Lost Hearts

Dr. Arnie Serota was furious.

On February 27, 2002, a young man had fallen while rock climbing at Mount Lemmon near Tucson. He died of a head injury a few days later at Tucson Medical Center. The death was tragic, the 19-year-old strong and healthy.

As medical director of Donor Network of Arizona, Serota was flabbergasted over what happened in the hours after the man was declared brain dead. The family consented to organ donation, and the man's kidneys and liver were successfully removed. But his heart among the most precious of the seven organs that can be taken after death went untouched. According to Serota, the most basic tests to determine if the heart could be transplanted were never conducted by the nurses employed by DNA and trained to coordinate organ donations.

Harvesting organs is tough. Fewer than 1 percent of hospital deaths result in a viable donor because the deceased must be a relatively healthy person who died of trauma that did not injure the internal organs. Then it can be difficult to get a family to consent, even if the victim wanted to be an organ donor.

And hearts are particularly hard to come by. Another Tucson hospital, University Medical Center, runs the state's only heart transplant program. Every year, about 20 patients die on UMC's waiting list because healthy hearts come along so infrequently especially here in Arizona.

In Arnie Serota's world, to lose the heart of a teenage rock climber was untenable. Worse, this was the second healthy heart lost in Arizona in a week, according to Serota. Days earlier, a similar situation had taken place with a 26-year-old man in Scottsdale.

After the rock climber's death, Serota called Dr. Larry Koep, chairman of the board of Donor Network of Arizona. Koep agreed to meet Serota after work that day. The two sat outside at AJ's Fine Foods at Central and Camelback in Phoenix, and Serota told Koep what had happened.

Koep was supportive and sympathetic, Serota recalls. "He told me, Oh, we need to do something about those coordinators....The board's behind you 100 percent.'"

Less than a week later, on March 7, Serota presented his findings about the two lost hearts to the full board of directors.

That night, Koep and the board asked Serota to resign. When he refused, they fired him for exhibiting poor leadership.

But Serota thinks he was fired because, over the nine months he was medical director of DNA, he continually pointed out problems with the program problems he says the board did not want to hear, problems that, according to Serota, may have cost people their lives.

Arizona has one of the worst organ recovery records in the country. In 2001, Donor Network of Arizona ranked 57th out of the 59 organizations that harvest organs, according to figures adjusted to population. In the past five years, the number of organ donors in Arizona has ranged between about 70 and 80.

Last year, 60 people in Arizona died while on the waiting list for transplanted organs.

An investigation last year by an expert for the federal agency that oversees donor networks agreed with Serota on many points, including that DNA was missing too many opportunities for organs, especially hearts.

For several years, Serota was a member of the DNA board of directors, just on the edge of this highly politicized little world. But it wasn't until he became medical director that he found himself in the middle of a maelstrom and learned, he says, how screwed-up that world really is.

Serota, who is now suing DNA, has reams of records documenting mistakes, bad decisions and troubling behavior by people who are supposed to be better prepared to deal with the critical business of organ donation and transplantation. Some of his paperwork details the night a cardiologist who, although on call, refused to come to the hospital on a weekend to evaluate a potential heart donor resulting, Serota contends, in the loss of yet another healthy heart.

Or the family physician who erroneously declared a young woman in Verde Valley brain dead and an overzealous organ recovery coordinator who wanted to act too quickly almost resulting in the harvesting of her organs.

He talks about an organ coordinator who tried to bar the doors of an operating room to keep Serota, who was performing surgery, from continuing to take a patient's organs after a distraught father changed his mind about donating his daughter's organs.

Serota also says he got resistance from nurses who didn't like a new medical director overseeing their work. He contends that nurses sometimes don't tell transplant doctors the truth about the condition of an organ in order to manipulate where a particular organ goes a practice that is strictly forbidden under federal rules governing organ donation.

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Amy Silverman is a two-time winner of the Arizona Press Club’s Journalist of the Year award. Her work has appeared on the radio show This American Life and in the New York Times, the Washington Post, Lenny Letter, and Brain, Child. She’s the co-curator of the live reading series Bar Flies, and a commentator for KJZZ, the NPR affiliate in Phoenix. Silverman is the author of the book My Heart Can’t Even Believe It: A Story of Science, Love, and Down Syndrome (Woodbine House 2016). Follow her on Instagram (@amysilverman), Twitter (@amysilvermanaz), and at amy-silverman.com.