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CNN SATURDAY MORNING NEWS

Weekend House Call: Double Transplant Patient Jesica Santillan Struggle for Survival

Aired February 22, 2003 - 08:30   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

JONATHAN KARL, CNN CORRESPONDENT: And now it's time for "House Call."
Heidi?

HEIDI COLLINS, CNN ANCHOR: All right, thank you, Jonathan.

Today on "Weekend House Call," double transplant patient Jesica Santillan, a sad story, and the questions that have come up about transplants and how such a medical state could ever happen.

Our Elizabeth Cohen has been reporting on this story this week from Durham, North Carolina and joins us now -- Elizabeth, tell us, first of all, what is the latest on Jesica's condition?

ELIZABETH COHEN, CNN CORRESPONDENT: The latest, Heidi, is that Duke University tells CNN that they did an EEG yesterday and they saw no brain activity. They also did a scan of the blood flow to her brain and they saw that there was no blood flowing to the brain. The family has told reporters that doctors have told them that Jesica is brain dead and that they need to do more tests today to confirm that.

(BEGIN VIDEOTAPE)

MACK MAHONEY, FAMILY SPOKESPERSON: If there's no change, then Jesica is officially brain dead, OK? At that time, he'll be 100 percent sure.

COHEN (voice-over): As Jesica's condition has deteriorated, so has the relationship between Duke University and the Santillan family. Jesica's friends and family have become increasingly frustrated with Duke University, even confronting a Duke official at a press conference. They're not just angry because of the original mistake, a transplant surgery February 7 where Duke admits it gave Jesica organs that were Type A when she's Type O. The family says Duke told them immediately about the mistake but didn't discuss it publicly for 10 days. That, they say, was costly, as media attention about the botched surgery would have helped them find another set of organs sooner.

MAHONEY: To me, if the little girl dies, if she dies, they murdered her.

COHEN: Duke says they've searched earnestly for organs and fought hard to save Jesica's life.

DR. WILLIAM FULKERSON, DUKE UNIVERSITY HOSPITAL: I and our entire Duke family have been devastated by this.

(END VIDEOTAPE)

COHEN: Duke University says that she has not officially been declared brain dead yet.

Let's talk a little bit about what it means to be brain dead. That means that there is no brain activity and that it's irreversible. The way that it works is that brain dead is dead. Brain dead is legally dead. When someone is brain dead, the doctor declares them dead and it's the doctor who makes that decision to turn off the respirator. It is not the family's decision.

We would like to answer your questions. There are so many ethical issues around this whole double transplant situation, around Jesica's condition. Our phone number is 1-800-807-2620. You can also e-mail us at housecall@cnn.com.

Now, to help us answer some of your questions, we have with us Dr. Lewis Teperman.

Dr. Teperman is head of transplantation at NYU Medical Center in New York City.

DR. LEWIS TEPERMAN, NEW YORK UNIVERSITY MEDICAL CENTER:

How are you?

COHEN: Doctor, we have -- hi, doctor.

Thank you for joining us.

Doctor, let's start right off with an e-mail that we have from a nurse. We have an e-mail that says, "I'm a nurse giving home care to a teenager on a waiting list for a heart transplant. My patient is an American citizen. While it's unfortunate that this happened, I'd like to know why that girl" -- she means Jesica Santillan -- "a foreigner who has paid no taxes or supported this country, received not just one organ, but three twice while my patient lies dying. All told, those organs could have saved six people, possibly mine."

I8 just want to add in here, Jesica Santillan is Mexican. She came to this country three years ago. Her mother works. In fact, she has health insurance and insurance paid for her first transplant. And as I understand it, doctor, medical centers like yours are allowed to do five percent of their transplants given to people who are not American and even if they are illegal immigrants.

Doctor?

TEPERMAN: Well, usually they have to be legal, but -- because you have a problem about obtaining medications or further care. Certainly, if they're going to be deported it's a problem. But the question is a good one. Five percent is the number that by regulation we're allowed to transplant that are foreigners. And if you get, if that number is exceeded, you will have an audit by an agency. Now, the next question was why this person versus another person? Patients are given organs according to a list and according to how sick they are. The sickest first. So this individual was higher up on the list and then matches, supposed to match for blood type and then a weight range. And the last question was why a double transplant where I suppose someone could have had a heart and then two other people would have had two lungs. And that's a medical decision.

COHEN: OK, Dr. Teperman, thank you.

Dr. Teperman will be staying with us to answer more of your questions about organ transplants and Jesica Santillan's case -- Heidi.

COLLINS: Elizabeth, it is such a sad story. And I want to talk to you when we come back a little bit more about something I'm hearing about Jesica's condition before the first transplant. I was not aware that it was obviously a very dire situation. So we'll talk about where she was at before she ever even had the first operation.

But when we do come back on "Weekend House Call," is a heart/lung transplant too risky? Should they even be performed? We'll look into that and answer your questions. Just call us at 1-800-807-2620 or e- mail us at housecall@cnn.com.

