Paolo Macchiarini - The Fallen Star Surgeon
He was hailed as a superstar, a genius that will advance transplantation with the most modern techniques in stem-cell therapy. He was the super-star surgeon Paolo Macchiarini, until his meticulously crafted house of cards fell. How could this man, a medical professional and long standing academic, directly be involved in the death of multiple of his patients?
This may be the story of one of the biggest scientific frauds of the early 21th century, a story of faked academic titles, falsified results in reputable journals and the death of multiple patients that trusted their doctor to do no harm. This is the turbulent story of the downfall of Dr. Paolo Macchiarini.
Paolo was born in 1958, in Basel Switzerland. In 1986 Macchiarini obtained his doctorate in medicine at the Medical School of the University of Pisa (Italy). It followed stays in the USA, France, Germany, Spain, Great Britain and Russia, where he according to his CV collected a Masters degree, a PhD, was later given multiple professorships and held countless high ranking positions within the respective institutions. However, later investigations into his former experience brought up multiple instances in which he added qualifications to his CV without clear evidence. For example, he never held a professorship at the University of Pisa nor a full professorship in Germany [1]. But it was this impressively inflated CV that led him ultimately to the renown Karolinska Institutet in Stockholm, Sweden, the place where his construct of lies would ultimately unravel.
We put much effort into constructing a comprehensive timeline of Macchiarini’s “work” pulling together information from a vast amount of sources and different news outlets to validate their claims, you find them linked below. We want to highlight here the detailed timeline put together by the Karolinska Institute which deals with a lot of the details post 2010 [2] and the magnificent blog posts by Lenonid Schneider on the For Better Science blog [3]. So let us dive in this story of a fall from grace:
Barcelona, June 2008
Paolo operates Claudia C., she received one of the first trachea transplants. This one was seeded with foreign stem cells (which according to some sources has been prepared without proper allowances [3] in a veterinary lab and thereby of questionable quality). The operation was deemed successful and has then been published soon thereafter in a reputable journal [3] where the patient's health status has been willingly overestimated. In 2016 Claudia underwent a partial lung amputation probably due to the ever deteriorating transplant.
Florence, July 2010
Keziah S. has been given a transplant from a deceased donor in an attempt to battle a rare form of cancer. Official reports considered her patient 2 [5] although Macchiarini was only involved peripherally. She died 2 years later in 2012 after she already had received a second, artificial, graft less than a year prior.
Stockholm, September 2010
Karolinska Institutet is proud to announce the recruitment of Macchiarini as a visiting professor.
Moscow, December 2010
While work in Sweden had just begun, Macchiarini held good ties to some russian institutions throughout the years. Here he operated on Zhadyra I. She received a trachea graft from an organ donor by Macchiarini. In 2015 the graft was removed, and in 2018 she died due to pneumonia [6 (primary source redacted)].
Stockholm, June 2011
Andemariam B. the 36-year old graduate student was the first one operated on in Sweden. Like Keziah he suffered from cancer. He received a synthetic trachea prepared at the Karolinska Hospitals laboratories. He died in 2014 after implant failure (7).
Stockholm, November 2011
Christopher L., Swedish patient number 2, he was operated on and received a synthetic trachea prepared at an external site. He died suddenly just 4 months later.
Krasnodar, June 2012
Back in Russia, Macchiarini grafted another plastic trachea onto Yulia T., after she’s been in a car accident, that although damaging her trachea didn’t leave her in a life threatening condition (8). After severe complications and despite acute interventions Yulia died in September of 2014.
Within the same month Alexander Z. also received a graft from Macchiarini and his russian colleagues, he died also in 2014, apparently unrelated to the procedure.
Stockholm, August 2012
Back at “Homebase” Macchiarini operates his last patient in Sweden (although at this time he is unaware of the consequences that soon will follow). Then 22 year old Yesim C. received her first synthetic trachea transplant. One year later it had to be replaced with a second one. In 2017 she died after a renewed transplant failed [9].
Of note here is that unlike Yulia, all three patients operated at Karolinska University Hospital were considered “vital indications”, meaning without intervention those patients would have died definitely.
Stockholm, 2013
After 2 out of 3 patients had died just months after surgery, the Karolinska Institute pulled the plug and terminated Macchiarinis contract as Surgeon and stopped all future operations with synthetic trachea transplants.
