Outlook grim for transplant patient, 17

Doctors detect swelling and bleeding in her brain

February 22, 2003|By Thomas H. Maugh II | Thomas H. Maugh II,SPECIAL TO THE SUN

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 yesterday after physicians detected swelling and bleeding in her brain. Doctors said she might have suffered irreversible brain damage.

The second transplant Thursday was required because physicians at the Duke University Medical Center made a severe error in her first one, implanting organs that were of a different blood type than her own.

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

The girl was undergoing further testing yesterday to confirm the diagnosis, and doctors inserted a tube into her skull to relieve swelling, but her 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 the family yesterday to prepare for a possible decision to remove her from life support.

Her new heart and lungs were reportedly performing as expected, but the damage to her brain might be too severe to allow recovery.

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 yesterday. "Don't underestimate her. I mean, she went through a lot, and she is still here."

Smuggled into U.S.

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 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. yesterday indicated her brain was swelling and had suffered damage.

Inadequate checking

In a letter to the United Network for Organ Sharing released by Duke late yesterday, Dr. William J. Fulkerson, chief executive officer of the Duke University Hospital, attributed the tragic mishap to a system that did not provide redundancy in checking compatibility of donor organs.

In the future, he said, three separate people will have to confirm compatibility before a transplant can proceed.

Fulkerson also said that on the evening of Feb. 6, Duke received an offer from Carolina Donor Services of a donor heart. Because they did not have an appropriate patient, Jaggers inquired if lungs were also available, specifying Jesica Santillan by name because she needed both.

Carolina Donor Services then offered a combination of heart and lungs for a different patient at Duke, but the organs were of an inappropriate size. The organs later were consigned to Jesica.

Fulkerson said Jaggers "does not recall [compatibility] being discussed with CDS."

Thomas H. Maugh II writes for the Los Angeles Times, a Tribune Publishing newspaper.

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