News Story: TYPE O patients transplanted in Durham with a TYPE A heart & lung

  1. Just read on the wire service that a teenage female was transplanted with organs that do not tissue match and she is expected to die within a matter of hours.
    How could this happen? I'd hate to be the one responsible for writing an explanation of this sentinel event.
    I'd hate to have this on my conscience.
    Hope we find out where in the checks and doublechecks the process failed.
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  2. 15 Comments

  3. by   Beach_RN
    This is the story! So sad!


    Transplant error leaves girl near death
    Tuesday, February 18, 2003 Posted: 1:28 PM EST (1828 GMT)



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    DURHAM, North Carolina (CNN) -- A Mexican teenager is fighting for her life at Duke University Hospital, where she mistakenly received organs with a different blood type during a heart-lung transplant operation

    Jesica Santillan, 17, was listed in critical condition Tuesday, and the hospital was working to get transplanted organs for her, said Richard Puff, a Duke hospital spokesman.

    Puff said he could not speculate on how much time the teen has to live.

    Jesica received the transplant February 7, according to a hospital statement, which said the error was the "result of a blood type mismatch."

    "Every effort is being made to save Jesica's life," said Dr. William Fulkerson, the hospital's chief executive officer.

    "Our primary concern has always been for Jesica and her family. This was a tragic error, and we accept responsibility for our part," Fulkerson said.

    "This is an especially sad situation since we intended this operation to save the life of a girl whose prognosis was grave. Jesica continues to remain at the top of the national organ donation list."

    Anne Paschke, spokeswoman at United Network for Organ Sharing, said there are critical shortages of organ donors through the United States and finding a donor for a heart-lung procedure is difficult.

    UNOS administers the nation's only organ procurement and transplantation network.

    Paschke said according to the latest statistics only 55 heart-lung transplants took place nationwide in 2001 and 2002, and 197 people were on the waiting list for the procedure as of February 7.

    Jesica, whose family moved to the United States so she could get the transplant, suffered from a heart deformity that affected her lungs, according to The Associated Press. After a three-year wait, she received a transplant with a heart and lungs flown from Boston, Massachusetts, to Durham 10 days ago.

    The organs were sent with paperwork correctly listing the donor's blood type, said Sean Fitzpatrick of the New England Organ Bank, which sent the organs, the AP reported. Despite the paperwork, the girl, who has type O-positive blood, received the type A organs.

    Fulkerson said the mix-up was the first such error after thousands of "successful organ transplants" at the facility.

    He said the hospital was implementing additional safeguards to ensure such an error doesn't happen again.



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    Copyright 2003 CNN. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed. Associated Press contributed to this report.
  4. by   passing thru
    It sounds like they are desperately searching for a new set of organs as that is all that could happen at this point to save her. "She remains at the top of the organ transplant list. !"
    I wonder what massive doses of anti rejection medication and vasopressors and everything else she is receiving !
    What a tragic situation. Unbelievable ! Even with new organs ???? They need a miracle.
    Thanks for the article B Matt
  5. by   debyan
    I know it is so sad, and Duke has such a good rep. deb
  6. by   Darlene K.
    This is a heart breaking story!
  7. by   kittyw
    wow
  8. by   wv_nurse 2003
    I agree it is tragic, and so hard to understand. What makes it doubly sad, is that those organs, which could have helped someone with the right blood type, will be of no use.
    It does make you really appreciate the checks and double checks we perform daily as nurses, and almost take for granted. My prayers go out to this girl, her family, and all those involved.
  9. by   ShandyLynnRN
    Just a question... if she IS able to get a second transplant, will the mismatched organs that will be taken out be able to be used for someone else, or will they be no good now?

    it is indeed a very sad situation!
  10. by   Nurse Izzy
    Wow. I can't even begin to imagine what her family, the medical staff and all others involved are going through.

    ShandyLynnRN, I don't think the organs could be "re-used" - my guess (repeat - guess) is that there would be too much damage done to them by her body as it attacks them.
  11. by   NicuGal
    OMG....that is awful!
  12. by   deespoohbear
    Very tragic.....
  13. by   passing thru
    This mornings new reports she has suffered a heart attack and also seizures last Sunday. It says "One of the countrys' top medical centers is trying to find out how they botched a heart-lung transplant that was supposed to save the life of a young girl and instead has placed her life in deaths' jeopardy.
    The hospital admits the mistake and is investigating to determine whether any staff should be disciplined."
    The patient is being kept alive by a heart-lung machine.
    There's more to the article-- but those are the 2 newest facts. '
    I find it so disturbing and can't figure out how it could have happened. I hope when they learn what happened it will be made public.
  14. by   Tinkertots
    I am an Agency Rn, but work mostly on a Transplant unit. When we know we have an organ, we call in all patients waiting for that organ. We have had 20 people show up. We have 15 min to get the blood to the lab to cross match. Not only that, the work up for a transplant takes several days to weeks. It doesnt just include cross match!!! We have teams of doctors, nurses, transplant coordinaters, PharmDs that are in the decision process. I can't understand how this could happen! I read last night where the surgeon was taking sole responsibility. I just don't get it. Not only will it kill this poor girl, but he could be the cause of another death. Those organs could have been used for the right match....possibly preventing another death.

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