Illinois, April 2013
Together with his colleagues in the USA Macchiarini operates on the three-year-old Hannah W., who has been born with a birth defect making her trachea non functioning. Three months later the little girl died. Originally she should have been the first human to ever receive a synthetic trachea. However FDA did for the longest time not approve of the method, concerns that in hindeside might have been valid after all.
Krasnodar, August 2013
Unimpressed by his loss of position in Sweden, Macchiarin continued to operate in Russia. Here he operated on Sadiq K.. He died the following year, although the exact date and cause are not entirely clear.
Krasnodar, June 2014
Dimitri O. marks the last of Macchiarinis victims. Just months after the annexation of Crimera, the Ukrainian citizen has been operated on. Half a year post operation the graft began to fail and had to be removed. Today he is one of the few of Paolos patients still alive.
Within the same month as Macchiarini operated on his last patient the first claims of scientific misconduct were ushered by a Belgian colleague of his and internal investigations were held at the Swedish research institute. In August and September further claims of misconduct, this time from Swedish doctors, increased the pressure. Main points of the accusation revolve around the overly positive reporting of patients post-operative health.
Stockholm, November 2014
An external review of the case takes place.
In 2015 the internal investigation by the Ethics committee deflects any accusations and Karolinska Institute cleared Macchiarini of the suspected misconduct.
Two months later, however, the external investigation comes to a different opinion and finds him guilty of misconduct in research. The Swedish research institute still holds on to the surgeon, although funding has been cut, and clears his name once again.
In 2016 the, in the beginning mentioned, inconsistencies in Macchiarinis CV were found by investigative journalists. Together with a 3-part documentary on the matter the debate around Macchiarini is resparked.
Paolo Macchiarins contract is finally terminated. What follows are renewed and extensive external investigations. Multiple high ranking officials within the institute's governing body resign as a direct consequence of the handling of the case.
In June of 2016 jurisdictive measures were taken, Macchiarini is informed that he is suspected of negligence causing manslaughter and bodily injury.
By now most of Macchiarinis publications are under scrutiny, including those including pre-clinical trials in animals from 2014.
In between August and September the reports on misconduct grow more and more, the handling of the earlier accusations is harshly criticized.
In March of 2017 the original article, where the procedure was tested in rats was withdrawn. Investigations find severe shortcomings in handling of animal experiments when it comes to the case [10].
Six more research articles are withdrawn in 2018 stabbing deep at Macchiarinis researcher career.
A decade after his recruitment Paolo Macchiarini is officially prosecuted on accounts of aggravated assault in 3 cases (those patients operated on in Sweden). Two years pass until trials are held and Macchiarini is found guilty in one of three cases. The Sentence gets appealed from the side of the prosecution. The case gets renewed and in 2023 the court finds him guilty and sentences him to 30 months in prison.
After the verdict 3 more articles are retracted after intense review.
Now, after more than 15 years, what we are left with is maybe one of the most intense cases of scientific wrongdoing that is by far not talked about enough. We stand at 11 retracted research papers, at least 9 dead patients, with more unaccounted for and a once promising superstar-surgeon who got away with less than 3 years of prison and a irreparably destroyed credibility for all this. And all just because one man was too convinced he stands above them all.
Personal opinion:
The case of Paolo Macchiarini has always been fascinating to me, since I first came across it by chance due to a youtube video (https://www.youtube.com/watch?v=PR_YM6PIoMc) by Swedish doctor and musician Henrik Widegren. As a researcher involved in biomedicine myself and working daily on what may one day improve patients' health, while also battling with ethical rules, animal experiments and getting publications and funding, I see how the allure of “tweaking” one's result may be appealing to many of us. But what’s shocking to me is the extent this particular case presents and how willingly, at least in the beginning, all were turning a blind eye, because they have been enchanted by the person presented in front of them. I strongly advocate that the story layed down here should be more broadly known to all those that work in a career where it’s ultimately human lifes that are at stake. A cautionary tale of how little actions, like twerking one's CV or not taking it so strictly with the necessary animal studies can create ripples that directly or indirectly cost human lives. Although on top it is the story of a severely flawed human being the story underneath reveals much more issues, that of a flawed system that values prestige and the upkeep of integrity over life itself. As a young researcher I have to ask myself, how common is such a behaviour within academia without us ever realizing? And who is perpetuating this behaviour? If there is one point you should take away from the downfall of Paolo Macchiarini, it is that you should speak up and expose issues when you see them to stop fueling this maschine that tolerates wrong science for research grants.
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