The story of the fraud doctor Paolo Macchiarini, who implanted plastic tracheas in people

In medicine, as everywhere, there are fraudsters. For example, the founder of the Theranos startup Elizabeth Holmes, pseudo-doctor and self-proclaimed genius Andrii Slisarchuk (“Doctor Pi”) were exposed as lies.

Another high-profile case of lying in the field of medicine is the experimental operations of the surgeon Paolo Macchiarini.

He was once called a “pioneer” of stem cell medicine. He forced the world media to write about “amazing” operations, and many colleagues to believe in the miracle of artificial tracheas, which he implanted in patients.

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Paolo seeded the plastic tracheal frameworks with stem cells in a bioreactor and then transplanted them into humans.

If it worked, patients in need of a tracheal implant could not wait for a donor, but instead receive an artificial organ made to order in a laboratory.

However, later almost all of his patients died. In July 2023, the Stockholm Court of Appeal sentenced Macchiarini to 2 years and 6 months in prison for harming the lives of patients.

And recently, Netflix released the film “Bad Surgeon: Love Under the Scalpel”, whose authors investigated the allegations against Macchiarini and collected the testimony of investigative journalists, relatives of deceased patients and women deceived by the doctor.

“UP. Life” tells the main facts of this story based on the publications of Science, The Guardian, The British Medical Journal and the BBC.

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Photo: Staffan Larsson/Karolinska Institute

Who is Paolo Macchiarini?

65-year-old Paolo Macchiarini is an Italian thoracic surgeon (chest organ surgeon) and former regenerative medicine researcher, who became famous for fraud in research and the death of most patients after experimental operations. He conducted them in Sweden, Italy, Great Britain, the USA and Russia.

Since 2010, Macchiarini has worked at one of the most prestigious medical universities in the world – the Karolinska Institute in Sweden, which annually selects Nobel Prize laureates in physiology or medicine.

There he invented his method. Instead of removing cells from donor airways, Macchiarini ordered plastic frameworks of tracheas, which he “seeded” with the stem cells of the patients themselves in a special environment.

The idea was that the artificial tube should be overgrown with living tissues and become a full-fledged organ. As it turned out later, the stem cells could not form tissue around the tube, the artificial tracheas began to rot, became clogged with mucus, and the patients developed infections and other complications.

Photo from the archive of Benita Alexander. Source: Vanity Fair

At first, Paolo’s operations were presented as a success. One of the films that talked about Macchiarini’s “miracle” was NBC News’ Leap of Faith, which won an Emmy. Its producer was Benita Alexander. However, during the shooting, a relationship developed between her and the surgeon.

At the time the program aired in 2014, the couple was planning a wedding. According to Benita, the doctor promised her that they would be crowned by the Pope himself.

He claimed that the then US President Barack Obama and First Lady Michelle, former US President Bill Clinton and his wife Hilary, President of the terrorist country of the Russian Federation Vladimir Putin, former French President Nicolas Sarkozy and other politicians with whom the surgeon invented “friendship” were invited to the ceremony.

However, it turned out that Macchiarini was already married, and at the same time he was meeting with several other partners, so the wedding was canceled.

Operations

Macchiarini first made headlines in 2008 when, along with partner Martin Birkall, he created a new airway for Barcelona’s Claudia Castillo.

The doctors took trachea from a deceased donorand then seeded the frame with stem cells taken from Castillo’s own bone marrow.

Soon the woman returned home and, according to Macchiarini, felt well. A similar operation was carried out by Macchiarini and Birhal in 2010 in London, for the first time transplanting such a trachea to a child.

In articles for the journal The Lancet, Macchiarini and Birkall described their “success” – allegedly the stem cells of these two patients actively transformed the transplants into “living” airways.

Claudia Castillo

Macchiarini wrote that the graft in Claudia Castillo already functioned as a trachea after 4 months, had a normal appearance and mechanical properties.

However, in 2018, doctors in Barcelona reported that Claudia’s new airway collapsed three weeks after the operation.

It turned out that Claudia was implanted with only a part of the trachea, and not the whole organ, and she needed permanent stenting – the introduction of special tubes into the trachea.

The woman survived, but in 2016 the implant was permanently removed along with her left lung.

Andemariam Beyen

In 2011-2012, working at the famous Karolinska Institute, Macchiarini already implanted artificial tracheas in patientsseeded with stem cells from their bone marrow.

All three patients diedbecause the implants did not take root.

The first person who received a completely new artificial trachea with stem cells was Andemariam Beyena graduate student from Eritrea who lived in Iceland.

Andemariam agreed to the first transplant in 2011. Shortly after the operation, he told the BBC that he was very frightened by the operation. Macchiarini warned him that this was the first such operation, but claimed that he had conducted experiments on pigs.

Two and a half years later, Andremariam died as a result of numerous infections. It turned out that his artificial trachea “wobbled”.

Christopher Lyles

The second patient was Christopher Lyles from the USA. He died a few months after the operation when he suddenly started bleeding.

The following year, the operation was performed on a 20-year-old woman Yesim Chetir from Turkey – later doctors kept her alive in intensive care for 4 years, but in 2017 the patient died.

Other patients who were treated abroad also died at different times. Among them is 2-year-old Hannah Warren from the States, who was transplanted with an artificial trachea in April 2013.

Macchiarini concealed that the method did not work. He referred to other diseases that the patients had – they said that it was precisely because of this that complications arose.