COMMERCIAL

COLLINS: You are watching "Weekend House Call" here on CNN SATURDAY MORNING. And we're talking about transplants, the risks and the rewards. We'll answer you questions. Go ahead and call us at 1- 800-807-2620 or e-mail us at housecall@cnn.com.

We'll be back in 60 seconds. Stick around everybody.

COMMERCIAL

COLLINS: Welcome back everyone.

We want to give you some information there on your screen, as you can see, about the International Organ Donation Program. So there you have it and we'll be talking some more about that in just a moment.

For now, we want to bring back in CNN medical correspondent Elizabeth Cohen to be talking about the transplant tragedy of Jesica Santillan and other medical mistakes.

Before we went to the break, Elizabeth, we were talking about Jesica's condition before the first transplant ever happened.

Can you clear us up a little bit on that?

COHEN: Right. Jesica was born in Mexico 17 years ago with a heart ailment and it was not treated in the way that it would have been treated in the United States, as I understand it. And she became very ill. And she's been on the organ transplant -- she was on the organ transplant list for three years before getting that first set of organs. She was not in great shape before that first surgery. She weighed 85 pounds. And remember, she's 17 years old.

Doctors said she only had months to live without that transplant and, of course, as we all know, that first transplant was done with organs of the wrong type and then two weeks later they did a transplant with organs of the right type.

But she, Heidi, she was not in great shape even before that first surgery -- Heidi.

COLLINS: Right. OK. And we'll talk more about that, I'm sure, later.

We want to right now go to Catherine (ph), who is on the line with us from New York.

Catherine, good morning.

And what's your question?

CATHERINE: Good morning.

Yes, I would like to know who is responsible for making sure that the organs were compatible?

COHEN: Great question.

Doctor, go ahead.

TEPERMAN: It's a great question. There are supposed to be multiple checks. One, the procurement agency. That's the agency that identifies where the organ is going to come from. They blood type it and they offer it to the transplant center and then finally the transplant center must make the determination that the blood type is correct. So it is the physician at the end of the line who is responsible.

COLLINS: And, doctor, if you don't mind, a quick question about that very thing. It seems like with such a huge operation, I mean this was clearly not, I don't know, a tonsillectomy. I mean this is a very big operation. Wouldn't that be one of the very first things to check?

TEPERMAN: Well, it is, and a name is printed up on a transplant list. The list is run by UNOS and we should see the correct blood type on that list. I am told that this patient didn't print up on that list and the surgeon asked to obtain the organ anyhow.

COHEN: We have an e-mail now from Jackie in Philadelphia. Jackie asks, "How long does a person live with a heart/lung transplant? Should these really be done in the first place?"

Dr. Teperman, as I understand it, heart/lung transplants do not have a very high success rate, even when it's just one heart/lung transplant and not two, but that these could be very risky operations. Doctor? TEPERMAN: Right. It's a very rare transplant, perhaps maybe 50 or 60 are done in the United States a year. And most times you're either able to transplant a heart or a lung. So very few conditions indicate that it should be done. But it's still going to save a life and they still should be done. The success rate approaches 60 or 75 percent and so it's a reasonable thing to do, especially if you have a young child that has their whole life ahead of them.

COLLINS: Dr. Teperman, we have another phone call for you.

Eileen is on the line, coming to us from New Jersey.

Good morning, Eileen.

Thanks for calling.

EILEEN: Good morning.

Actually, my question was almost the same as the caller before, so I'll ask a second one then. As far as the waiting list goes -- and I have privy to this. My son was on the waiting list for almost three years for a kidney and he did receive a transplant...

TEPERMAN: Good for him.

EILEEN: Thank you very much. But I think that the public is not really aware that when my son was on the waiting list, at first there were about 40,000 people waiting for a kidney. Now, if you log onto UNOS, you see there's almost 52,000 people waiting for a kidney. Why do you think in this country that the list is increasing so much?

TEPERMAN: Well, we're a very talented country with medical care and, in fact, there are over 80,000 people waiting for transplants of all kinds. One of the most important things that has come out of this is the need, the critical need for organ donors and people in the country just don't give as much as we should. And, in fact, because of this case, the second set of organs came around and because the press was there to tell us how critical this girl needed the organs.

But thousands of people are dying all the time and the cases are not publicized.

COHEN: We have an e-mail now from Roger in California. Roger asks, "Will the organs she rejected be able to be used by another recipient?"

Doctor, if organs don't work out in one patient, do you try them out in another?

TEPERMAN: Roger, that's a brilliant question. You know, the first set of organs we're rejected and they're not usable. They're destroyed. They're damaged by the immune system. But the second set of organs that have only been in there for a couple set of days, it's possible that they could be used for other patients.

COLLINS: Wow, that's amazing. I guess they would have to be, obviously, harvested for a little while longer to go ahead and transplant them into someone else. I did not know that.

Thank you, Dr. Teperman.

We want to take a quick break and think about this question, are doctors and hospitals doing enough to avoid medical mistakes? We will tackle the controversial issue and take more of your e-mails and phone calls.

