Faculty Bibliography

After reviewing Ms. [Jesica Santillan], Duke officials began requiring three members of the transplant team to verbally communicate the results of the tests of the donor's and recipient's blood types, which are important in determining compatibility. Duke had not required it before. ''We believe that the changes we have put in place enhance the safety of the procurement process and should be considered as a national guideline,'' said Dr. William J. Fulkerson, vice president and chief executive of Duke University Hospital, and Dr. R. Duane Davis, surgical director of Duke's transplant program. Others believe that such changes should be determined by independent panels, not the hospitals that make the errors. Ms. Santillan's case ''is an unfortunate but pertinent illustration of the fact that these kinds of errors in complex situations are systematic errors,'' said Dr. Joseph J. Fins, an internist and the director of medical ethics at New York Hospital-Cornell Medical Center, ''and we need to devote as much money to the prevention of error and understanding of the systems that can engender error as we do to the understanding of the immunology of transplantation.''

Medical errors are thought to be responsible for as many as 98,000 deaths in the United States every year, and the nation's most august hospitals are far from immune. The errors have often resulted, as in Duke's case, not from a failure of cutting-edge medicine but from lapses in the most basic safety procedures. In 1999, the Institute of Medicine of the National Academy of Sciences reported that medical errors kill 44,000 to 98,000 people a year and that many of these deaths could be prevented by improving safety measures. Most medical errors do not result from individual recklessness, but from basic flaws in the way hospitals and clinics operate, the report said

Once the organs arrived, [Jesica Santillan]'s heart and lungs were removed and the donor organs were implanted. Santillan was removed from the heart-lung bypass machine and the organs functioned well for 30 or 40 minutes. Then they began to fail and Santillan was returned to the machine. Moments later, the operating room heard the from the transplant immunology lab: 'The transplant was ABO incompatible with the recipient.'

The vaccine, known as Aidsvax, is made from a protein called gp120, the same protein that protrudes from the surface of HIV and helps the virus dock with cells of the body's immune system. The protein in the vaccine is made in genetically engineered hamster ovary cells. Since the vaccine consists of only one protein and not the whole virus, it cannot give someone AIDS. But it is designed to provoke the immune system into making antibodies that will latch on to the gp120 protein in the real virus and the virus from infecting immune cells

The vaccine did seem to significantly lower the infection rate among African-Americans and other non-Hispanic minorities participating in the trial, the company said. Its researchers called this finding totally unexpected and said they were at a loss to explain why there would be ethnic differences in response to the vaccine. They conceded that the findings, though statistically significant, might change if the vaccine were tested among more members of minorities, who were only a small fraction of the people in the trial. The vaccine, known as Aidsvax, is made from a protein called gp120, the same protein that protrudes from the surface of HIV and helps the virus dock with cells of the body's immune system. The protein in the vaccine is made in genetically engineered hamster ovary cells. Since the vaccine consists of only one protein and not the whole virus, it cannot give someone AIDS. But it is designed to provoke the immune system into making antibodies that will latch on to the gp120 protein in the real virus and the virus from infecting immune cells. Most mainstream AIDS researchers have said they do not believe the approach will succeed. For one thing, HIV mutates rapidly and there are a number of subtypes of the virus, which themselves may have many different strains. VaxGen's vaccine is designed to elicit antibodies to only two strains of subtype B, the type most prevalent in North America and Europe

''This is the first demonstration of protection in humans, and one of the most significant findings in H.I.V. vaccine research in many years,'' Dr. [Jose Esparza] said. Though the vaccine is ''not the final product that we need for public health use'' and is not ready to be licensed for sale, he said, it ''should give encouragement to all vaccine developers.'' The vaccine, known as Aidsvax, is made from a protein called gp120, the same protein that protrudes from the surface of H.I.V. and helps the virus dock with cells of the body's immune system. The protein in the vaccine is made in genetically engineered hamster ovary cells. Since the vaccine consists of only one protein and not the whole virus, it cannot give someone AIDS. But it is designed to provoke the immune system into making antibodies that will latch on to the gp120 protein in the real virus and prevent the virus from infecting immune cells. The [VaxGen] researchers also said they would study blood samples from participants who received the vaccine, and would compare antibodies from those who became infected with antibodies of those who remained free of the virus. They hope to identify which antibodies actually protect against infection, rather than simply signaling that infection has occurred. The identification of such antibodies, known as correlates of immunity, might greatly assist future vaccine development

