A Miracle Denied

By Unmesh Kher with Paul Cuadros Sunday, Feb. 23, 2003
    • AP

    Mack Mahoney leans over Jesica Santillan at the Duke University Hospital in Durham, N.C.

    Jesica Santillan's story had all the makings of the American miracle. There were the immigrants: Jesica—the shy 17year-old battling a congenitally enlarged heart and failing lungs—and her poor, devout parents, who three years ago paid a coyote to smuggle Jesica and themselves into the U.S., where they hoped to find help for the dying girl. There was the wealthy philanthropist Mack Mahoney, who read of Jesica's plight in a North Carolina paper and made it his mission to get her a heart-and-lung transplant to try to save her life. Finally, there was the venerable institution where the story would unfold, Duke University Hospital, renowned for the brilliance and dexterity of its surgeons.

    Jesica had her surgery on Feb. 7. And so the story should have had its happy ending, except that Jesica got the wrong organs—a heart and a pair of lungs from someone with type-A blood, not Jesica's type O. Her immune system rejected the organs, and over the next few days, Jesica suffered seizure after seizure and was sustained only by life-support machines. Her new heart, ravaged by the immune assault, started to fail, and Jesica's tale turned from the stuff of American mythology into that of American tragedy. After a rare second transplant, doctors on Saturday told her parents Jesica was brain dead.

    Her benefactor, Mahoney, has emerged from the ordeal embittered and more than a little hoarse from fielding media interviews. Mahoney says Duke officials misled Jesica's parents, who barely speak English, about the gravity of Jesica's condition. "Dumb Mexicans—that's how they saw (the Santillans)," he growls. He says he had to fight the hospital to make it admit to—and attempt to fix—the mistake. He also claims that Duke officials refused to let him see the girl when they learned he was taking her story to the press. Says the hospital's CEO, Dr. William Fulkerson: "I think we have been honest and forthcoming with the family and will continue to (be) so."

    But the publicity had its effect. And a call that Senator Elizabeth Dole made to Mahoney asking about Jesica—when he happened to be meeting with Duke's administrators—probably didn't hurt. Duke officials publicly accepted responsibility for the botched operation last Monday. Three days later, a new set of organs, for which recipients typically have to wait a year or two, made its way to Jesica. But it came two weeks too late. Jesica's latest set of heart and lungs was working well, but the trauma had caused irreparable brain damage.

    The hospital's once gleaming reputation has taken a beating. How could its surgeons have erred so egregiously? Fulkerson says the procedures that should prevent such errors broke down twice: when the surgeon, Dr. James Jaggers, instead of checking, assumed that the blood type of the donated organs matched Jesica's and when he failed to verbally confirm that assumption with Carolina Donor Services, the organ-donor agency. "Jesica's case has clearly sent a warning to transplant centers," says Dr. David Yuh, a transplant surgeon at Johns Hopkins Hospital in Baltimore, Md., where the transplant staff is double-checking its own organ-matching processes.

    Another question is ethical: How did Jesica get her last set of organs so quickly? There are about 200 very sick people waiting to get heart-and-lung combinations in the U.S., and Jesica seems to have leapfrogged the entire list. Carolina Donor Services says the organs were not directed to Jesica by the donor family. The likely answer is that the urgency of Jesica's need pushed her to the front of the line, which is accepted practice. Duke's error may have cost others as well: those waiting for just one of those organs.

    The hospital's handling of the disaster has cost Duke whatever gratitude it had earned from the Santillans for writing off the 20% of Jesica's surgery not covered by insurance. On Saturday, the Santillans argued with doctors to keep her on life support, but the absence of brain activity is a legal definition of death, and the machines were disconnected. The family is not donating any of her organs. Earlier in the week, Jesica's mother Magdalena had thanked the media for keeping the spotlight on the case. Without sustained attention, she suggested, "they would have let my baby die." Ultimately, no amount of media attention could guarantee Jesica a miracle.