Tests Saturday Confirm No Brain Activity for Jesica
Posted February 22, 2003
DURHAM, N.C. — Life was slipping away Saturday from the teenage girl whose first heart-lung transplant was unsuccessful after a communicaton mixup before a second procedure offered renewed hope.
Medical tests confirmed what doctors feared Friday, when they said 17-year-old Jesica Santillan had severe and irreversible brain damage.
Jesica had no brain activity Saturday, a spokesman for Duke University Medical Center said.
The grim statement came a day after the family's spokesman said doctors had told the family to be ready to decide whether to remove her from life support.
A 24-hour gap in brain activity - the hospital's definition for declaring brain death - was winding down early Saturday afternoon. Doctors planned new tests on her condition.
Jesica's family met with doctors to discuss the prognosis for the girl who nearly died after her first heart-lung transplant Feb.7 because the organs were the wrong blood type.
A second set of donated organs, implanted Thursday, were working well. But Jesica's brain began swelling and bleeding shortly afterthe second operation.
"The swelling in her brain is severe, severe to the point we fear it's irreversible," said Dr. Karen Frush, the hospital's medicaldirector of children's services.
Hospital spokesman Richard Puff said Saturday that tests found blood was no longer flowing to the 17-year-old's brain, and no brainactivity could be discerned.
Mack Mahoney, a family friend and Jesica's chief benefactor, checked out of his room at a motel across the street from thehospital on Saturday. He said he had been mentally and physically exhausted by the ordeal.
Jesica's mother, Magdalena Santillan, said at a news conference Friday night that she believed hospital officials were not tellingher the full story. She said then that she wasn't ready to remove her daughter from life support.
Jesica continued to lay unconscious as her family and her doctors discussed her grim prognosis.
As Santillan remains in critical condition in the pediatric intensive care unit, some of her supporters claim Duke transplant surgeon Dr. James Jaggers, who worked on both procedures, admitted right away that
he made a mistake
in giving Jesica organs with the wrong blood type.
Some of Santillan's supporters allege Jaggers told them that she could live up to a year while she waited for another transplant.
"All this time, this girl is on life support and they knew that it was ruining her brain and ruining her kidneys and no body would stand up and do something about it," said family spokesman Mack Mahoney.
Officials with Duke University Hospital said they have been truthful about the information given to Santillan's family.
"I think we have been honest and forthcoming with Jesica's family about her medical care every step of the way," said William Fulkerson, M.D., CEO of Duke University Hospital.
Jaggers, who is chief of pediatric surgery at Duke, joined the staff at the hospital in 1996.
The state Division of Facility Services, the group that oversees hospitals across North Carolina, said they are focusing on Duke University Hospital's role in the mix-up. There is no word on when their findings will be released. Officials said it could take up to a few months
Officials with the N.C. Medical Board said they may also investigate the incident.
Thursday, Santillan received a heart-lung transplant in a procedure that lasted nearly four hours. Her physicians said the procedure went as expected, and her status at that time was standard for post-transplant patients.
"Speaking for Duke University Hospital and the entire health care team, we are so grateful that organs became available to help Jesica Santillan," Fulkerson said. "Our heart goes out to the family of the donor because of their loss."
Fulkerson said the transplant process began at 11:30 p.m. Wednesday when Jaggers was notified by Carolina Donor Services that compatible organs were available for Santillan. The procedure for ensuring compatibility was completed and the surgical team discussed the situation with Jesica's family at about 12:30 a.m. Thursday.
At approximately 5:15 a.m., Santillan was taken to the operating room. The operation began at about 6 a.m. and was completed by 10:15 a.m. with the family receiving updates throughout the course of the surgery.
Santillan received a heart-lung transplant on Feb. 7, but rejected the organs. It was later discovered that type-A organs were transplanted into the girl with type O-positive blood.
Fulkerson said a review of the events leading up to the blood-type mismatch is ongoing.
"One error is a false assumption that Dr. Jaggers made, that when he gave the name to the external agency who offered the organs, he assumed that there has been match confirmation of compatibility," said Dr. William Fulkerson, chief executive officer of Duke University Hospital.
However, there still appears to be a rift between family members and hospital officials.
"They should have confessed to it right then that the organs were not a match," family friend Mack Mahoney said.
The hospital has revised its procedures to prevent such errors in the future. As a result of the new procedures, three additional physicians were involved in the organ compatibility process before Thursday's transplant.
In response to Duke Hospital's self-reporting of the blood type mismatch in the organ transplant operation, the North Carolina Department of Facility Services is conducting an on-site review of Duke's transplant program. Duke is fully cooperating with the DFS site visitors.
The Santillan family has hired a medical malpractice attorney, but they said they are unsure whether they plan to take legal action.
Fulkerson said Santillan is receiving aggressive support by her doctors, nurses and health care team.
"We just screamed and just hugged each other. It's a miracle," said Americas Santillan, Jesica's cousin. "Our family has a lot of hope and faith. [Jesica] has gone through a lot and she's still with us. She's still fighting."
There is no word on the identity or location of the donor.
Jaggers performed both of Santillan's transplants. Duane Davis, M.D., surgical director of Duke's lung transplant program, assisted in the second transplant due to Santillan's medical complexities.
"This has been a difficult and heart-wrenching time for many people. At Duke it has resulted in a tense re-examination of internal controls in transplantation," said Fulkerson. "We have a tremendous need for organ donations in this country, and indeed, worldwide. We sincerely hope that, through the widespread appeal for organs for Jesica, that more individuals and families have considered becoming organ donors. If people across America could take time today to consider becoming an organ donor, not one but several patients and their families would benefit from their actions."
A CAT scan conducted Wednesday revealed that Santillan had brain activity and remained eligible for another transplant.