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A doctor has been charged with deliberately hastening the death of a disabled man so that he could harvest his kidneys for another patient, in the first case of its kind in America.
The case centres on allegations that Hootan Roozrokh, a transplant surgeon in California, ordered a nurse to administer lethal doses of narcotic painkillers and sedatives to Ruben Navarro, who was terminally ill, after taking him off life support. The man died hours later.
Prosecutors claim that Dr Roozrokh, 33, acted without a legitimate medical purpose in his handling of Mr Navarro, 25, who suffered from a neurological disorder and had been kept alive artificially for several days after suffering respiratory and cardiac arrest.
Rosa Navarro, the patient’s mother, had agreed that her son’s organs should be used for transplant in the event of his death but did not authorise him to be removed from life support or given drugs to hasten his death.
“The facts indicate that Dr Roozrokh tried to accelerate his death to facilitate the harvesting of his organs,” said Stephen Brown, deputy district attorney for San Luis Obispo County. “The central issue of the case was the mistreatment of a severely disabled adult.”
However, Gerald Schwartzbach, Dr Roozroh’s lawyer, said that his client had been the victim of a witch-hunt and that the criminal charges against him of dependent adult abuse, administering a harmful substance and prescribing controlled substances without a legitimate medical purpose were “unfounded and ill-advised”. He added: “He is an extremely dedicated and accomplished organ transplant surgeon . . . Dr Roozrokh did not commit any crime.”
The doctor faces a maximum prison sentence of eight years if found guilty.
Mr Navarro’s organs were deemed useless for transplant because of the seven-hour time lapse between his life-support equipment being switched off and his death.
The US, like Britain, operates an “opt-in” system, meaning that anyone who wants their parts used for transplant after their death must carry a donor card, which is registered on a national database network. But there is a critical gulf between supply and demand: the latest figures from the United Network for Organ Sharing show that 9,218 transplants were carried out between January and April this year, yet there are 96,849 patients currently on the waiting list.
Arthur Caplan, director of the Centre for Bioethics at the University of Pennsylvania, said last night: “If the allegations in this case are true, the doctor’s behaviour would be alarming, shocking and devastating, because it might actually lead some people to shy away from becoming potential organ donors.” Doctors are banned by law from raising the issue of organ donation until a person has been pronounced dead by a practitioner independent of the transplant process.
At the time of the incident in February, Dr Roozroh was a surgeon at a hospital in San Francisco but went to a medical centre in San Luis Obispo, where Mr Navarro was a patient, on behalf of a group that procures and distributes organs in California.
“You are supposed to keep a very tall wall between who’s managing the patient’s care and pronouncing death, and the triggering of any activity regarding organ donation. If you hasten death, that not only breaches the wall, it blows it down completely,” Dr Caplan said. “Discussions about moving towards an opt-out system are imperilled as a result. People will be worried that if they carry a donor card they might not be treated as they should.”
Donation details
13,266 kidneys were donated in the US in 2005
65,859 people were on the waiting list at the end of the year
84 out of every 1,000 patients waiting for a kidney in the US in 2005 died before an organ was found
95 per cent of patients given a kidney from a living donor survive, compared with 90 per cent from a dead donor
58 successfully recovered donated kidneys were disposed of in 2005 because they had spent too long with an inadequate oxygen supply in the donor’s body
30,000—50,000 rupees (£360-£610) was the average payment to donors in an illegal organ-selling scheme in Bombay in 2005
200,000 rupees were charged to those purchasing kidneys
Source: US Department of Health and Human Services; British Medical Journal
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I want to know why the nurse(s) involved with this patientâs care did not question the orders to, number one, terminally extubate, and number two, give a questionable dose of the narcotics/sedatives that ultimately lead to this man's demise? This doctor, to quote, "ordered a nurse to administer lethal doses of narcotic painkillers and sedatives to Ruben Navarro"; it is a nurse's responsibility to question any 'orders' written by physicians especially when it comes to the type and dosage of any pharmaceutical agent. In the critical care environment, or any environment for that matter, special attention is paid to the respiratory status of patients' receiving narcotics. If this doctor did indeed order a lethal dose of any given narcotic, the nurse should not have administered it and it was her/his right to question the physician. Long story short, there is information missing here and I would hope that people would keep an open mind re organ donation because it is such a gift.
