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What They Said: Statements on Jesica Santillan

Excerpts from public statements and news coverage of Jesica Santillan

I have never been more proud to be a part of the Duke University Medical Center family than I am right now. This statement may seem strange at a time when our institution is under such duress and international scrutiny because of a tragic event surrounding a patient who was in our care.

The treatment of Jeca Santillademonstrates the strengths and weaknesses of our nation's healthcare system. An impoverished individual from a foreign country who would certainly have died of a fatal heart disease came to Duke to benefit from a surgical procedure that requires technology at least as complicated as that needed to send a human to the moon and back. The surgical procedure was performed with technical excellence second to none, but tragically her organs were rejected due to a blood type mismatch. The tragic outcome of this heroic procedure was the result of human errors and an insufficient backup system.

The response to the tragedy, however, was a true test of our institution. When the surgeon, Dr. Jim Jaggers, understood the problem of the mismatch, he immediately assumed responsibility for his role, informed the family, and placed the patient on the priority list for a second heart-lung transplant. He signaled the problem to the institution which immediately initiated a sentinel review process and instituted corrective actions to prevent such mishaps in the future. The nature of the error and the international press attention has put our institution under the magnifying glass by the outside world as never before.

Ralph Snyderman, M.D. Chancellor for Health Affairs


Jeca Santillawas pronounced dead by Dr. Eva Grayck, the attending physician in the pediatric intensive care unit, following declaration of brain death by the attending neurologist at 1:25 p.m. Saturday (Feb. 22, 2003). Dr. Grayck told the family that we were very sorry but Jeca had died. All criteria to determine brain death had been met including multiple clinical examinations and confirmatory tests, such as an EEG, cerebral perfusion study and apnea tests. The critical message that we tried to convey, with the assistance of interpreters, was that Jeca was dead. All requests by the family, such as second opinion or continuation of ventilator and medication support, were not options in the setting of death. By North Carolina law it is up to the physician to stop all support once the patient has died. We explained to them that Jeca was not in a coma or a vegetative state and therefore it was not the family's option to maintain her on a ventilator. After Jeca's family and clergy had time to be with her and offer prayers and last rites, we made the decision to stop infusion of the medications supporting her heart at 5 p.m. and by 5:07 p.m. her heart stopped. We then turned off the ventilator at 5:10 p.m.

Karen Frush, M.D. chief medical director of children's services


As Jeca's surgeon I am ultimately responsible for the team and for this error. I personally told the Santillafamily about the errors that were made and then tried to do everything medically possible to treat Jeca and try to save her life. The staff at Duke Hospital, including the staff of the pediatric ICU and the other transplant surgeons, supported me in this effort. We put our all into what was, unfortunately, a losing battle.

Everyone at Duke Hospital made great efforts to provide Jeca with a better life and we failed. We all join the family in their sense of devastation. I hope that we, and others, can learn from this tragic mistake and move forward to make the process safer and available to more of those in need. To do otherwise would fail to properly honor Jeca and her memory."

James Jaggers, M.D. Surgeon for Jeca Santilla/STRONG>

In the midst of a tragic event such as Jeca's death, those of us who have cared for her throughout her ordeal cannot truly comprehend the depth of her family's sorrow and grief over losing their daughter. Yet we, as her medical team, have experienced a unique sense of pain and sorrow that comes with the loss of one of our children. Despite our most diligent efforts and our most compassionate care, we were unable to save a young life, a reality that is extraordinarily painful and difficult to accept. We continue to include Jeca, her family, and all the families in the pediatric intensive care unit in our thoughts and prayers, for we live their losses and triumphs each and every day.

We also include in our prayers our colleague and friend Dr. James Jaggers. We know that he has experienced overwhelming grief and despair. Yet we hope the knowledge of all the children he has saved, and the prospect of children he will someday save, can bring him some peace in this time of sorrow. It has been our great blessing to work along side him and to witness, firsthand, his unique combination of skill, compassion and honesty with patients and staff alike. He is a great teacher and an inspiration to all of us with whom he works.

Pediatric Intensive Care Unit staff


With the nation facing a dire shortage of human organs, the case of Jeca Santillarenews long-simmering questions in medical ethics: Should surgeons perform second transplants on patients like Ms. Santilla whose chances of survival are diminished because they have rejected their first organs? Or should others on the waiting list come first?

In the case of Ms. Santilla the 17-year-old patient at Duke University Hospital who was mistakenly given a heart and lungs that did not match her blood type, the debate is especially poignant. That is because her body rejected the organs because of a medical mistake that her doctors, who gave her a second heart and lungs on Thursday, are furiously trying to correct.

"This is a horrible moral tension," said Arthur Caplan, a professor of bioethics at the University of Pennsylvania who has written extensively about transplant ethics. "Doctors feel an obligation to their patient in any transplant situation. They feel a special obligation when they made a mistake that is causing the death of this patient. Now they are trying to rescue her. This makes perfect sense, but it isn't necessarily the best national policy."

New York Times, Feb. 21


If there is to be a good use for this story, let it awaken the conscience of all those Americans who, for whatever reason, resist offering to donate their organs upon their death. The United Network for Organ Sharing (UNOS), which coordinates donations nationwide, reported yesterday that there were 80,438 people on its waiting list. That's roughly equal to the population of Upper Darby. Or the city of Camden.

The toughest ethical issues raised by a story like Jeca Santillas would evaporate if that number, instead, were zero. It is only in the context of a severe shortage of organ donations that we debate how former Pennsylvania Gov. Robert Casey received a heart and liver transplant so quickly in 1993. And whether baseball hero Mickey Mantle deserved a new liver when he was extremely sick eight years ago.

Philadelphia Inquirer, Feb. 25


In the days since Jeca Santillas death, much attention has been paid to what went wrong at Duke Hospital during two heart-lung transplants that cost the 17-year-old her life. Certainly those events deserve scrutiny, but it is just as important to look for the good that has arisen from her ordeal.

Jeca's plight brought national attention to the scarcity of donor organs. The subject has been planted into our consciousness as never before.

Durham Herald-Sun, Feb. 26


This front-page tragedy is an important reminder of the enormous number of fatal medical errors -- from 44,000 to 98,000 a year, according to the now famous 1999 report from the Institute of Medicine. But so far it seems the fallout from the case is likely to teach the wrong lessons about how to reduce the number of such errors. Yes, the surgeon handbook probably instructs Dr. Jaggers to double-check that the blood types of the donor and the organ match. But in this case, as in most similar cases, it's likely that the system failed to work in several places; personnel at the hospital and the donor bank crossed signals, and no one ultimately coordinated the information. . . . Perhaps this latest tragedy will force hospitals to rethink. Washington Post, Feb. 26