ONLINE UPDATE (2/22/2003, 6 p.m.): Doctors at Duke University Hospital have removed Jesica Santillan from life support.
ONLINE UPDATE (2/22/2003, 5 p.m.): The family of Jesica Santillan has been informed the girl is brain dead, an attorney for the family told news media Saturday. Santillan was pronounced brain dead at 1:25 p.m. by Duke Hospital doctors. Tests early Saturday indicated that Jesica had lost all brain activity and that blood was no longer flowing to her brain, which had begun swelling and bleeding shortly after the second heart-lung transplant. She remains on life support.
ONLINE UPDATE (2/20/2003, 4 p.m.): If Jesica Santillan survives, she may have "irreversible brain damage," Duke Hospital doctors reported at a Friday press conference. A brain scan performed early Friday revealed swelling, and a neurologist later confirmed an assessment of the 17-year-old was consistent with permanent brain damage. Hospital officials said they expect to know more about her condition within the next 24 hours.
Following a second heart-lung transplant performed Thursday morning at Duke Hospital, 17-year-old Jesica Santillan is off life support and doctors are giving her a fighting chance.
This most recent surgery became necessary after Hospital surgeons transplanted a heart and lungs of the wrong blood type into Jesica Feb. 7, causing the girl's body to reject the organs and for her health to enter into sharp decline. Doctors believe she suffered from a heart attack, stroke and severe kidney failure as a result.
Although doctors said it is too soon to fully judge Jesica's status after the most recent transplant, the four-hour procedure went smoothly and her heart and lungs are functioning on their own. She is still listed in critical condition.
"She's as critical as a person can be. I really can't say that someone could be any sicker," said Dr. Duane Davis, associate professor of thoracic surgery and surgical director of the Hospital's lung transplant program, during an afternoon press conference in Hanes House. "We are going to have to wait to see how she recovers.... There's nothing we know right now that says the damage is irreversible."
Hospital Chief Executive Officer Dr. William Fulkerson would not comment on the organs' donor except to say they came through normal channels, countering suspicions about the quick organ procurement. Jesica had waited three years for the first transplant.
Carolina Donor Services, the regional transplant office, noted in a Thursday statement that the organs were not procured as a "direct donation" to Jesica.
A CAT scan performed late Wednesday implied a lack of significant brain damage, which preserved her eligibility to receive organ donations.
Without a replacement for the mismatched organs, Jesica was not expected to live through the week. At 11:30 p.m. Wednesday, however, Duke received a call from CDS about the availability of potentially compatible organs.
After confirmation that the organs matched, the transplant was performed from about 6 a.m. to 10:15 a.m. by Davis and Associate Professor of Surgery Dr. James Jaggers - who also performed the initial operation. The family requested that another surgeon oversee Jaggers for the latest procedure.
Jaggers remained with Jesica in the intensive care unit throughout the day, and previously expressed contrition for his errors in a Wednesday press release. "I continue to oversee Jesica's care and have been devastated by this tragic event," he said.
During the afternoon news conference, Fulkerson pointed to two major errors made by Jaggers during the Feb. 7 transplant - one in assuming a blood type match had been made when he requested the organs from CDS, and the other in failing to verbally confirm the blood type.
During a morning press conference, family friend Mack Mahoney - who retains medical power of attorney for the girl because her parents do not speak English - said the family was "relieved" by the new events and he praised the Hospital's work on the latest operation.
By the afternoon, Mahoney's tone had changed dramatically. In an impromptu discussion with the media, held despite the objections of Duke officials, he harshly criticized the Hospital's actions following the failed Feb. 7 operation.
Mahoney accused the Hospital of initially underplaying the severity of its mistake and leading the family to believe the blood mismatch would easily be handled by drug treatment. As a result, the news blitz begun by Mahoney in hopes of attracting an organ donation was delayed, and the holdup increased the chances of permanent damage to Jesica, he said.
"You can't hide behind a corporate veil when children's lives are at stake, and that's what happened here," he said. "If we hadn't put [Duke] right square in sight of the world, [Jesica] would be dead today."
Mahoney also claimed that Hospital administrators tried to limit his access to Jesica against the wishes of her parents and to stop the family from speaking to the press. "You name it, they tried it," he said. "Duke bullied me around.... I was talking to the press and they didn't like it."
Medical Center officials declined to comment on Mahoney's assertions.
The North Carolina Department of Facility Services is currently inspecting the Hospital's transplantation program following report of the error. In addition, the national accrediting organization for health care facilities is mandating that the Hospital submit a thorough review of its transplantation procedures and analysis of the system's failure within the next 45 days.
The Hospital has already launched such an investigation, and has also strengthened its transplant confirmation procedures - three additional physicians confirmed a blood match for Jesica's second transplant.
Dave Ingram contributed to this story.
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