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Organ Donation Did a Doctor Speed a Patient's Death?

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As 25-year-old Ruben Navarro lay comatose in a California hospital, his mother, Rosa, was twice asked if she would consider donating her son’s organs. “Upset and confused,” Rosa says, she declined. The next day as she sat by her son’s bed, Rosa, 55, a Guatemalan immigrant, recalls a doctor telling her that Ruben, suffering from a rare neurological condition, should be removed from life support because there was “no hope.” Hours later, she was asked yet again about organ donation. This time, Rosa relented. If all hope was lost, she thought, at least Ruben’s organs “could help other people.”

But what happened next—and why—lies at the heart of an unprecedented criminal case in San Luis Obispo Superior Court that could have a chilling effect on organ donation. Dr. Hootan Roozrokh, 34, head of the five-member Bay Area organ-procurement team that flew to the Sierra Vista Regional Medical Center on Feb. 3, 2006, to harvest Ruben’s liver and kidneys, stands accused of hastening the patient’s death to remove the organs before they deteriorated. The felony leveled at Roozrokh—dependent adult abuse—threatens to put the surgeon behind bars for four years. His attorney, M. Gerald Schwartzbach, has said that Roozrokh is the subject of a “witch hunt” and committed no crime.

Organ donor networks fear the attendant publicity may destroy years of uphill efforts to boost donor rates. Says Bryan Stewart of OneLegacy, a nonprofit network that serves Southern California: “The idea that a surgeon might not have the best interest of the patient in mind is the most widespread fear about organ donation.”

Organ donation, one of the most highly regulated areas of medicine, is not usually so fraught. Most harvests involve donors, often car-crash victims, who have been declared brain-dead and whose organs are being maintained on machines until a procurement team can arrive. But in the tiny sliver of cases like Ruben’s, where minimal brain function is still present, a hornet’s nest of ethical concerns surrounds the dying patient, whose last heartbeat holds the promise of renewed life for other desperately ill patients. To safeguard the patient’s final moments, United Network for Organ Sharing protocol dictates that after a donor is removed from life support, an attending physician must wait for five minutes after the last heartbeat to declare death. Only then does the transplant team enter the OR.

Or at least that’s the way it’s supposed to be. When Ruben Navarro was rushed to the hospital on Jan. 29, 2006, he was in cardiac and respiratory arrest. Afflicted since age 9 with a debilitating neurological disorder called adrenoleukodystrophy, Ruben weighed 70 lbs.; doctors diagnosed irreversible brain damage. On Feb. 3, after his mother consented to organ donation, he was unhooked from his ventilator—but his heart kept beating. His oxygen-deprived organs were becoming less viable with each passing minute.

According to a March 19 ruling by Superior Court Judge Martin Tangeman, that’s when Roozrokh, already present in the OR, is alleged to have “willfully caused or permitted” Navarro to be given large doses of the painkiller morphine and the antianxiety medication Ativan. Despite repeated doses, the last three of them at 10- to 15-minute intervals, the ruling states, Ruben survived for eight more hours. Nurse Jennifer Endsley told police that he was “frothing from the mouth and shivering.”

Supporters of Roozrokh, who, the court opinion says, was less than a year out of his transplant fellowship and had observed only one such procedure, maintain he would never harm a patient. Says Joe Quiroz, 60, who received post-liver-transplant care from Roozrokh 10 years ago during the doctor’s fellowship at the Stanford University School of Medicine: “He had this amazing bedside manner, always coming in and checking on me.” Quiroz says that Roozrokh told him that his own mother had died while waiting for a liver transplant. “That was when he decided he needed to help other people,” says Quiroz.

That is scant consolation for Rosa, who later learned a nurse told police that Ruben was responsive to human touch in his final hours. “What happened to him, he didn’t deserve,” she says. “I don’t want this sort of thing to ever happen again to anybody.”