When Dr. Autumn Klein's husband called 911 the night she lost consciousness, he told dispatchers she was showing stroke-like symptoms, records reviewed by the Pittsburgh Post-Gazette show.
At 11:52 p.m. on April 17, Robert J. Ferrante called 911 and stated that his wife was not alert in their Oakland home.
Two minutes later, a call-taker noted that Dr. Klein was "conscious breathing" and then "not alert."
The call-taker wrote that Mr. Ferrante, a professor of neurological surgery, told dispatchers he thought his wife might be having a stroke and that "about 10 minutes ago" she began "just staring off into space."
A medic unit was dispatched at 11:56 p.m. and a note made in the system at 11:57 p.m. says, "Female is groaning right now ... is conscious and breathing."
Three days later she was dead in what officials have since described as a rare cyanide-related death that investigators are probing as either a homicide or suicide.
This week, city homicide detectives asked the FBI for assistance with the case and requested documents from UPMC pertaining to both Dr. Klein's private practice and cyanide at the University of Pittsburgh School of Medicine, where her husband works. Investigators executed a search warrant on the couple's Oakland home Friday night.
"We are assisting the city homicide unit with the investigation," FBI spokeswoman Kelly Kochamba said, "because the cause of death was the use of cyanide and the reason why we're involved assisting the city homicide unit is because of our scientific resources to support them."
She declined to say what specific resources the FBI is providing and said the FBI "occasionally" assists local authorities in death investigations.
UPMC spokeswoman Gloria Kreps said, "The police have asked for documents and records related to Dr. Klein's personal practice and we have willingly provided those." She declined to comment on other aspects of the case.
Mr. Ferrante did not respond to a request for comment and his attorney, Jerry Johnson, declined to comment.
Dr. Klein's mother, Lois Klein, said on Friday that she does not know what to make of her daughter's death and investigators have not given her details of the case.
"I certainly am working under the assumption she certainly would not do that to herself," Ms. Klein said. "I'm just totally dumbfounded. I can't imagine anybody that would want to harm her."
Ms. Klein said Mr. Ferrante called her at 12:20 a.m. on April 18 and told her that Dr. Klein was en route to the hospital and he was waiting for a friend to pick up their 6-year-old daughter so he could take her to the hospital.
Ms. Klein said she and her husband, William Klein, left their house in Towson, Md., about 1:30 a.m. and made it to her daughter's home about 5:30 a.m. They waited there until Mr. Ferrante returned and they all went to the hospital that evening, she said.
Ms. Klein said the next few days were a blur. Sometimes they would all visit Dr. Klein in the hospital.
Other times, Mr. Ferrante would head there with just his daughter and the Kleins would stay behind, or vice versa. Colleagues and doctors and nurses visited off and on throughout.
At no point, Ms. Klein said, did she hear any mention of cyanide or poison.
At some point, Ms. Klein said she, her husband and Mr. Ferrante met with some people to coordinate organ donation.
The family said their goodbyes and held a gathering with Dr. Klein's friends and colleagues, before which her body was cremated.
Neither UPMC nor the Center for Organ Recovery and Education, or CORE, which handles organ donations, would say whether any transplants occurred.
There have been past cases where organs were successfully transplanted from cyanide poisoning victims, including one case in Pittsburgh in 1993.
In that incident, a patient died from ingesting cyanide and other drugs, and doctors ended up transplanting the patient's liver, heart, corneas and skin and bone.
The recipients of the organs and tissue were doing well eight months afterward, a research study said, leading the doctors to conclude that "the focus of procurement personnel should be on tissue injury and not on the mere presence of a toxic agent."
Edward Krenzelok, an emeritus pharmacy professor at the University of Pittsburgh, was involved in that case, and said that cyanide dissipates quickly enough that organs can still be suitable for transplant.
"As long as you had organs and tissues that were not overly damaged by the lack of oxygen from the cyanide poisoning, the organs would be viable," he said.
Former Allegheny County Coroner Cyril H. Wecht, who is consulting with an attorney in Dr. Klein's case, agreed that is an accurate scientific description, but said he doubts many organ procurement agencies would knowingly transplant organs from a cyanide poisoning victim.
"While this is an interesting discussion," Dr. Wecht said, "I would be willing to bet you if you told a donor bank person, 'We know this is cyanide [that killed the patient], and would you still donate the organs?' he would say no way."
Because both UPMC and CORE have declined comment, it is difficult to know when doctors first learned of the cyanide levels in Klein's body, or whether any organ donations went forward.
Fred Fochtman, director of the forensic science and law program at Duquesne University and a former coroner's official, said that in normal circumstances, if someone is an organ donor and also undergoes an autopsy, the organs already will have been removed before the autopsy is carried out.
Skin, bone and corneas, on the other hand, can be taken after the autopsy for storage and later donation.
Mr. Krenzelok said that if hospital officials knew Dr. Klein had cyanide poisoning while she was on life support, it would have been possible to treat her with antidotes to cyanide or let the poison dissipate enough that the organs would have remained viable for transplant.
"Since cyanide is cleared relatively quickly," said John Fung, an organ transplant expert at the Cleveland Clinic, " as long as the organ is functioning at that point, pursuit of organ donation is sensible."
Mark Roth: email@example.com or 412-263-1130. Liz Navratil: 412-263-1438, firstname.lastname@example.org and on Twitter @liznavratil. Moriah Balingit: email@example.com and on Twitter @MoriahBee.