YOU ARE HERE: LAT HomeCollections


Deception Behind Liver-Transplant Switch Proved to Be Fatal

October 13, 2005|Charles Ornstein and Alan Zarembo | Times Staff Writers

In January 2003, after more than two years on a waiting list for a liver transplant, Saad Al-Harthi was finally considered sick enough to rank near the top.

If a donated organ became available, he would have only a few hours to get to St. Vincent Medical Center in Los Angeles.

But that same month, Dr. Richard R. Lopez Jr., then-director of the hospital's liver transplant program, told him he faced a long wait and was better off at home in Saudi Arabia, according to Al-Harthi's son Majed.

That's where he was Sept. 8, 2003, when the hospital accepted a liver in his name.

Lopez and Dr. Hector Ramos, his assistant director, transplanted the organ into another Saudi national 50 places behind him on the list, St. Vincent officials now acknowledge. The misallocation, reported by The Times last month, is a serious breach of the national code governing placement of donated organs.

Al-Harthi never knew any of this. He died less than a year later from liver cancer that had spread throughout his body. He was 59.

"They killed my father," Majed Al-Harthi said in a telephone interview from Rome, where he works for a Saudi oil and gas company. "Intentionally or unintentionally, they killed him, and they have to be punished for it."

For months leading up to the inappropriate transplant, and for months afterward, the hospital misled Al-Harthi, his family and the Saudi Embassy in Washington about his prospects for a liver, according to letters and e-mails from hospital staff that were reviewed by The Times.

Although the motive behind the transplant switch remains a mystery, the tactic was clear: use one patient's position on the list to obtain an organ for somebody else. In doing so, the hospital bypassed not only Al-Harthi but dozens of other patients in Southern California whose conditions were deemed more dire than the recipient's.

Eventually the hospital lost track of Al-Harthi, a popular school principal in his hometown of Taif. St. Vincent administrators learned of his death from Times reporters this week.

Hospital and transplant officials did not identify the transplant candidates in question, referring to them only as patients A and B. The Times has verified the names with three knowledgeable people, including two who have seen the names in hospital documents.

The sources requested anonymity because of patient privacy rules.

Medical leaders at the hospital have hired outside experts to determine if Lopez and Ramos acted improperly. Lopez has resigned from the medical staff, said hospital spokesman Paul Silva. Ramos remains on the staff but has stepped down from the chairmanship of the medical center's bioethics committee.

The hospital administration is also looking at the conduct of other employees, including two who have said they falsified records as instructed either directly or indirectly by Lopez, according to Silva.

The hospital suspended all liver transplants more than two weeks ago after a routine audit caught the problem, and officials are looking into whether any other organs might have been improperly diverted.

Under national transplant rules, the hospital should have turned down the liver because the intended recipient, Al-Harthi, was unavailable. A patient at UCLA Medical Center was next in line on the list, and doctors there were ready to accept the organ.

In rare instances, physicians can transplant a liver accepted for one patient into another -- but only after consultation with the local organ procurement agency. The hospital is also required to justify such actions to the United Network for Organ Sharing, which administers the national transplant system.

Neither agency was consulted in this case.

For more than a year after the September 2003 transplant, St. Vincent filed documents with the national network showing, falsely, that Al-Harthi had received the liver and was doing well, the hospital has acknowledged.

In fact, the evidence suggests that the surgeons had little intention of transplanting a liver into Al-Harthi.


Saad Al-Harthi, a father of five, had a home library of more than 2,000 books and was known around Taif for his charitable demeanor.

He began searching for a liver transplant center in 2000 after his doctors told him he might have cancer.

It wasn't urgent, but his family was worried because he also had hepatitis C, another potentially lethal disease of the liver.

Foreign nationals are allowed to seek transplants in the United States, and Al-Harthi settled on St. Vincent because several Saudi friends had traveled there for treatment for a variety of ailments. When he visited for the first time that October, the hospital placed him on the regional transplant list and he went home.

The Saudi government agreed to pay his medical bills and travel expenses, as it commonly does for its most seriously ill citizens. Majed, who speaks English, routinely served as a long-distance translator between his father and the medical staff at the hospital.

Los Angeles Times Articles