Surgical errors can be one of the most complicated forms of medical malpractice. In many cases, these errors are not discovered for a significant period of time (for example if a sponge or other foreign body is left inside a patient). However, some surgical errors are discovered almost immediately- and often times these errors are quite egregious and can include surgery performed on the wrong site (amputation of the left leg rather than the right, for example), or as was the case at a hospital in New Jersey, when surgery is performed on the wrong patient altogether.
Currently, more than 120,000 people in the U.S. are waiting to receive an organ transplant. The Department of Health and Human Services maintains recipient lists for each major organ in order to properly prioritize who is permitted to receive a donor organ when one becomes available. Factors that govern the prioritization vary based on the type of organ, yet all lists take geography (limiting the amount of distance that an organ must be transported from donor to recipient) and size (children respond better to child-sized organs). Factors that influence recipient list position for a kidney in the United States include waiting time, donor/recipient immune system incompatibility, pediatric status, prior living donor, distance from donor hospital, and the survival benefit.
A patient at a southern New Jersey hospital inadvertently got a transplanted kidney that was intended for another patient, officials confirmed Tuesday. The patient who actually received the organ was indeed on the transplant list. However, according to a press release from Virtua Our Lady of Lourdes Hospital, the recipient patient “was inadvertently transplanted out of priority order.” Virtua Our Lady of Lourdes is home to The Lourdes Regional Organ Transplantation Center, the only medical facility which performs transplant procedures in southern New Jersey. The patients were not identified, but statements made by senior personnel suggest that they shared some identifying characteristics which may have led to the mistake.
The hospital notified both patients involved in the mix-up. The patient who was originally intended to receive the kidney got a donor organ six days later. According to the hospital, both patients are doing well. The incident was also reported to the Organ Procurement and Transplantation Network and the New Jersey Department of Health. The Department of Health conducted an investigation into the error.
According to Dr. Reginald Balber, the executive vice president and chief clinical officer of Virtua Health, “Mistakes of this magnitude are rare, and despite the unusual circumstances of similar patient identities, additional verification would have prevented this error.” He went on to call the patient mix-up “an unprecedented event in our respected 40-plus-year transplant program,” and promised that the hospital is committed to safety and immediately instituted additional measures and educational reinforcement to ensure that such a mistake never happens again.