Five Years On, Convicted Transplant Surgeon Earns Expressions of Concern From Lancet

Frederik Joelving

February 15, 2023

In 2018, when The Lancet pulled two studies by once-celebrated transplant surgeon Paolo Macchiarini after he was found guilty of misconduct, we suggested in a post that the journal's chapter of the long-running Macchiarini saga was finally over. 

We were wrong.

Last week, the journal issued expressions of concern about a pair of papers by the Italian doctor, who is currently on probation after a court in Sweden convicted him of causing bodily harm to a patient.

In the first paper, published in 2008, Macchiarini and his colleagues reported how they implanted a cadaveric windpipe seeded with stem cells into a 30-year-old woman; in the second, from 2013, they described how the patient fared over the next five years. Despite needing repeated bronchoscopic interventions, the authors wrote, she "had a normal social and working life."

The research made headlines across the globe. But it did not live up to its promise: Of eight patients who had an artificial windpipe implanted by Macchiarini between 2011 and 2014, seven died following complications from the procedure. 

Likewise, the woman described in the 2008 report suffered multiple complications, including respiratory failure, and had to have surgery to remove her left lung, according to a 2019 Lancet report

Macchiarini – who has had eight papers retracted – first came to our attention more than a decade ago, when he had a paper retracted in November 2012 "for scientific misconduct for reproducing a table but failing to acknowledge and cite the previous, original work from which it was taken." At the time, he was reportedly under house arrest for fraud and attempted extortion charges. 

Two years later, The New York Times revealed that Macchiarini, then at the Karolinska Institutet, was facing misconduct allegations. The story took numerous twists and turns, particularly in 2016, when filmmakers released a documentary about the allegations and Vanity Fair published a piece on how the surgeon scammed – in the romantic way – an NBC News producer.

For years, critics continued to press for investigations, sanctions, and retractions. Last year, a letter to the editor in The BMJ  called for the retraction of the case report in The Lancet, noting the journal:

was informed in May 2018 that the key findings of the article were false. Despite this, and subsequent demands for retraction of the paper by us and others, the Lancet has refused to retract, without providing any explanation.

The case report has been cited more than 1,000 times, according to Clarivate's Web of Science, and the follow-up has garnered 196 citations. 

In its expression of concern from February 8, the journal noted: 

The Lancet has received continuing questions over the reliability of the findings and conduct of this reported case, since Paolo Macchiarini was found guilty of scientific misconduct in 2018.

It added:

The Committee on Publication Ethics (COPE) has discussed these concerns at length again and their view, as an expert body in publication ethics, is that these two unretracted articles should, at a minimum, have received an Expression of Concern given the severity of the concerns raised and the length of time during which the concerns have persisted. As members of COPE, we are now following this advice and are issuing an Expression of Concern for these two Articles.

Reached for comment in Spain, Macchiarini said he was not aware of the new expressions of concern and did not have time to look at them. "I'm doing surgery, so… busy," he told Retraction Watch, adding "I don't give interviews."

DISCLOSURE: Adam Marcus, a cofounder of Retraction Watch , is an editor at Medscape.