[Anthony Fauci] said he would first consult with a number of statisticians to try to determine whether the possible protective benefits among minorities from the vaccine -- known as Aidsvax and manufactured by VaxGen of Brisbane, Calif. -- represented a statistical fluke or some biological or behavioral factor

The baby in the Dallas case was Jeanella Aranda, who had surgery on July 16 for a noncancerous liver tumor called a hamartoma. According to legal documents filed by the family's malpractice lawyer, Steven Laird of Fort Worth, Texas, damage to blood vessels during the surgery cut off the blood supply to the liver, and doctors, unable to repair the damage, had to remove Jeanella's liver. Without a transplant, she would die in 24 to 48 hours. Her parents, Cesar and Alicia Aranda, were told that one of them might be able to donate a partial liver to save their daughter. Their blood was drawn to see which parent matched Jeanella's Type O. The laboratory initially reported that Alicia Aranda matched, but then called back to say it had made a mistake and Cesar Aranda matched. In fact, the first result was correct Alicia Aranda matched but doctors accepted the second, incorrect report. In the days and weeks after the transplant, Jeanella deteriorated, developing a blood disorder, fever, kidney problems, lung hemorrhages and severe jaundice. The blood type mismatch was not detected until Aug. 5, 19 days after the surgery, when Alicia Aranda, aware that her husband had Type A blood, noticed that Jeanelle's transfusions were Type O, and asked whether the transplant had been a mismatch. Doctors determined that she was correct. The baby died the next day

The baby in the Dallas case was Jeanella Aranda, who had surgery on July 16 for a noncancerous liver tumor called a hamartoma. According to legal documents filed by the family's malpractice lawyer, Steven Laird of Fort Worth, damage to blood vessels during the surgery cut off the blood supply to the liver, and doctors, unable to repair the damage, had to remove Jeanella's liver. Without a transplant, she would die in 24 to 48 hours. Her parents, [Cesar Aranda] and Alicia Aranda, were told that one of them might be able to donate a partial liver to save their daughter. Their blood was drawn to see which parent matched Jeanella's Type O. The laboratory initially reported that Mrs. Aranda matched, but then called back to say it had made a mistake and Mr. Aranda matched. In fact, the first result was correct -- Mrs. Aranda matched -- but doctors accepted the second, incorrect report. In the days and weeks after the transplant, Jeanella deteriorated, developing a blood disorder, fever, kidney problems, lung hemorrhages and severe jaundice. The blood type mismatch was not detected until Aug. 5, 19 days after the surgery, when Mrs. Aranda, aware that her husband had Type A blood, noticed that Jeanelle's transfusions were Type O, and asked whether the transplant had been a mismatch. Doctors determined that she was correct. The baby died the next day

The baby in the Dallas case was Jeanella Aranda, who had surgery on July 16 for a noncancerous liver tumor called a hamartoma. According to legal documents filed by the family's malpractice lawyer, Steven Laird of Fort Worth, damage to blood vessels during the surgery cut off the blood supply to the liver, and doctors, unable to repair the damage, had to remove Jeanella's liver. Without a transplant, she would die within 24 to 48 hours. Her parents, Cesar and Alicia Aranda, were told that one of them might be able to donate a partial liver to save their daughter. Their blood was drawn to see which parent matched Jeanella's Type O. The laboratory initially reported that Mrs. Aranda matched, but then called back to say it had made a mistake and Mr. Aranda matched. In fact, the first result was correct -- Mrs. Aranda matched -- but doctors accepted the second, incorrect report. In the days and weeks after the transplant, Jeanella deteriorated, developing a blood disorder, fever, kidney problems, lung hemorrhages and severe jaundice. The blood type mismatch was not detected until Aug. 5, 19 days after the surgery, when Mrs. Aranda, aware that her husband had Type A blood, noticed that Jeanelle's transfusions were Type O, and asked whether the transplant had been a mismatch. Doctors determined that she was correct. The baby died the next day