SAN LUIS OBISPO, Calif. — On a winter night in 2006, a disabled and brain damaged man named Ruben Navarro was wheeled into an operating room at a hospital here. By most accounts, Mr. Navarro, 25, was near death, and doctors hoped that he might sustain other lives by donating his kidneys and liver.

But what happened to Mr. Navarro quickly went from the potentially life-saving to what law enforcement officials say was criminal. In what transplant experts believe is the first such case in the country, prosecutors have charged the surgeon, Dr. Hootan C. Roozrokh, with prescribing excessive and improper doses of drugs, apparently in an attempt to hasten Mr. Navarro’s death to retrieve his organs sooner.

A preliminary hearing begins here on Wednesday, with Dr. Roozrokh facing three felony counts relating to Mr. Navarro’s treatment as a donor. At the heart of the case is whether Dr. Roozrokh, who studied at a transplant fellowship program at the Stanford University School of Medicine, was pursuing organs at any cost or had become entangled in a web of misunderstanding about a lesser-used harvesting technique known as “donation after cardiac death.”

Dr. Roozrokh has pleaded not guilty, and his lawyer said the charges were the result of overzealous prosecutors. But the case has sent a shudder through the tight-knit field of transplant surgeons — if convicted on all counts, Dr. Roozrokh could face eight years in prison — while also worrying donation advocacy groups that organ donors could be frightened away.

“If you think a malpractice lawsuit is scaring surgeons off, wait to see what happens when people see a surgeon being charged criminally and going to jail,” said Dr. Goran B. Klintmalm, president of the American Society of Transplant Surgeons, who added that he considered the case unprecedented.

David Fleming, the executive director of Donate Life America, a nonprofit group that promotes donations, said the case had “given some support to the myths and misperceptions we spend an inordinate amount of time telling people won’t happen.”

Mr. Fleming said about 18 people a day die in the United States waiting for transplants. That has created a tremendous demand for donor organs, and over the years the medical community has established strict protocols to govern organ harvesting.

Transplanting organs from patients whose hearts have stopped, or cardiac-death donations, began to go out of vogue in the late 1960s and early ’70s after medical advances like life support and subsequent changes in the legal definition of death made donations from those declared brain dead more efficient. But health officials have encouraged cardiac-death donations in recent years.

There were 670 cardiac-death donations through the first nine months of 2007, the most in any year this decade, according to the United Network for Organ Sharing, which oversees organ allocation. Over the same period, there were 12,553 brain-dead donations, according to the network.

In brain-death donations, the donor is legally dead, but machines keep the organs viable by machines. In cardiac-death donations, after the patient’s ventilator is removed, the heart slows. Once it stops, brain function ceases. Most donor protocols call for a five-minute delay before the patient is declared dead. Transplant teams are not allowed in the room of the potential donor before that.

Cardiac-death donations can make some doctors and nurses skittish if they have not previously witnessed one, said Dr. Robert Sade, the former chairman of the American Medical Association’s Council on Ethical and Judicial Affairs.

“It all works exactly the same, the cuts and the procedure,” Dr. Sade said. “But the circumstances are quite different.”

Several days after Mr. Navarro was hospitalized at the Sierra Vista Regional Medical Center here, a decision was made to remove his ventilator. According to the criminal complaint, Dr. Roozrokh ordered excessive doses of morphine and Ativan, an anti-anxiety medicine, both of which are used to comfort dying patients. In the most shocking accusation, the complaint said Dr. Roozrokh introduced Betadine, a topical antiseptic, into Mr. Navarro’s system; Betadine, the complaint said, is “a harmful substance that may cause death if ingested.”

Mr. Navarro died about eight hours later of what the coroner ruled was natural causes. In the end, however, because his death was not more immediate, his organs had deteriorated too much to be usable for transplant.

Prosecutors have charged Dr. Roozrokh with felony counts of dependent adult abuse, mingling a harmful substance (Betadine) and prescribing a controlled substance (morphine and Ativan) without medical purpose.

The doctor’s lawyer, M. Gerald Schwartzbach, said that Dr. Roozrokh, 34, who moved to Wisconsin from Iran when he was a toddler and excelled as a collegiate swimmer, did “nothing that adversely affected the quality or length” of Mr. Navarro’s life.

“Dr. Roozrokh is a brilliant young surgeon, who has dedicated his life to saving lives,” Mr. Schwartzbach said. Neither the police nor prosecutors would comment on the case.

Mr. Navarro was diagnosed with adrenoleukodystrophy, a neurological disorder, when he was 9. “He would walk like he was drunk,” said his mother, Rosa, a Guatemalan immigrant. “And when he would play, he would fall like Bambi.”