NMB, RN, Pasadena, CA
The difference is between clinical death - no vital signs - and brain death - no neurological activity with a beating heart. Brain dead patients can't breathe on their own because that is run by the brain, so a patient who is breathing spontaneously is not brain dead.
Having worked with organ procurement teams as ICU staff, I can say that I have seen very unprofessional behavior. We had a boy who had shot himself in the head at the same time as the team was harvesting - that's the term - the organs of another patient. The nurse managing the ongoing case rushed over and started ordering tests on the new patient. His ICU nurse called the neurosurgeon who came in and read the procurement nurse the riot act. The patient got better. Keep in mind that this is only one story...
I'm not denying that they do a valuable service. Probably most of the staff are dedicated professionals who exercise high ethics. I'm only saying that no one who works in hospitals will be shocked.
Kathy, Atlanta, Ga., USA
leslie, check the information on the clinical death. it is the state of the living body without any brain activity. looks like in this case the brain was not in control of the bodily functions any more, otherwise the patient wouldn't have been kept alive by machines.
"..Mr Navarro, 25, who suffered from a neurological disorder and had been kept alive artificially for several days after suffering respiratory and cardiac arrest..."
cherry, vienna, austria
I was a donor card carrier for many years. Because of cases like this and people like Lyndsey in Atlanta, USA, I ripped up my donor card. I have been a part of a "harvest team", and some turned out to be as "clinically dead" as Lyndsey's "kept alive artificially". I stopped the harvest (even being the junior member of the team), ordered an EEG, and found out that the person WAS NOT CLINICALLY DEAD. Some are now "wide awake" and living with their families in perfect condition. Some doctors and nurses are now in jail. Some people are now divorced and received custody of their children because of the attempted murder of the spouse who was "kept alive artificially" and ended up not even being in a coma, just severe enough to need time to heal, be taken off of the respirator, and WALK out of the hospital on their own two feet.
Thank you Lyndsey, it is people like you who have kept me from ever harvesting another organ, or carrying a donor card in my wallet.
Dr. Robbie J, MD, MS, Northern Cal, USA
Lyndsey ... You must be a new RN. What are they teaching you girls now a days? Evidently not logic ... Navarro was removed from "life support", was HEAVILY sedated (slowing his breathing and making it erratic and shallow) and the patient died HOURS LATER. HOURS. Navarro had a functioning heart + lungs + brain+ other vital organs that only quit because they were stopped by sedation = He was alive. It's not only logic, it's moral calculus. Check it out sometime.
Leslie Armstrong, Tampa, FL/USA
That's funny Lindsey because a good few years back a senior surgeon from a hospital here in the UK gave up doing transplants because he found that when he cut the organs out of the donor; the heart rate went up and so did the pulse. He made the decision to stop doing these op's because that showed that the person still felt pain as the organs were being cut out of em!
I believe they need you still alive to take em out! It stopped me carrying a kidney donor card after reading that!
Kevin, Ashford, Middlesex, UK
In Bayview Hunters Point, the last African-American neighborhood in San Francisco, kids shot by the police have
arrived at mortuaries with internal organs missing.
Ann Garrison, San Francisco, CA
Lyndsey is wrong on this point. Of course this guy was not clinically dead before the doctor did anything - in fact, his heart kept beating and he kept breathing for several hours after he was disconnected fron artificial support. Most people, even those who aren't in the medical profession, recognize that if your heart and lungs are working, you're not dead!
Stacey McKenzie, MD, Lexington, Kentucky, USA
And the authorities wonder why people won't carry donor cards, so they are flirting with the idea of making it compulsory.
F Guiness, UK,
It's the film Coma!
Ian Whiteman, Granada, Spain
Being "kept alive artificially" means you are clinically dead. Mr. Navarro was dead before this doctor did anything.
Lyndsey, Atlanta, USA