In fact, Macchiarin had patients who did not have terminal illnesses. In particular, Oleksandr Zozulya from Kuban. The man was not terminally ill, but he lived with a tracheostomy. He was operated on in 2012, and in 2014 he died. The same thing happened to the Russian Yulia Tuulik.

Yesim Chetir

Macchiarini transplanted artificial tracheas, according to various sources, from 8 to 17 patients around the world. Most of them died, and those who survived needed removal of the artificial trachea.

What was wrong with the Macchiarini method?

At first, Macchiarini used an algorithm according to which a trachea was taken from a donor, its cells were “cleaned”, the outside was seeded with mesenchymal stem cells from the patient’s own bone marrow, and the inside – with his epithelial cells. Then the trachea was to be implanted in the patient.

Paolo Macchiarini and Martin Birkall first used this procedure on a patient from Barcelona in 2008, and the case gained worldwide publicity.

Macchiarini operated on more than a dozen other patients, but switched to using it in 2011 polymer trachea instead of donor organs.

This idea was wrong even in theory, Macchiarini’s critics argued. In particular, surgeon Pierre Deler from the Catholic University of Leuven in Belgium wrote that there is no evidence that stem cells can grow into new tissue on a plastic trachea.

He called the idea “absolutely unrealistic” and in 2015 accused Macchiarini and Birkall of malpractice and “the biggest lie in the history of medicine.”

Photo: Conan Fitzpatrick/SVT

Other researchers accused Macchiarini of falsifying research and exposed numerous errors (for example, some photos were taken from other works).

Macchiarini and his partner published the results of alleged “studies on pigs”, but evidence of such experiments was lacking. They were confused in their conclusions.

Some publications suggested that the stem cells formed new tissue, but in one “pig study” the authors admitted that they were unable to follow the fate of the stem cells and found “no evidence of cartilage regeneration.”

In 2014, four former colleagues accused Macchiarini of falsifying research, but then the ethics committee of the Karolinska Institute found the claims “unsubstantiated”.

The institute hired an independent expert, Bengt Gerdin, who also confirmed that Macchiarini distorted the results of research and operations.

Even after that, in August 2015, the vice chancellor of the Karolinska Institute, Anders Hamsten, said that although Macchiarini had acted “without due care”, he had not committed any wrongdoing. The Lancet, which published Macchiarini’s work, also published an article in his defense.

But a journalistic investigation changed everything.

Exposure

Source: Vanity Fair

In 2016, a number of publications appeared that questioned Macchiarini’s methodology. On January 5, 2016, Vanity Fair published a story about Macchiarini’s affair with Benita Alexander, an NBC News producer who shot a movie about him. The journalists also exposed the surgeon’s lie in his resume.

In a few days, journalists from public television in Sweden Bosse Lindqvist and Johannes Hallbom published a three-part investigation about Macchiarini under the title “Experimenten” (“Experimenten”).

They proved that Macchiarini’s artificial tracheas were not a “breakthrough” in medicine, but on the contrary caused terrible complications, which the surgeon knew about.

The investigation at the institute resumed. In March 2016, Macchiarini was fired from the Karolinska Institute for violating medical ethics. After the release of the film, the vice-chancellor of the institute Anders Hamsten and the administration of the university resigned.

In the end, one by one, world publications began to tell the story of the “fall” of the brilliant surgeon. Against the background of the scandal, the commission that awards the Nobel Prize in medicine dismissed two members of the assembly.

In 2023, the Swedish National Board for the Evaluation of Research Misconduct concluded that Macchiarini’s articles contained falsified information. They were recently retracted by The Lancet.

At this time, it is impossible to say for sure whether Macchiarini conducted animal studies before performing surgeries on humans.

Court verdict

Paolo Macchiarini was finally tried in Sweden for the three deaths of patients that occurred in the country.

One patient died suddenly when the implant caused massive bleeding just 4 months after surgery.

The other two lived 2.5 and almost 5 years, respectively, but suffered from pain and debilitating complications before they died.

Swedish prosecutors initially accused Macchiarini of involuntary manslaughter of these patients. The surgeon denied any criminal wrongdoing.

There was not enough evidence to prove manslaughter, and prosecutors closed the case.

In 2018, the investigation resumed. The Swedish prosecutor’s office reopened criminal proceedings and in 2020 charged Macchiarini with “aggravated assault” and causing grievous bodily harm.

In 2022, a Swedish district court found Macchiarini guilty of one count of assault and sentenced him to a year’s probation.

Both Macchiarini’s side and the prosecutor, who asked for a 5-year sentence, appealed the decision.

Ultimately, the Court of Appeal considered the case and sentenced the doctor to 2.5 years in prison. The judges disagreed with the decision of the first instance that “the first two patients were treated in emergency conditions.”

According to them, both patients could live for a long time even without surgery.

The court decided that only the third case was an “emergency”, but the treatment was still not justified because at the time Macchiarini was aware of serious complications from his method.

“The investigation shows that he was aware of the risk that the procedures could cause physical injury and suffering to patients, and that he was indifferent to the realization of those risks.”the message said.

Macchiarini himself said he was disappointed with the outcome of the trial, particularly with the court’s finding that he acted with intent.

The surgeon denied that he wanted to harm the patients. He claimed that he only wanted to help those who “had no other treatment options.”

“Intent to do harm is the worst charge you can make against a doctor…There were 20, 25 of us in the operating room. What I’m wondering is, why am I here alone?”the doctor stated at the press conference.

Paolo Macchiarini lost his job and his career. Now he is serving his sentence, but he does not agree with the sentence. The surgeon appealed to the Supreme Court.

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