ORGAN DONATION AFTER CARDIAC DEATH Ethical Issues     Saints Cosmas and Damian, Fra Angelico, 1438  [not blue]

[not blue]

The Patient and his Mother	Sierra Vista Regional Medical Center	California Transplant Donor Network
Patient REUBEN NAVARRO	Nurse DIANNA STEVENS	Surgeon HOOTAN ROOZROKH
Patient's Mother ROSA NAVARRO	Attending Physician LAURA LUBARSKY	nurse CARLA ALBRIGHT

REUBEN NAVARRO
25 year old severely-disabled male with adrenoleukodystrophy,  celebral palsy, and a seizure disorder

   Reuben found unconscious, admitted to Sierra Vista Hospital placed on life support (presumably respirator), determined to be comatose without hope of recovery (never diagnosed as brain dead).  Mother, Rosa Navarro, agrees to Organ Donation after Cardiac Death.

   [N.B. Neither critical care nurse Dianna Stevens, nor ICU attending physician Dr. Laura Lubarsky familiar with protocols for Organ Donation after Cardiac Death

   Transplant nurse Carla Albright arrives first, examines chart and patient, orders Sierra Vista nurse Dianna Stephens to administer 20 mg morphine in ICU.  No evidence of distress
 

   Patient moved to operating room where life support removed.

Over one hour an additional 180 mg morphine and 80 mg Ativan administered by Nurse Stevens on orders from Dr. Roozrokh.

At one point Dr. Roozrokh ordered betadine infusion via :feeding" (NG? gastrostomy?) tube.

“I was like a technician,” said Lubarsky, who was one of at least half a dozen medical personnel in the room. “I deferred to the experts who were there, who were presumably following protocol.”

Roozrokh took Navarro’s pulse and suggested that electronic monitors may have been showing “pulseless electronic activity” -an indication that the patient had died. But, she said, she saw Navarro’s heart beating in his thin, uncovered chest and heard it when she examined him.

   Patient returned to ICU where expired after approx. seven hours.  Organs were not harvested.

    Sierra Vista Medical Center settles civil complaint with Ms. Navarro for $250,000.  Medical Center not listed in current civil complaint.

Initial hearing in criminal case against Dr. Roozrokh:

“The central issue of this case is the mistreatment of a developmentally disabled, dependent adult in an attempt to hasten the person’s death for organ transplantation,”

District Attorney notes that this is the first such criminal case against a transplant doctor in the United States

Dr. Roozrokh was initially  charged with:
[1] dependent adult abuse,
[2] unlawful prescribing of a drug [prescribing a controlled substance without a legitimate medical need] and
[3] administering a harmful substance — Betadine.

Criminal charges against Dr. Roozrokh reduced to one felony count of abuse of an adult.

The Jury Trial is taking place at this time.

ORGAN TRANSPLANTATION

PALLIATIVE SEDATION

COMPASSION and CARE for the DYING:
     RESPECT for the DEAD

PROFESSIONAL CONFLICT of INTEREST

    Transplant surgeon and Attending physician

PATIENT AUTONOMY

    Mother acting as Surrogate

AUTHORITY over PATIENT

    Who is attending physician?  When does Role change

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