Cyanide-laced death of possible organ donor brings calls for transparency

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It has been more than two weeks since UPMC neurologist Autumn Klein died of apparent cyanide poisoning, and officials still have not said whether her organs or tissues were transplanted.

Following standard privacy guidelines for organ transplants, both UPMC, where Dr. Klein worked and died, and the Center for Organ Recovery & Education, or CORE, which coordinates transplants in this region, have declined to comment about her case.

But a leading medical ethicist said the highly unusual nature of her death might make it worthwhile to at least say whether any transplants occurred and whether patients who received tissue from Dr. Klein have been notified about the cyanide findings.

Arthur Caplan, director of the division of medical ethics at the NYU Langone Medical Center in New York, said that most of the time privacy rules help to encourage organ donations by assuring people their names won't be revealed without their consent.

But in cases like the cyanide poisoning, he said, there might be some value in releasing basic information.

If transplants did occur, Mr. Caplan said, the hospital or organ procurement organization "probably wouldn't have to go into much detail. They could say something was transplanted, we have tracked down the recipients and they have been notified.

"While there is an important goal in protecting donor privacy, it is also valuable to cement people's trust in the reliability of the system when something like this comes up, and ensure the public that efforts are being made to follow up."

In a statement released Tuesday afternoon, CORE CEO Susan Stuart said the organization does not say whether transplants have occurred unless the donor's family gives permission. She then added:

"When an organ donor has been identified, CORE does conduct a number of tests on the donor to identify any potentially transmissible diseases. We share the results of that testing with the transplant center that receives the organs for transplantation, and it is then at the discretion of the transplant center to share that information with a transplant recipient."

UPMC spokeswoman Jennifer Yates also said the hospital system won't comment on Dr. Klein's case.

"Generally speaking," she added, "any organ we transplant is carefully assessed by our surgeons to ensure its viability and to minimize any health risks for our patients. Also, we routinely communicate to recipients anything of significance regarding disease transmission.

"It's known that cyanide disintegrates rapidly in the body," she said, "and studies have documented successful transplants from donors exposed to cyanide."

Gil Siegal, a physician and law professor at the University of Virginia, said the risks of cyanide contamination of transplanted organs does seem low, and "I think the public health risks have to be substantial to create a real imperative to run after these recipients" and inform them of that. "If there are no actionable items that will stem from the notification, notification is completely in vain," he said.

While some have speculated that the fear of potential lawsuits may be keeping the hospital and organ agency quiet, a veteran Pittsburgh malpractice attorney said the likelihood of a successful suit in this case would be slim.

Results of the cyanide poisoning were not announced until last week, so if Dr. Klein's organs were transplanted, it's probable no one knew about the poison at the time.

Veronica Richards, a malpractice attorney with Richards & Richards, said transplant organizations have an obligation to use "reasonable care under the circumstances, and these circumstances are certainly unusual, so it would be very difficult for a recipient of an organ to go back and say to CORE, 'You should have done something to check on this beforehand.'

"So I don't see the threat of successful civil lawsuits being a real barrier to making statements" about whether transplants occurred.

Lois Klein, Dr. Klein's mother, said officials approached her, her husband, and Dr. Klein's husband, neurologist Robert Ferrante, to talk about organ donation April 20, before Dr. Klein was removed from life support at UPMC.

She said they agreed to the transplants, but she does not know in fact if Dr. Ferrante signed paperwork granting consent.

Boyd Ward, president of the executive committee of the national Association of Organ Procurement Agencies, said he agrees with the position that UPMC and CORE have taken.

Mr. Ward, executive director of the Arkansas Regional Organ Recovery Agency, noted that the rate of diseases being transmitted during organ transplants is extremely low.

"I feel very confident that the safety guidelines in place are very stringent and all of the information that is available to us is passed along to the transplant surgeons before the organs are transplanted, or if the results come along later, we pass along any information about possible disease transmission."

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Mark Roth: mroth@post-gazette.com or 412-263-1130. First Published May 8, 2013 4:00 AM


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