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February 23, 2003
Second Chances
While what happened to Jesica Santillan is tragic, her parents' refusal to allow any of her organs be donated to others - including the new heart and lungs that were implanted 2 days ago - is unbelievable.
Like most everyone else, I don't understand how such a mistake - using organs of the wrong blood-type - could be made in the first place. In an interview I heard with a doctor who is familiar with transplant procedures, he commented that there are usually at least 5 checks made to ensure that the organs will be compatable with the patient, including blood type. Additionally, Duke University has admitted that the organs were properly labeled as being Type A, when the patient was Type O, and that the Dr. James Jaggers had failed to double-check the blood type before implanting the first set of organs.
I cannot deny that when an error of this magnitude is made, there should be some special considerations given when deciding how to handle it. The problem is, after the initial error was made, Jesica's body underwent horrific stresses while on life support, waiting to see if a second transplant could be done. By the time the new organs were located, doctors believed she had little chance of surviving - her own doctors put it at no better than 50% - even with a 2nd transplant, and it was unclear what kind of life she might have if she did survive.
Doctors not connected to her case, however, were pessimistic. The one-year survival rate for transplanting a heart and both lungs as a unit is ordinarily about 60 percent, but Jésica's case is far from ordinary.
Heart transplant surgeons from other hospitals said there were no studies to provide specific odds of survival, but they put them at less than 50 percent short term.
``It is a long shot for her to recover,'' said Dr. Robert C. Robbins, who directs the heart-lung and lung transplant center at Stanford.
Unlike Jésica, most patients who receive second heart transplants do so because their immune systems reject the donor organs. Because the heart and lungs Jésica received came from a person with a different blood type, her body mounted a monster attack on the mismatched organs.
The blood type incompatibility is generally more serious in transplanting lungs because lung tissue has a propensity to react very strongly immunologically, the doctors said.
One of the most cruical factors in dealing with any kind of a transplant situation is time, and, according to the Boston Globe, the hospital may have wasted as much as a week by not immediately admitting that an error had been made.
Yesterday, Mahoney said he believes that the Duke doctors had wasted valuable time by not publicly admitting their error for more than a week. ''Life support ruins kidneys, it ruins brains, it ruins all the organs of the body,'' he said, accusing hospital officials of having ''played with that little girl's life'' as they tried to decide whether to admit to making a mistake.
It easy for me to sit here and look at the situation in the abstract - I have no personal connection to the Santillans or anyone else involved, and have never even known someone in need of a transplant. What I do know, though, is that many people wait for years on a list, hoping and praying that they will get that second chance a transplant can give them. Jesica herself had been on the translant list for three years before her first operation. Yet after the error was admitted, after her body had already been brutally damaged by its own attempts to fight off the immunological effects of the botched transplant, and after the case became known to the media, it was less than a week before new organs were found to make a second try. It was less than 2 weeks overall from the date of the inital transplant attempt.
It's hard to say this, as I'm sure many will think me cold and unfeeling, but would compassion have not been better served if those 2nd organs had gone to someone who had a real chance of survival? If there hadn't been anyone else who could have used them (and I don't know for sure if there was - but given the number of people awaiting transplants, I have to think that the odds are good that there would have been), then, by all means, try the 2nd transplant for Jesica - but wouldn't it have made more sense to have given them to someone else who had also been waiting for years, whose body would have been strong enough to accept them and make use of them?
Regardless, I find it unimaginable that her parents would not have allowed whatever of her organs could possibly have been used for someone else to have a chance to live. I have no doubt that there will be a debate rise from this entire incident - part surrounding the questions I raised above, and part from two other factors: her parents refusal to donate her organs to anyone, and the fact that her parents illegally entered this country 3 years ago in order to get a transplant for Jesica. It will be interesting to see what shape the debate takes, as we strive to balance practicality, hope and compassion.
Update: Reading a bit further, it seems that after she was declared brain dead, her doctors stopped giving her medication that was keeping her heart beating. In a discussion at MetaFilter, many are saying that this should help mitigate the parents' decision not to allow any of her organs to be used for transplant, especially since it was massive medical negligence that killed her. I can understand the sentiment, but I don't agree. If the girl was brain dead and her body was only funcitoning because of machines and medicines - and there was no hope at all for her recovery (not just no meaningful hope, but no hope whatsoever), then, tragically, Jesica was dead.
Others have noted that its likely none of her organs could have been used - but that is speculation only. Because her parents refused to even consider donating any of her organs, the viability of doing so wouldn't have been checked. Maybe there wouldn't have been anything that could have been used - and if that were the case, then that would be the end of it. But even though I know her parents are going through a horrific time right now, I still cannot comprehend or agree with their decision to not try to help someone else. Their daughter's only chance depended on the kindness of strangers who had also just lost a loved one - in this case, specifically a child, as only child-sized organs would work for Jesica. In the last two weeks, two sets of parents have lost their children and been able to overcome their grief and emotional turmoil enough to say "yes" when asked about donating those organs. Because of that, Jesica was able to have two operations to try and save her life.
Posted by thorswitch at February 23, 2003 01:41 AM
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