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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
  p.m.
• Once the organs arrived at Duke Hospital, the recipient's
  heart and lungs were removed and the donor organs were
  implanted.
• 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
  rejection.
• 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
  matching.
• 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
  ventilation.
• Over the course of the afternoon, her lung function
  deteriorated and mechanical ventilation was resumed.
• Lung function continued to decline and ECMO support was
  initiated.

February 11-18, 2003

• Medical therapies continued during the search for new
  organs.

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
  Jesica.
• The Duke transplant coordinator confirmed the blood type
  compatibility with Dr. Jaggers and then subsequently with the
  CDS coordinator.

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
  transplant.
• Dr. Jaggers received confirmation from the procuring Duke
  surgical team of organ acceptability and blood group
  compatibility.
• 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
  ventilation.
• 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
  rapidly.
• 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.