This case involves a 65-year-old male with a known history of pulmonary fibrosis. Due to the severity of his condition, he underwent a lung transplant and suffered intraoperative and postoperative complications due to an acute rejection reaction resulting from an ABO blood donor-recipient mismatch that rapidly led to his death.
Fibrosis of the lungs occurs when lung tissue becomes scarred and damaged. Inefficient lung function is caused by this thickened, stiff tissue. A person with pulmonary fibrosis becomes increasingly short of breath as the disease progresses. Lung transplantation in PF patients is associated with significant improvements in quality of life and is an option for patients with pulmonary fibrosis. For people with late-stage lung disease, lung transplantation can be a life-saving treatment that removes a damaged or diseased lung and replaces it with a healthy lung donated by a deceased donor. A lung transplantation patient has a survival rate of 88 percent after one year. There is a 73 percent survival rate for lung transplants after 3 years. Five years after lung transplantation, 60 percent of patients survive.
Each blood group in the human body has its own distinct characteristics, and if the wrong blood type is transfused, serious complications can occur. For every 1 million units of blood transfused, approximately 4 patients receive the wrong blood type. Endothelium reactions will be caused by this error. The endothelium is a thin membrane that lines the inside of the heart and blood vessels. The red blood cells of the transfused blood will be destroyed by the recipient’s antibodies within the blood vessel. A cascade of severe reactions will occur simultaneously, causing shock and almost always resulting in the rapid death of the patient.
During a major hemolytic transfusion reaction, the recipient’s immune system vigorously attacks the donated blood. Cells are torn apart, toxic chemicals are released, and the person becomes extremely ill. The kidneys can fail, and a severe flu-like illness can develop. The mortality rate is high without treatment and considerable even with immediate treatment. In this case, the administration of a mismatched blood type is malpractice and led to acute organ rejection and wrongful death.
Expert Witness Specialty
An expert in transplant surgery can opine on the standard of care and common practices to ensure a patient receives the correct blood type during surgery.
Questions for Expert Witnesses
- What are common etiologies associated with acute organ rejection?
- How might a blood type mismatch impact an adverse outcome?
- What safety measures are standard of care to ensure patients receive the correct blood type?
Expert Witness Involvement
Here is what a lung and heart transplant surgeon had to say about this case:
Expert Witness Response E-092542
I have been a lung and heart transplant surgeon for 25 years. I do 15-20 heart transplants a year and, until three years ago when I moved to a new program, I did 8-10 lung transplants per year over a period of 13 years. Acute rejection is due to antigen mismatch. We match for the major ones but can have a rejection due to previously unknown sensitivities. Blood type mismatch can lead to a range of problems, from minor to lethal. I have no conflicts and would be happy to help with the case.