Posted on Jun 07, 2012

Montefiore Hospital in the Bronx has suspended its organ transplant program after the medical center suffered its first fatality in history within the last two weeks.


The mother of a 2-year-old was donating her kidney to a male relative. In the operating room, her aorta was cut or ruptured and she bled to death despite the best efforts of the medical staff. The kidney was not delivered either.


The NY Health Department dubbed this a "major incident," and is investigating the Montefiore Einstein Center for Transplantation. The center, meanwhile, has decided to voluntarily shut its operations until the investigation is over.


Montefiore is a major national hub for organ transplants and harvesting organs. Since 1967, they have conducted 3500 kidney transplants, including 1000 from live donors. Not a single instance of death during organ surgery (called nephrectomy) had ever occurred at the hospital.


Such fatalities are rare in general. The risk of death is only 0.03%.


The first recorded occurrence in New York was in 2008: Michael King, 29, had entered SUNY Downstate Hospital in Brooklyn to donate a kidney to his wife. The hospital used an artery-closing clip, which was at the time under recall.




Comment: the aorta is the largest blood vessel in our body. If the aorta is cut or damaged during surgery, there is the potential the patient will bleed to death very quickly. The New York Post article does not reveal whether this patient bled to death or whether the surgeons encountered this exact complication.


How could the aorta had been burned? The surgeons use a cautery device to close small bleeding vessels. This literally burns the ends of the blood vessels so the surgeon has a clear field of view. There are instances where this device has caused injury to adjacent organs and tissues requiring surgical repair if recognized during the surgery.


Regardless of how the aorta was injured, this is a life-threatening injury, and time is of the essence in repairing it. The article does not report who were the surgeons nor did they have an opportunity to interview any of the surgical team to ascertain exactly what the complication was and why the hospital felt the need to immediately shut down their kidney transplant program.


The New York State Department of Health typically gets involved when a tragedy like this occurs at a well-known hospital.


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