Ill Teen Suffers Brain Damage

Only one day after undergoing an apparently successful heart-lung transplant to rectify an earlier botched effort, 17-year-old Jesica Santillan was clinging to life Friday after physicians detected swelling and bleeding in her brain. Doctors said she may have suffered irreversible brain damage.

Jesica’s second transplant was required because during the first one Feb. 7, physicians at Duke University Hospital in Durham, N.C., implanted organs that were of a different blood type from her own.

“Yesterday, after the transplant, we were all very hopeful,” Dr. Karen Frush told reporters gathered outside the hospital Friday. But now, “the swelling in her brain is severe, severe to the point we fear it is irreversible.”

The girl was undergoing further testing Friday to confirm the diagnosis, and doctors inserted a tube into her skull to relieve swelling, but the outlook was grim.

“At this point in time, we are doing everything we can to continue to support Jesica and her family,” said Frush, who is the hospital’s medical director of children’s services.

Mack Mahoney, an area contractor who had been the leader in the effort to raise money for the initial transplant, said doctors had told Jesica’s family Friday to prepare for a possible decision to remove her from life support.

Her new heart and lungs were performing as expected, but the damage to her brain may be too severe to allow recovery, doctors said. She was also undergoing dialysis because of damage to her kidneys.

Mahoney said the doctors told the family the damage occurred while Jesica was connected to life support machinery as the hospital searched for a second set of organs. Mahoney said the family was not ready to give up.

“That’s a tough little girl,” he said in an emotionally charged news conference Friday. “Don’t underestimate her. I mean, she went through a lot and she is still here.”

Jesica was born with a heart deformity that prevented her lungs from infusing sufficient oxygen into her blood. Her family, from a small town near Guadalajara, paid a smuggler to bring them into this country because heart-lung transplants are not available in Mexico. They moved to the Raleigh-Durham area because of Duke’s reputation for successfully performing such procedures.

Jesica spent three years on a waiting list before a set of organs became available. But 30 minutes after Dr. James Jaggers finished the initial transplant two weeks ago, it became apparent that a mismatch had occurred. Jesica was placed on life support. The transplant team then discovered that the organs came from a donor with type A blood, while Jesica was type O-positive.

She was stabilized and removed from life support again, but as her condition slowly deteriorated, she ultimately had to be placed on the machines again.

She received the second set of organs from an anonymous donor in a four-hour operation Thursday morning, and physicians said that everything initially appeared normal. But a CT scan performed at 3 a.m. Friday indicated her brain was swelling and had suffered damage.

A combined heart and lung transplant is a complicated procedure that is performed rarely -- 27 times in 2001 and 28 times in the first 11 months of 2002. The chief problem is the lungs, which provoke a strong immune reaction when transplanted, so that preventing their rejection requires sophisticated handling and powerful drugs.

The odds of success in such an operation are about 50-50. But physicians said they could not even begin to estimate the likelihood that an individual would survive a second procedure.

In a letter to the United Network for Organ Sharing released by Duke late Friday, Dr. William J. Fulkerson, Duke University Hospital’s chief executive, attributed the tragic error to a system that did not provide redundancy in checking compatibility of donor organs. In the future, he said, three people will confirm compatibility before a transplant. Fulkerson also said that on the evening of Feb. 6, Carolina Donor Services offered a donor heart to Duke University Hospital. Because the hospital did not have an appropriate patient, Jaggers asked if lungs were also available, mentioning Jesica. Carolina Donor Services then offered a combination of heart and lungs for a different patient at Duke, but the organs were an inappropriate size. Ultimately, the organs were consigned to Jesica. Fulkerson said Jaggers “does not recall [compatibility] being discussed with CDS.”