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Chronology of Events Regarding Jesica Santillan

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Duke Health News 919-660-1306

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.

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