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Chronology of events regarding Jesica Santillan compiled by Duke University Medical Center Press Office.

Evening of February 6, 2003

*Carolina Donor Services (CDS) makes initial offer of a transplantable heart to Duke University Hospital.

1.CDS first contacted Dr. Armando 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. James 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. Duane 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.

*While the organ procurement team was traveling, Jesica Santillan was admitted to Duke University Hospital's pediatric intensive care unit.

*Once the organs arrive at Duke Hospital, the recipient's heart and lungs were removed and the donor organs were transplanted.

*Following implantation of the organs, 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.

*Jessica 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

*Jesica continued to receive aggressive therapy for the treatment of organ rejection, including plasmapheresis and the administration of high dose immunosuppressants.

February 10-18

*Medical therapies continued during search for new organs.

February 19

*Heart and lung of the same blood type as Jesica were offered to Dr. Jaggers, and he accepted them for Jesica.

February 20

*Shortly after midnight, Dr. Jagger discussed the possible second heart-lung transplant with Jesica's family and the supporters who wished to proceed with the transplant.

*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

*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 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

*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 the ventilator support was then discontinued at 5:10 p.m.
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Article Details
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Publication:Transplant News
Geographic Code:1USA
Date:Feb 28, 2003
Previous Article:OPTN/UNOS Statement Regarding Jesica Santillan's Transplant.
Next Article:E-mail message sent to UNOS board members and a number of media outlets.

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