A candle lights a picture of Ruben Navarro who's death, prosecutors say, was hastened by a desire to harvest his organs for transplant. (Jill Connelly for The New York Times)

Surgeon accused of hastening patient's death to retrieve organs sooner

By Jesse Mckinley

Published: February 27, 2008

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SAN LUIS OBISPO, California: 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, Navarro, 25, was near death, and doctors hoped that he might sustain other lives by donating his kidneys and liver.

But what happened to 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 Roozrokh, with prescribing excessive and improper doses of drugs, apparently in an attempt to hasten Navarro's death to retrieve his organs sooner.

A preliminary hearing begins here on Wednesday, with Roozrokh facing three felony counts relating to Navarro's treatment as a donor. At the heart of the case is whether 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."

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, 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 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."

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," Sade said. "But the circumstances are quite different."

Several days after Navarro was hospitalized at the Sierra Vista Regional Medical Center here, a decision was made to remove his ventilator. According to the criminal complaint, 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 Roozrokh introduced Betadine, a topical antiseptic, into Navarro's system; Betadine, the complaint said, is "a harmful substance that may cause death if ingested."

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 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 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 Navarro's life.