesica remained so sick that her chances for recovery were uncertain.

“She has a number of hurdles to overcome,” said Duane Davis, a transplant surgeon who assisted in the latest procedure. “Our hopes and prayers are that she will overcome all of them.”

The widely publicized case brought embarrassment to Duke, a respected medical center that has been the site of thousands of successful organ transplants. Duke officials accepted responsibility and responded by putting into place new safeguards. William Fulkerson, a physician who is the hospital’s chief executive, said one of those new checks -- requiring three physicians to confirm that the donated organs are compatible with the patient receiving them -- was employed Thursday. Fulkerson said at a news conference in Durham that the incident showed the need for better checks. A hospital review of the events was still underway.

“This has been a very difficult and a heart-wrenching time for many people here at Duke,” Fulkerson said, his voice cracking. “It certainly has resulted in an intense reexamination of internal controls in transplantation.”

Fulkerson said that James Jaggers, the surgeon who oversaw both operations, was continuing to supervise Jesica’s care and that he had been “devastated by the events.”

It was Jaggers’ responsibility to confirm that the blood type of the donated heart and lungs was a match for Jesica, Fulkerson said. The hospital executive said the hospital’s review had turned up errors at two points in the process. First, he said, Jaggers assumed incorrectly that the compatibility of the organs had been confirmed when the organs were first offered. Second, the surgeon did not recheck that the blood types matched at the time of surgery, Fulkerson said.

Two outside agencies involved in locating the heart and lungs and passing along word to Duke said they had informed the doctors that the donated organs were of blood type A-positive. Jesica’s blood type is O-positive.

The error became evident before the transplant was complete as Jesica’s system began to fight back. Jaggers informed the girl’s parents immediately.

As Jesica’s condition deteriorated, her plight gained extensive coverage, owing to the efforts of a North Carolina charity. Jesica’s Hope Chest, which is led by a contractor, Mack Mahoney, built houses using donated labor and sold them to raise money for the $500,000 transplant expense.

Mahoney has publicly clashed with hospital officials over their handling of the matter. He remains angry, saying that without his group’s efforts to draw attention to the case, “that baby would have died.”

Experts in the world of donated organs said the episode highlighted the shortage of organs nationwide. Slightly more than 80,000 people are awaiting organs, mainly kidneys and livers, according to Anne Paschke, spokeswoman for the United Network for Organ Sharing, which manages the nation’s waiting list for organs.

Among those are 199 people waiting for heart-lung transplants. Despite the high-profile search for new organs for Jesica, hospital officials said the heart and lungs became available through a routine match.

Officials of the organ-sharing network said Thursday that they had begun an inquiry into the case that would seek to answer, among other questions, whether another patient should have received the heart and lungs that were mistakenly transplanted into Jesica.

At that time, there were six heart-lung transplant candidates nationwide who were 11 to 17 years old with type A blood -- patients who might have been suitable recipients for the organs that went to Jesica by mistake.

But it was unclear whether doctors would have deemed any of them a match, given the variety of medical conditions that ultimately determine suitability. Nor was it known whether any of the six were offered the organs ahead of Jesica. “Our investigation will look at whether, by our policy, somebody else should have” received the first set of organs, Paschke said.

Under the donor system, a hospital with a potential donor notifies one of the nation’s 59 regional organ-procurement agencies, which check a database for possible matches, based on criteria such as blood type and, in the case of heart and lung transplants, body size. Those not ruled out by the computer for medical reasons are ranked according to the urgency of their condition, and the awaiting transplant hospital is notified.

Geographic proximity can be a factor, since some organs, such as hearts and lungs, generally survive for four to six hours, Paschke said.

Heart-lung transplants are rare. Only 28 were performed in the first 11 months of last year; 27 were done in all of 2001. Only one of the operations performed last year involved a patient sharing Jesica’s blood type and age group, 11 to 17 years old.

About 43% of heart-lung recipients in this age group survive at least three years, according to the organ-sharing network.

Davis acknowledged the bittersweet nature of organ transplants: for a patient to receive a needed organ, someone else must first die. Davis said gratitude was owed to the family of the donors in Jesica’s case.

“Our heart really goes out to them in their time of grief,” he said.