Duke Continues Review of Jesica Santillan Case

Nearly a week after the death of 17-year-old Jesica Santillan, Duke University Hospital is continuing its investigation of a transplant error that has prompted intensive media scrutiny and public discussion of related medical, legal and public policy issues.

Jesica underwent a second heart-lung transplantation on Feb. 20 after her body rejected the first set of organs, transplanted on Feb. 7, because they were not the correct blood type. The second set of heart and lungs was successfully transplanted, but on Friday, Feb. 21, doctors treating Jesica detected significant worsening of brain function. Despite aggressive medical support, her condition worsened, and she died the next day.

"All of us at Duke University Hospital are deeply saddened by Jesica's passing," said William J. Fulkerson, M.D., chief executive officer of Duke University Hospital. "Jesica's care team is especially saddened. We want Jesica's family and supporters to know that we share their loss and their grief. We very much regret the heartbreaking circumstances surrounding her care.

"The original mismatch was a tragic error, and Duke accepts responsibility for our mistake," continued Fulkerson. "Every effort was made to save Jesica's life. I give my heartfelt sympathy to Jesica's family and supporters, and I thank the entire care team who worked so hard to sustain her."

(For public statements on the case, see the Medical Center News Office's Web site.)

The case has prompted wide public discussion. Bioethicists have used it as an opportunity to discuss the ethics of organ transplants and reexamine who should be given priority when scarce organs become available. Leaders of organ procurement groups hoped the case would encourage more people to register as organ donors. Public policy experts discussed how the case might affect tort reform legislation pending in Congress.

In the Triangle, concerns about how Duke handled the case were heard alongside a strong outpouring of support for the hospital and Dr. James Jaggers, the respected transplant surgeon who took responsibility for the mistake. In both the Durham Herald-Sun and the Raleigh News and Observer, several letters to the editor from community members expressed sadness for Jesica's family as well as concern for Jaggers.

"We should also offer our sympathy (and admiration) for Dr. James Jaggers, who has taken full responsibility (almost unheard of today) for the mistakes made while Jesica was in the care of Duke University Medical Center," wrote Tom Belton of Apex in Tuesday's News and Observer. "Despite the 'reverence' many of us give to our physicians, they still are only ordinary human beings. By all accounts, Jaggers is a compassionate and skillful surgeon who for years has given of his skills by performing free heart surgery in Nicaragua."

Caregivers at the hospital's Pediatric Intensive Care unit offered similar sentiments in a statement released Wednesday. "It has been our great blessing to work alongside [Jaggers] and to witness, firsthand, his unique combination of skill, compassion and honesty with patients and staff alike," they said. "He is a great teacher and an inspiration to all of us with whom he works. As parents, we would all undoubtedly choose Dr. Jaggers if our children needed the skilled hand of a surgeon.

Last week, the hospital launched a review of the organ procurement process and established additional internal safeguards. Officials there are cooperating with reviews by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), the North Carolina Division of Facility Services, the North Carolina Medical Board, and the United Network for Organ Sharing (UNOS), the organization that coordinates the national organ donor list.

Duke is reviewing all aspects of its organ procurement procedures and has already made changes to ensure that the events that occurred in Jesica's case will not be repeated. The results of the full review are expected any time.