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Donor Service Admits It Did Not Check Jesica Santillan's Blood Type

Posted March 17, 2003

— The head of a donor services group that helped locate organs for Jesica Santillan says his organization didn't know her blood type before it released the organs for Jesica's first heart-lung transplant.

"We could have requested her blood type, and I wish we had," Lloyd Jordan, president of Carolina Donor Services, told CBS-TV in a "60 Minutes" interview airing Sunday night. "We did not do that."

Jesica, 17, died Feb. 22, more than two weeks after her first heart-lung transplant at Duke University Medical Center.

A second set of organs was required because Jesica had type-O blood, and the first organs were type A. Correctly matched organs were implanted Feb. 20, but she died two days later.

Dr. James Jaggers, the surgeon who implanted the first and second set of organs, said he didn't realize the first set of organs were the wrong blood type until he got a call in the operating room from someone in a Duke lab.

Jaggers already has said publicly he bears responsibility for the error as head of Jesica's surgical team.

"I'm confident that we did everything we possibly could for Jesica," Jaggers said on "60 Minutes."

"We acknowledged that an error was made. We did everything we could to save her, to get her new organs, to treat her medically. And, as tragic as it is, sometimes things don't go the way you want them to."

In a letter to the United Network for Organ Sharing, which matches patients with donated organs, Duke officials said Jaggers and Carolina Donor Services failed to share information about Jesica's blood type.

UNOS policy requires that blood types of donors and recipients be matched before releasing any organs.

Jaggers said he doesn't remember Carolina Donor Services alerting him to the blood type of the first set of organs before acquiring them.

"I have no recollection of them talking about the blood type," Jaggers said in the interview.

Carolina Donor Services hadn't checked to determine Jesica's blood type, Jordan said.

A second Duke surgeon, Dr. Shu Shiuh-Shieu Lin, flew to Boston to get the first set of organs for Jesica, but he was never told of her blood type.

"Should we as a group, have made it mandatory that the procuring surgeon knew that? Yes," Dr. Duane Davis, head of Duke's transplant unit, said on "60 Minutes." "But it wasn't Dr. Lin's fault that he didn't know."

Duke already admitted its own errors and has implemented new rules for handling organ transplants to prevent another mismatch. One rule requires a blood sample from donor organs be taken directly to Duke's transfusion services department for blood typing.

The transplant surgeon, the transplant coordinator and the organ-harvesting surgeon also will have to perform compatibility checks.


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