By his early 20s, however, Mr. Navarro’s mental and physical condition had deteriorated to a point where he was placed in an assisted-care facility.

On Jan. 29, 2006, Ms. Navarro received a call from the facility that her son had been found unconscious, in cardiac and respiratory arrest, but that he had been revived and transported to Sierra Vista. His brain had been damaged from lack of oxygen.

Several days later, Ms. Navarro says she was told by a doctor at the hospital, whose name she did not know, that her son would not recover and that he would be disconnected from life support.

Ms. Navarro, a machinist from Oxnard, Calif., who is on disability, said she did not have enough money to stay another night near her son. She said that shortly after leaving the hospital, she received a call from the California Transplant Donor Network, a nonprofit organization. On a tape recording made by the network, Ms. Navarro agreed to donate her son’s organs, saying she did not want him “to suffer too long.”

Late on Feb. 3, a transplant team including Dr. Roozrokh arrived at the hospital.

According to a police interview with Jennifer Endsley, a nurse, the transplant team, including Dr. Roozrokh, stayed in the room during the removal of the ventilator and gave orders for medication, something that would violate donation protocol. Ms. Endsley, who stayed to watch because she had never participated in this type of procedure, also told the police that Dr. Roozrokh asked an intensive care nurse to administer more “candy” — meaning drugs — after Mr. Navarro did not die immediately after his ventilator was removed.

Mr. Schwartzbach said he would address the accusations in court. “I think a great many people, lay and medical, will realize they have been significantly misinformed,” he said.

Several months after the incident, federal health officials cited the hospital for a series of lapses, including failing to grant temporary clinical privileges to Dr. Roozrokh, who was under contract with the donor network. Last February, the United Network for Organ Sharing reprimanded the California Transplant Donor Network for breaking “established protocol” in the case. The donor network declined to comment.

Ms. Navarro has filed a civil suit against Dr. Roozrokh, the donor network and other doctors in the operating room, and has settled a lawsuit against the hospital. A spokesman for the hospital, Ron Yukelson, said a plan to correct the problems had been accepted by federal health officials.

Ms. Navarro said she remained angry about the way her son’s life ended.

“He didn’t deserve to be like that, to go that way,” she said. “He died without dignity and sympathy and without respect.”

Melanie Carroll contributed reporting from San Luis Obispo, and Lawrence K. Altman from New York.

http://www.nytimes.com/2008/02/27/us/27transplant.html?pagewanted=print

GURGAON, India — As the anesthetic wore off, Naseem Mohammed said, he felt an acute pain in the lower left side of his abdomen. Fighting drowsiness, he fumbled beneath the unfamiliar folds of a green medical gown and traced his fingers over a bandage attached with surgical tape. An armed guard by the door told him that his kidney had been removed.

Mr. Mohammed was the last of about 500 Indians whose kidneys were removed by a team of doctors running an illegal transplant operation, supplying kidneys to rich Indians and foreigners, police officials said. A few hours after his operation last Thursday, the police raided the clinic and moved him to a government hospital.

Many of the donors were day laborers, like Mr. Mohammed, picked up from the streets with the offer of work, driven to a well-equipped private clinic, and duped or forced at gunpoint to undergo operations. Others were bicycle rickshaw drivers and impoverished farmers who were persuaded to sell their organs, which is illegal in India.

Although several kidney rings have been exposed in India in recent years, the police said the scale of this one was unprecedented. Four doctors, five nurses, 20 paramedics, three private hospitals, 10 pathology clinics and five diagnostic centers were involved, Mohinder Lal, the police officer in charge of the investigation, said.

“We suspect around 400 or 500 kidney transplants were done by these doctors over the last nine years,” said Mr. Lal, the Gurgaon police commissioner.

The case has enthralled India’s newspapers. Editorial writers have been particularly incensed by the failure of the police to capture the main doctor, who has many names but was known most recently as Amit Kumar.

He was arrested in 1994 on suspicion of running a kidney transplant racket in Mumbai, but jumped bail, changed his name and set up work again from several clinics hidden in residential apartments in Gurgaon, a prosperous city outside Delhi.

The police raided one of his clinics in 2000, but somehow he was allowed to continue working. Officials neglected to investigate further even after at least one television investigation exposed his work.

On Tuesday, The Times of India called on the government to investigate “the nexus between the organ traders and the police.”

Investigators were alerted to the ring on Thursday by a donor who said the operation had ruined his health.

Apparently tipped off to the raid, Dr. Kumar escaped arrest. Only one of the four main doctors implicated has been detained.