Stay with us

COMMERCIAL

COLLINS: If you would like to become an organ donor, sign up to be one when you get your driver's license. You can download a donor card at www.shareyourlife.org. Sign your donor card and have two family members sign as witnesses and carry that card with you in your wallet at all times. And most importantly, tell your family about your decision to be a donor. They will be asked to sign off on it at your death.

All right, we are going to go back to Elizabeth Cohen, who also has with her Dr. Lewis Teperman, joining us on the subject this morning. And we also, I believe, have a phone call coming into us from Dallas. He is calling from Las Vegas.

Hi, Dallas. What's your question?

UNIDENTIFIED FEMALE: Hi. I'd like to know is there's steps and procedures that they have to take and why wasn't the doctor like triple checking it? It seems to me that, you know, they just got so used to the same old routine and now this poor girl is on the, is going to die.

TEPERMAN: Well, I think the poor girl, unfortunately, is actually dead. She's brain dead. And we don't know what steps they took or didn't take. We don't know what errors were made exactly. And I'm sure an investigation or a hearing will find that out for us.

COHEN: Doctor, I want to ask you a question. When it's two in the morning and you get that phone call saying we have organs for your patient, John Smith, do you ask is it the right blood type or do you just assume hey, if they're calling me, it must be the right blood type?

COHEN: No, I always ask, I always ask who was ahead of us on the list, who's behind us on the list, why did or did not one of my patients print up? And you should know that I, before I go to sleep, I always check my most critical patients and know their blood type and have them known in my head when an organ is going to become available.

COHEN: OK, we have another e-mail here. This one is from Fred in Dayton, Ohio. Fred says, "This is a horrific mistake. What guidelines are in place to prevent this from ever happening in the future?"

Doctor, do you know anything about, have people, are people like you working on guidelines to see that this kind of thing doesn't happen or is this such a fluke that guidelines aren't necessary?

TEPERMAN: You know, I can't remember this happening in the last 10 years of doing transplantation. There are very strict guidelines to establish both on the procurement site and on the transplanting site what the blood types are. So I'm sure they will be even strengthened. But I doubt that you'll ever see this happen again.

COLLINS: All right, we do have a phone call coming in...

COHEN: Do we have any phone calls?

COLLINS: Sorry, yes, we do.

Chase (ph) in Oregon is on the line now.

Hi, Chase.

CHASE: Hi.

Actually, to the doctor's last comment, there was a similar situation in Oregon about eight years ago and I also wanted to know, we haven't heard anything on possible lawsuits going on.

TEPERMAN: Well, Chase, as you know, I'm sure this is going to be looked at both on the institutional side, the hospital side, the country, the state and I'm sure there'll be legal action taken.

COHEN: I want to add here, I asked a lawyer, I asked the -- the family has hired a medical malpractice lawyer to, he says he's there to help handle the media. And I said are they going to sue? And he said they have not mentioned that to me yet. Of course, if there is a suit, I mean it has the potential to be just huge.

Let's read from another e-mail. Dave in Boulder, Colorado says, "What strikes me as truly remarkable in this day and age is that Dr. James Jaggers" -- that's the surgeon who did the first surgery where he made a mistake -- "took responsibility for the mistake when he could have easily cast blame elsewhere. Mistake or no mistake, this is the kind of doctor, no, the kind of person that we could use more of in our world. Personal responsibility, how refreshing."

I do think it's interesting that as I talked to the family, they seemed really less angry at the doctor than at the Duke administration. I mean the doctor obviously made a terrible error and he said to them, "Do you want me to continue being your doctor or do you want to switch to some else?" And they asked him to stay on the case. They said they did not question his surgical capabilities. They are furious with Duke because they think that they have not handled this situation well.

Doctor, when you heard that he had taken responsibility for this, what went through your mind?

TEPERMAN: First off, I thought he did the right thing for taking responsibility and he's a very talented surgeon, a very well known surgeon. And mistakes do happen. Inadvertent errors do happen. And he was trying to do the best for his patient.

Now, there is a mistake here, a terrible tragedy, a death, and we'll see what's going to happen to him. But I think it's very proactive that he took the high road and took responsibility.

COHEN: Doctor, thank you.

And we'll come back with more questions on this issue -- Heidi.

COMMERCIAL

COHEN: Welcome back to "Weekend House Call," where we're discussing the Jesica Santillan transplant case.

We're here with Dr. Lewis Teperman, who's head of transplantation at New York University Medical Center.

Dr. Teperman, any final thoughts?

TEPERMAN: Well, I think we're going to see corrective action take place. But one of the most important things now is to realize how critical a donor shortage we have. This girl and this tragedy tell us about this. And if people will now donate and realize that so many people are waiting on the list, we'll be able to transplant that many more people and do it correctly.

Thank you for having me.

COHEN: Thank you, Dr. Teperman.

To summarize Jesica's condition, Duke says that an EEG shows no brain activity and a blood flow scan shows no blood flow to the brain. The family says they will be doing more tests today.

Tomorrow, our "Weekend House Call" will be on ephedra, following the death of pitcher Steve Beckler. There are more questions about the safety of this herbal supplement. We'll take your e-mails at housecall@cnn.com.

TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com



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