Chronology of Events Regarding Jesica Santillan
Evening of Feb. 6, 2003
- Carolina Donor Services makes initial offer of a
transplantable heart to Duke University Hospital.
1. CDS first contacted Dr. Milano, the on-call surgeon
in charge of adult heart transplants. Because the first
potential recipient identified at Duke was a pediatric
patient; CDS was referred to Dr. Jaggers, the on-call
surgeon in charge of pediatric heart transplants.
2. Dr. Jaggers declined for the first potential
recipient, because that patient was not ready for
transplant. Dr. Jaggers inquired as to whether the heart
and lungs might be available for Jesica Santillan,
specifying the patient by name. The CDS organ procurement
coordinator offered to check this and call back.
3. CDS contacts Dr. Davis, the on-call surgeon in charge
of adult heart-lung transplants and offered a heart-lung
block from the same donor for an adult recipient. Dr. Davis
declined due to size incompatibility.
4. CDS calls Dr. Jaggers back offering the heart and
lungs for Jesica. (CDS and Jaggers discussed organ size.
Jaggers does not recall blood-type matching being discussed
with CDS, but does recall the discussion including the
donor's height, weight, organ function and cause of death.
Dr. Jaggers assumed that they wouldn't have called back and
released the organs if they weren't a match. This was a
wrong assumption on his part.)
February 7, 2003
- The procuring team, including a Duke University Hospital
surgeon, traveled to the hospital where the donor was
located. The procuring surgeon examined the organs and judged
them to be of good quality. He called Dr. Jaggers and was
directed to procure the heart and lungs.
- The organs were transported back to Duke University
Hospital following a delay due to bad weather.
- While the organ procurement team was traveling, Jesica
Santillan was admitted to Duke University Hospital's
pediatric intensive care unit.
- Organ transplantation operation begins at about 4:50
- Once the organs arrived at Duke Hospital, the recipient's
heart and lungs were removed and the donor organs were
- Following implantation of the organs (approximately 10
p.m.), the surgical team received a call from Duke's Clinical
Transplant Immunology Laboratory reporting the organs were
incompatible with Jesica's blood type.
- Initiation of plasmapheresis and high dose
immunosuppressants were begun in an effort to prevent organ
- Jesica was transferred to PICU on conventional support
which included mechanical ventilation.
- After surgery, Dr. Jaggers immediately informed the
family and their supporters about the mistake in blood type
- Duke immediately notified United Network for Organ
Sharing about the ABO incompatibility and the need for new
organs for Jesica.
February 8-9, 2003
- Jesica continued to receive aggressive therapy for the
treatment of organ rejection, including plasmapheresis and
the administration of high dose immunosuppressants.
February 10, 2003
- In the morning, Jesica was removed from mechanical
- Over the course of the afternoon, her lung function
deteriorated and mechanical ventilation was resumed.
- Lung function continued to decline and ECMO support was
February 11-18, 2003
- Medical therapies continued during the search for new
February 19, 2003
- In consultation with a neurologist, a CT scan was
performed to evaluate the brain. Findings did not imply
irreversible brain damage.
- In the evening, heart and lungs of the same blood type as
Jessica were offered to Dr. Jaggers, and he accepted them for
- The Duke transplant coordinator confirmed the blood type
compatibility with Dr. Jaggers and then subsequently with the
February 20, 2003
- Shortly after midnight, Dr. Jaggers discussed the
possible second heart-lung transplant with Jesica's family
and supporters who wished to proceed with the
- Dr. Jaggers received confirmation from the procuring Duke
surgical team of organ acceptability and blood group
- 5:15 a.m. – Jesica was transported to the operating room
from the intensive care unit.
- 6 a.m. – Drs. James Jaggers and Duane Davis began the
second transplant surgery.
- 10:15 a.m. - Transplant surgery completed and Jesica was
transported from the operating room to the PICU off ECMO but
on conventional support that included mechanical
- Jesica's heart and lungs were functioning acceptably.
There was no evidence that her neurologic status or other
bodily functions had changed.
February 21, 2003
- 2 a.m. - Jesica's neurologic status declined
- 3 a.m. - Jesica underwent a CT scan of her brain that
showed evidence of bleeding and swelling. Shortly thereafter,
a catheter was placed to drain fluid and to measure the
pressure in her brain.
- 9 a.m. - Clinical evaluation of Jesica by the neurologist
showed no brain function
- 10 a.m. - CT scan of her head showed further
deterioration of her brain.
- 11 a.m. - Jesica's family was informed that additional
diagnostic tests would be performed. The electroencephalogram
(EEG) showed no electrical brain activity and the perfusion
scan of the head showed no blood flow to the brain.
February 22, 2003
- 7 a.m. - A neurologic examination of Jesica was performed
and her family and supporters were informed that there was no
evidence of brain activity and that this likely indicated
that Jesica had suffered brain death. A confirmatory
neurologic examination was scheduled for midday.
- 1 p.m. - Jesica underwent a second neurologic examination
that confirmed that she met the criteria for the declaration
of brain death.
- 1:25 p.m. - Official time of death.
Note: Life support was continued throughout the afternoon so
that family and friends could say good-bye. Medications for the
heart were discontinued at 5 p.m. and her heart rate began to
slow. Her heart stopped at 5:07 p.m. and ventilator support was
then discontinued at 5:10 p.m.