Jesica Santillan, who received a heart incompatible with her blood type in a transplant operation last week, remained in critical condition late Thursday after more than four hours of surgery to provide the 17-year-old Mexican girl with a new heart and lungs. Further details continue to surface surrounding Duke University Hospital’s botched Feb. 7 transplant.

Associate Professor of Surgery Dr. James Jaggers, who performed the Feb. 7 operation on Jesica, said Wednesday he mistakenly assumed a blood-type match had been completed.

“I am heartbroken about what happened to Jesica … Early in the morning of Feb. 7, I received a call from Carolina Donor Services and was informed of available organs,” Jaggers said in a Wednesday statement. “I assumed that after providing Jesica’s name to the organ procurement organization and after the organs were released to me for Jesica, that the organs were compatible.”

“I continue to oversee Jesica’s care and have been devastated by this tragic event,” Jaggers continued in the release. “I informed Jesica’s parents immediately after the operation that an error had been made and that the organs were blood-type A and Jesica was blood-type O and that this was an incompatible transplant.”

Meanwhile, Duke has 45 days to submit a thorough review of its transplantation procedures and an analysis of how the mistake occurred to the Joint Commission on Accreditation of Healthcare Organizations, the national evaluation and accreditation association for health care institutions.

“We classify [the blood-type mismatch] as a ‘sentinel event,'” said JCAHO spokesperson Mark Forstneger, which he defined as an unexpected occurrence involving death or serious injury. “Any time a sentinel event occurs at a JCAHO organization, the organization is required to conduct a thorough ‘root-cause analysis.’ They have to look at the roots of their system, where the system failed and determine what changes need to be made.”

Since the mistake, the hospital has reconfigured some of its transplantation procedures by mandating multiple confirmations of blood-type matching by the patient-care team instead of a single confirmation by the surgeon performing the operation.

“As a result of this tragic event, it is clear to us at Duke that we need to have more robust processes internally and a better understanding of the responsibilities of all partners involved in the organ procurement process,” hospital chief executive officer Dr. William Fulkerson said in the Wednesday statement.

Mahoney, who has medical power of attorney for the girl because her parents do not speak English, has accused Duke officials of trying to stop the family from speaking to the press about the incident and of attempting to limit Mahoney’s access to Jesica against the wishes of her parents.

The pressure stopped when Sen. Elizabeth Dole, Woman’s College ’57, offered assistance to Mahoney, he says. Since then, Mahoney and the family have hired a Greenville, N.C., lawyer.

Hospital representatives are not responding to the charges.

Officials at the United Network for Organ Sharing said the botched transplant was only the second such error in the last 15 years in addition to one other nonmatching organ that was delivered but not transplanted.

Pointing fault for the error solely at Duke, both the New England Organ Bank, the source of the donated organs, and Carolina Donor Services, the regional transplant office that notified Duke of the organs’ availability, are insisting the mistake did not originate with them.

NEOB originally notified CDS that the type-A organs were potential matches for two Duke Hospital patients, who were both rejected as recipients for reasons other than blood type.

According to a CDS statement, a Duke surgeon then requested to use the organs for a third patient — Jesica Santillan, who has O-positive blood type. “Carolina Donor Services was informed that Duke suspected an incompatible blood match only after the transplant took place,” the statement reads.

The Duke surgeons who flew into Boston to remove the heart and lungs from the donor were told of the organs’ blood type twice, once when Duke made the request for the organs, and again before the surgery removing them, the NEOB said.

Fulkerson publicly admitted the hospital erred in a Monday press release.

“This was a tragic error, and we accept responsibility for our part,” Fulkerson said in the release. “This is an especially sad situation since we intended this operation to save the life of a girl whose prognosis was grave.”

Hospital administrators declined to elaborate further on how the multiple errors occurred until an internal investigation is completed.

Fulkerson has indicated Duke has no intention of stopping its transplant programs, many of which are among the largest in the country.