A bill for Jesica's care would have listed charges totaling exactly $899,382, according to an accounting done at U.S. News's request. Jesica's family will never have to pay a dime. Duke has taken care of it. In May, Duke also announced that it had created a $4 million fund to help underwrite care for Latino children, with the hospital contributing $1 million over the next five years and raising the other $3 million elsewhere.

But unless a generous settlement is negotiated, a lawsuit is only a matter of time. Lawyers for the Santillan family are readying a complaint that could be filed in North Carolina Superior Court on short notice. It depends on the state legislature, which is considering a bill that would cap malpractice awards for pain and suffering at $250,000. Magdalena Santillan now says she wants to see Jaggers lose his medical license. But she still keeps an organ-donor card tucked safely in her purse.

THE PLAYERS

Five entities in three states were involved in the transplant that went wrong. Each had a unique role.

Children's Hospital Boston, which found Jesica's first set of organs, is itself a leading pediatric transplant center and ranks high in "America's Best Hospitals."

The New England Organ Bank began the search for a recipient. It is one of 59 regional organ procurement organizations, or OPOs.

The Richmond, Va.-based United Network for Organ Sharing, known as UNOS, is the nexus for organ donation. It maintains the national wait lists--data describing the thousands of people hoping to become recipients of various organs.

Carolina Donor Services is the OPO that serves transplant hospitals in much of North Carolina, including Duke.

William Fulkerson is chief executive officer of Duke University Medical Center, where, prior to Jesica Santillan, doctors had performed only 18 heart-lung transplants in adults and two in children since 1988. "We've certainly learned a lot from this," he says.

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