Disgraced Italian Surgeon Found Guilty of Criminally Harming Stem Cell Patient | Science
A surgeon who just a decade ago was celebrated around the world as a pioneer of stem cell transplants has been found guilty of one count of ‘bodily harm’, a felony, by a court Swedish. Solna District Court today found Paolo Macchiarini not guilty of other charges, including aggravated assault, which could have resulted in prison sentences of up to 4 years, in relation to three patients whom he treated while working for the famous Karolinska Institute (KI). The court said the sentence was “a suspended sentence”, but did not specify the length of the sentence if imposed.
The verdict is the latest development in Macchiarini’s incredible fall from grace. In 2010, the Italian surgeon was recruited by KI, headquarters of the committee that awards the Nobel Prize in Physiology or Medicine. A year later, he began implanting synthetic tracheas seeded with stem cells isolated from the patients’ own bone marrow, claiming the cells would grow and integrate with the patients’ tissues. The operations were hailed at the time as a breakthrough in regenerative medicine, although some observers remained skeptical. Macchiarini was fired in 2016 amid allegations of fraud and scientific misconduct after the deaths of several of his transplant recipients.
Macchiarini always maintained that he was innocent. During his testimony in court, he defended himself as only trying to help desperately ill patients and said he had the full support of KI and his colleagues. His attorney did not respond to emails from Science today.
The light sentence is a disappointment for Macchiarini’s critics. Cardiothoracic surgeon Matthias Corbascio, one of Macchiarini’s former colleagues at KI who first raised questions about the work, describes it as “terrible” and “insane”. “The court basically gave him a slap on the wrist,” says Corbascio, who is now at the University of Copenhagen. “There are people who go to jail for 5 years for not paying their taxes. This guy mutilated people.
Between 2011 and 2014, Macchiarini implanted artificial tracheas in at least eight patients in Sweden, the United States and Russia. All but one died from serious complications related to the implants. (The surviving patient had the implant removed.)
Four of Macchiarini’s colleagues at KI, including Corbascio, filed formal complaints in 2014, accusing several articles describing the surgeries of deliberately omitting serious patient complications. They also questioned whether Macchiarini had obtained proper ethical clearance for the surgeries, and challenged a paper describing animal experiments with the technique.
KI commissioned surgeon Bengt Gerdin, professor emeritus at Uppsala University, to investigate the matter. Gerdin’s report, released in May 2015, found Macchiarini guilty of misconduct, but university administrators rejected that finding 3 months later, arguing that Macchinarini and his co-authors had “satisfactorily addressed the issues raised by Gerdin. They allowed Macchiarini to continue his work as a visiting professor in a research laboratory.
However, Swedish television journalists also decided to take a close look at Macchiarini’s work. Their devastating documentary, aired in January 2016, led KI officials to reopen the investigation. Around the same time, an article in vanity lounge described how Macchiarini tricked a girlfriend – an NBC news producer working on a flattering documentary about his operations – into believing they would be married in a ceremony attended by the Clintons and Obamas and presided over by Pope. The story portrays Macchiarini, who was already married at the time, as a serial fabulist who exaggerated or lied about degrees, college appointments, and personal accomplishments.
KI fired Macchiarini in March 2016, 2 months after the Swedish documentary was released. In 2018, KI finally released the findings of his second investigation, which confirmed that he was at fault.
In 2017, Swedish prosecutors charged Macchiarini with manslaughter in connection with the three patients who received transplants at KI in 2011 and 2012, all of whom died: Andemariam Teklesenbet Beyene, a graduate student from Eritrea with cancer at slow progress obstructing his trachea; Christopher Lyles, a 30-year-old American with tracheal cancer; and Yesim Cetir, a Turkish teenager whose trachea had been accidentally damaged in a previous surgery. However, prosecutors dropped the case a few months later, saying they did not have enough evidence to prove manslaughter.
They reopened the case in 2020, this time charging Macchiarini on lesser counts of aggravated assault and grievous bodily harm. The court heard testimony in the case between April 27 and May 12.
At trial, Macchiarini and his attorney argued that the patients, with no other option, were treated to compassionate standards. Other witnesses contradicted this, saying that with Andemariam’s slowly growing cancer, minor surgeries and other treatments could have kept him alive. “Each patient had another non-lethal option,” said Pierre Delaere, a trachea expert at KU Leuven and one of Macchiarini’s early critics, in an email to Science.
A panel of judges unanimously ruled that “the interventions were not consistent with science and proven experience”, according to a statement released today. But the judges ruled that because the initial prognoses for Andemariam and Lyles were so grim without surgery, Macchiarini could not be held criminally responsible in those cases. In the case of Cetir, he should have known that the risk of complications was greater than the expected benefit, the judges ruled. But they found prosecutors had not proven Macchiarini was “indifferent” to the injury or suffering the surgeries could cause, the standard required for aggravated assault. Instead, they found him guilty of negligence and the lesser charge of causing bodily harm.
In Sweden, the defense and prosecution can appeal decisions, and lead prosecutor Karin Lundström-Kron says she and her colleagues will decide in the coming weeks. In particular, they will examine the judges’ decision that Macchiarini could not be held responsible for what happened to Andemariam and Lyles “because he acted out of distress”, according to the court statement. “It’s something that was new for us, so we have to analyze that,” says Lundström-Kron. She says that may mean the judges thought he and the patients thought time was short and options were few. Macchiarini’s lawyer declined to comment to Swedish media today whether his client would appeal.
Delaere believes the sentence is too light for what he considers a serious crime. He says prosecutors should have pushed for manslaughter charges because Macchiarini had no evidence that the tracheas he implanted would develop into normally functioning organs. “When you implant a synthetic trachea, you have a certainty that the patient will die from it,” Delaere says in the email. “The acquittal is therefore difficult to defend.”
But Gerdin says the verdict is not unexpected. The court had to apply the standard of “intentional disregard” for the assault charges, he says, which is difficult to prove. Macchiarini’s argument that KI fully supported and encouraged the surgeries likely influenced the judges as well, he says. KI officials “let him go. It took some of the burden off him.
Gerdin says the conviction of one count always shows “that health care is not above the law. If, as a doctor, you do stupid things, you can be accused. But the not-guilty verdicts in the other two cases underscore how the law can leave vulnerable people unprotected, he says, such as when they face life-and-death decisions and hold less information than their doctor.
The felony conviction means Macchiarini would have a hard time finding a job in Sweden, Gerdin says. But because Macchiarini apparently lives in Spain, that’s unlikely to have much effect. “It actually doesn’t make sense to him,” Gerdin says. “But he lost his reputation, and that’s more important.”