That left Dr. Sean Cao as the only full-time liver transplant surgeon. Cao had joined the program in 2000 and quickly alienated many staffers, according to people who had worked with him.
Many were deeply loyal to Imagawa, who was struggling to retain some control of the program. The two surgeons clashed, and Imagawa was eventually moved to a separate building, said Lorrie Gibson, who coordinated transplants but has subsequently retired.
Cao was promoted to liver transplant director. Resentment against him grew, said former staffers.
Most worrisome was that he appeared focused on liver and pancreas surgeries that could be scheduled -- and not transplants.
"He was building a practice in other types of liver surgery," said Dr. Jorge Ortiz, a transplant surgeon who overlapped with Cao at UCI for most of 2000.
Cao did not return phone calls seeking comment.
Cygan, the hospital's chief executive, said he and others worked with Cao to "develop him as a physician leader." They guaranteed him a salary so he wouldn't feel the need to perform so many elective procedures instead of transplants.
On Friday, Cygan acknowledged that "we may have stuck with Dr. Cao, in retrospect, a little longer than we should have."
After Imagawa stopped performing transplants in 2001, staff members at OneLegacy, the local agency in charge of allocating donated organs, noticed that UCI was turning down an increasing share of organ offers, said Thomas Mone, the CEO.
Many of the refused organs were accepted by other medical centers and transplanted into their patients. In 2002, UCI received 165 liver offers from OneLegacy. Just six were accepted. Two other transplants were done that year, but those livers came from outside the Los Angeles region.
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UCI was desperate to recruit new surgeons.
In July 2002, the hospital hired Dr. Anthony Savo, a transplant surgeon. But three months later, the administration moved him to general surgery after he clashed with Cao, according to Gibson.
She and the other transplant coordinators rushed to Savo's defense, she said, but the administrators would not heed their complaints about Cao.
Savo, who finished his two-year contract and left UCI, declined to comment.
Tensions escalated to the point that the surgery department chairman called a special meeting to reduce anxiety, according to a memo drafted by the transplant coordinators in October 2002 but never sent.