The officials suspect that several private hospitals in Delhi and its suburbs were quietly complicit in Dr. Kumar’s work and treated patients recovering from kidney transplants.

“Due to its scale, we believe more members of the Delhi medical fraternity must have been aware of what was going on,” Mr. Lal told reporters on Monday.

He said a team of criminals he called kidney scouts usually roamed labor markets in Delhi and cities in Uttar Pradesh, one of India’s poorest states, searching for potential donors. Some prospects were asked outright if they wanted to sell a kidney and were offered $1,000 to $2,500.

A car equipped with testing equipment was often on hand so that potential donors could be checked immediately to see whether their kidneys matched the needs of prospective patients.

Letters and e-mail messages from 48 foreigners inquiring about transplants were discovered in Dr. Kumar’s office, Mr. Lal said. Five foreigners — three from Greece and two Indian-born American citizens — were found in one of the clinics during the raids. The police suspected that they were about to receive kidney transplants, Mr. Lal said, but they were allowed to return home because the evidence was insufficient to detain them.

Mr. Mohammed, 25, said Monday that he had no idea that it was possible to sell a kidney. He had been picking up odd jobs in Delhi for the past two years and sending money to his family in Gujarat, he said.

Two weeks ago, he was approached by a bearded man as he waited at the early-morning labor market by the Old Delhi train station, he said. The man offered him an unusually generous deal: one and a half months’ work painting, for a little less than $4 a day, with free food and lodging.

Mr. Mohammed said he was driven four or five hours, to a secluded bungalow, where he was placed in a room with four other young men, under the watch of two armed guards.

“When I asked why I had been locked inside, the guards slapped me and said they would shoot me if I asked any more questions,” Mr. Mohammed said, lying in a hospital bed, wrapped in an orange blanket, clenching his teeth and shutting his eyes in pain. He said the men were given food to cook and periodically nurses would take blood samples.

One by one, he said, they were taken away for operations.

“They told us not to speak to each other or we would pay with our lives,” he said. “I was the last one to be taken.”

Nearby in the drafty isolation ward at the Gurgaon Civic hospital, Shakeel Ahmed, 28, a laborer from Uttar Pradesh, said he, too, had been promised well-paid work. After days of confinement with Mr. Mohammed, Mr. Ahmed said, a blood sample was taken and a few hours later, against his will, he received an injection and lost consciousness.

“I had no idea about kidney transplants, but when they made me lie down on the stretcher, I was terrified,” he said. “I knew that these people meant to do evil to me. When I woke up, a doctor said my kidney had been removed. He said I would be shot if I ever told anyone what happened.”

The men said that they received no postoperative medical checks and that money or other compensation was not discussed.

Three police officers guard the ward.

“These are the main witnesses to the crime,” said Badlu Ram, a police inspector. “The operation was so well organized that we believe there may be a threat to their lives.”

Mr. Ahmed’s father, Abdullah Ahmed, sat on the edge of his son’s bed, weeping. The father said his son’s damaged health would keep him from working, leaving the family destitute.

“I don’t know what we will do,” he said. “The men who did this should be hanged.”

http://www.nytimes.com/2008/01/30/world/asia/30kidney.html?_r=1&ref=health&oref=slogin

Plea deal in US body parts case

The head of a US plot to illegally remove body parts from corpses and sell them for transplant is to admit guilt in a plea bargain, his lawyer has said.

One of the bodies plundered was that of famous BBC broadcaster Alistair Cooke, whose bones sold for $11,000 (£5,600).

Michael Mastromarino, 44, allegedly earned millions from the plot and is expected to face a minimum of 18 years in prison.

Another 10 people have been charged in connection with the case.

Co-operation

Mr Mastromarino’s lawyer, Mario Gallucci, said his client was “facing a daunting battle and he sees this as his best opportunity to accept responsibility and move on”.

Mr Mastromarino was charged with corruption, body stealing, opening graves, unlawful dissection and forgery.

His assistant, Lee Cruceta, has agreed to a deal to serve eight years in prison.

Seven funeral directors have admitted other charges while charges on two other people are still pending.

Thousands of people received body part transplants supplied by Mr Mastromarino’s Biomedical Tissue Services and his plea bargain is expected to include co-operation on providing information on who else dealt in the parts.

The parts were taken without permission from more than 1,000 corpses awaiting cremation in New York state and may have exposed people to infection, prosecutors say.

The four-year operation ran until 2005.

Alistair Cooke died in 2004, aged 95. He presented Letter from America, the world’s longest-running radio speech show, for 58 years.
Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/hi/americas/7192462.stm