Tuesday, December 23, 2008

Can Anything Good Come of the Navarro Fiasco?

Terry Rosell
December 23, 2008

A transplant surgeon has been acquitted of criminal wrongdoing in the dying of Ruben Navarro http://www.latimes.com/features/health/la-me-transplant19-2008dec19,0,2830878.story. With limited knowledge of what went on in the operating room and the courtroom, I assume this is a good outcome.

But I think the jury is still out on public opinion regarding donation of body parts after cardiac death, and on what should happen next.

Dr. Hootan Roozrokh was accused, and is found not guilty, of dependent adult abuse. He had flown in with a team from San Francisco to procure organs upon the death of Mr. Navarro at the regional medical center in San Luis Obispo.

Organ recovery usually takes place after brain death. This 25 year old comatose patient was not brain dead, and was expected to die the old fashioned way. He had suffered cardiac arrest once already, and his family had consented to organ donation at such time as his heart stopped permanently.

But things didn’t proceed as they should. A prosecuting attorney claimed, unconvincingly, that Dr Roozrokh hastened the prospective donor’s death by ordering relatively large doses of pain and anti-anxiety medications for a patient who was not dying quickly enough. Defense convinced the jury that whatever occurred in that operating room, it wasn’t criminal.

Indeed, it may well have been compassionate care of a patient who was suffering needlessly and in a prolonged manner.

What all can agree on is that, whatever happened in San Luis Obispo, it resulted in little good beyond that of the defense attorney’s claims. Yes, the patient’s suffering was ended. However, the bereaved family experienced a grief complicated by suspicions of medical abuse and a long court battle.

The young surgeon experienced a disruption of vocation from which he may never recover fully. Other well intended clinical caregivers surely were traumatized by testimony or depositions, by the scrutiny of law and media. Organ procurement and hospital institutions have expended scarce resources that might have gone to healing rather than defending.

The American public is left wondering who to trust and whether organ donation is a risky endeavor. And in the Navarro case, no organs ultimately were recovered anyway.

If there is anything good yet to come of this tragedy, it will be seen in the delineation of clearer policies and procedures for recovery of organs and tissue after cardiac death—with sanctions for violation, whether intentional or unintentional. What we hope will not occur is clinical resistance to or additional restrictions on administration of pain and anti-anxiety medications for patients who are actively dying.

That would be tragedy upon tragedy. Clinicians and policy wogs need to focus attention elsewhere.

In reference to recovery of organs after cardiac death, Cleveland transplant surgeon Dr. John Fung accurately noted that the Navarro case “certainly highlighted the potential of extreme problems that could occur without having the proper policies and procedures in place.” (http://www.latimes.com/features/health/la-me-transplant19-2008dec19,0,2830878.story).

The jury concurred with the need for “well defined ethical standards.” Now it is mostly up to the United Network for Organ Sharing (UNOS) and its Department of Health and Human Services contractor to take appropriate actions with sufficient communication such that this fiasco is less apt to be repeated elsewhere or ever again.

I hope they are doing so.

Link: Transplant surgeon acquitted in case involving potential organ donor's death, Los Angeles Times, December 19

What do you think? Please view and share comments.

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