Chronology Of Events Regarding Jesica Santillan Transplant Attempts

Posted 3:14 p.m. Feb 22, 2003 — Updated 3:14 p.m. Feb 22, 2003

DURHAM, N.C. — CHRONOLOGY OF EVENTS REGARDING JESICA SANTILLAN

Evening of Feb. 6, 2003

Carolina Donor Services makes initial offer of a transplantable heart to Duke University Hospital.

1. CDS first contacted Dr. Milano, the on-call surgeon in charge of adult heart transplants. Because the first potential recipient identified at Duke was a pediatric patient, CDS was referred to Dr. Jaggers, the on-call surgeon in charge of pediatric heart transplants.

2. Dr. Jaggers declined for the first potential recipient, because that patient was not ready for transplant. Dr. Jaggers inquired as to whether the heart and lungs might be available for Jesica Santillan, specifying the patient by name. The CDS organ procurement coordinator offered to check this and call back.

3. CDS contacts Dr. Davis, the on-call surgeon in charge of adult heart-lung transplants and offered a heart-lung block from the same donor for an adult recipient. Dr. Davis declined due to size incompatibility.

4. CDS calls Dr. Jaggers back offering the heart and lungs for Jesica. (CDS and Jaggers discussed organ size. Jaggers does not recall blood-type matching being discussed with CDS but does recall the discussion including the donor's height, weight, organ function and cause of death. Dr. Jaggers assumed that they wouldn't have called back and released the organs if they weren't a match. This was a wrong assumption on his part.)

February 7, 2003

The procuring team, including a Duke University Hospital surgeon, traveled to the hospital where the donor was located. The procuring surgeon examined the organs and judged them to be of good quality. He called Dr. Jaggers and was directed to procure the heart and lungs.

The organs were transported back to Duke University Hospital following a delay due to bad weather.

While the organ procurement team was traveling, Jesica Santillan was admitted to Duke University Hospital's pediatric intensive care unit.

Organ transplantation operation begins at about 4:50 p.m.

Once the organs arrived at Duke Hospital, the recipient's heart and lungs were removed, and the donor organs were implanted.

Following implantation of the organs (approximately 10 p.m.), the surgical team received a call from Duke's Clinical Transplant Immunology Laboratory reporting the organs were incompatible with Jesica's blood type.

Initiation of plasmapheresis and high dose immunosuppressants were begun in an effort to prevent organ rejection.

Jesica was transferred to PICU on conventional support, which included mechanical ventilation.

After surgery, Dr. Jaggers immediately informed the family and their supporters about the mistake in blood type matching.

Duke immediately notified United Network for Organ Sharing about the ABO incompatibility and the need for new organs for Jesica.

February 8-9, 2003

Jesica continued to receive aggressive therapy for the treatment of organ rejection, including plasmapheresis and the administration of high dose immunosuppressants.

February 10, 2003

In the morning, Jesica was removed from mechanical ventilation.

Over the course of the afternoon, her lung function deteriorated, and mechanical ventilation was resumed.

Lung function continued to decline, and ECMO support was initiated.

February 11-18, 2003

Medical therapies continued during the search for new organs.

February 19, 2003

In consultation with a neurologist, a CT scan was performed to evaluate the brain. Findings did not imply irreversible brain damage.

In the evening, heart and lungs of the same blood type as Jessica were offered to Dr. Jaggers, and he accepted them for Jesica.

The Duke transplant coordinator confirmed the blood type compatibility with Dr. Jaggers and then subsequently with the CDS coordinator.

February 20, 2003

Shortly after midnight, Dr. Jaggers discussed the possible second heart-lung transplant with Jesica's family and supporters who wished to proceed with the transplant.

Dr. Jaggers received confirmation from the procuring Duke surgical team of organ acceptability and blood group compatibility.

5:15 a.m. - Jesica was transported to the operating room from the intensive care unit.

6 a.m. - Drs. James Jaggers and Duane Davis began the second transplant surgery.

10:15 a.m. - Transplant surgery completed, and Jesica was transported from the operating room to the PICU off ECMO but on conventional support that included mechanical ventilation.

Jesica's heart and lungs were functioning acceptably. There was no evidence that her neurologic status or other bodily functions had changed.

February 21, 2003

2 a.m. - Jesica's neurologic status declined rapidly.

3 a.m. - Jesica underwent a CT scan of her brain that showed evidence of bleeding and swelling. Shortly thereafter, a catheter was placed to drain fluid and to measure the pressure in her brain.

9 a.m. - Clinical evaluation of Jesica by the neurologist showed no brain function.

10 a.m. - CT scan of her head showed further deterioration of her brain.

11 a.m. - Jesica's family was informed that additional diagnostic tests would be performed. The electroencephalogram (EEG) showed no electrical brain activity, and the perfusion scan of the head showed no blood flow to the brain.

February 22, 2003

7 a.m. - A neurologic examination of Jesica was performed. Her family and supporters were informed that there was no evidence of brain activity and that this likely indicated that Jesica had suffered brain death. A confirmatory neurologic examination was scheduled for midday.

1 p.m. - Jesica underwent a second neurologic examination that confirmed that she met the criteria for the declaration of brain death.

1:25 p.m. - Official time of death.

Note: Life support was continued throughout the afternoon so that family and friends could say good-bye. Medications for the heart were discontinued at 5 p.m., and her heart rate began to slow. Her heart stopped at 5:07 p.m., and ventilator support was then discontinued at 5:10 p.m.

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