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A UCLA Medical Center liver transplant patient at the top of the regional waiting list was denied receipt of an available liver when doctors at St. Vincent Medical Center instead chose to transplant the liver to a Saudi national ranked 52nd on the list, officials said.

The surgery took place in September 2003.

Two former directors of the program, Dr. Richard Lopez and Dr. Hector Ramos, are now under investigation by the hospital, which has suspended its liver transplant program pending the review.

As the investigation continues, St. Vincent said it is making attempts to mend relationships broken by the recent discovery.

“We’ve done everything we can to communicate with UCLA in any way we can about this situation,” said Paul Silva, a spokesman for St. Vincent. “We’ve been very cooperative, they’ve been very helpful.”

UCLA officials have declined to comment on the situation.

The general hospital privileges for the doctors, which include working with other patients in other departments at the hospital, are also under review by St. Vincent medical staff leadership.

An attorney for Ramos told the Los Angeles Times his client had done nothing wrong, while an attorney for Lopez declined comment to the paper.

Patients awaiting organs at St. Vincent have the option of being relocated to other medical centers across Los Angeles as the investigation continues, including Cedar-Sinai Medical Center and USC University Hospital.

Dale Tate, a spokeswoman for UCLA, said UCLA Medical Center will also be open to accepting patients.

Money is a point of interest in the situation as investigators search for a motive for the bypassing of the higher priority UCLA patient. The Saudi national’s surgery was paid for by the Royal Embassy of Saudi Arabia at a cost of $339,000, a price 20 to 25 percent higher than what would have been paid by an average insurance company for an average patient.

“The doctors have not been very forthcoming,” Silva said. “The doctors haven’t come out and told us that this was about money.”

Another possible motive being investigated is the nationality of the patient. United Network for Organ Sharing has guidelines requiring that no more than 5 percent of transplants can be provided to foreign nationals. Silva said St. Vincent is operating according to those guidelines.

“We have no preference for foreign nationals,” he said.

Organ recipient ranking takes into account how sick the patient is and how long they have been waiting.

St. Vincent is also trying to regain the trust of patients and insure to them and their families that the hospital is doing whatever it can to make things right.

Speaking over the phone outside of a meeting for affected patients and those concerned about the situation, Silva said the hospital knows how they feel.

“All of the patients on the list, including UCLA patients, have a right to be saddened, to be angry, to be anxious about this. We have the same reaction. Clearly trust has been broken. We are trying to do everything we can to restore trust to the transplantation community as a whole,” he said.

A loss of trust in the transplantation community as a result of this situation has those who work with organ donors and recipients concerned, said Lisa Stocks, executive director of Life Sharing, an organ procurement agency affiliated with UC San Diego in La Jolla, Calif.

“The need for organ donations is important and this (situation) shouldn’t affect people’s decisions,” she said.

Stocks, who has worked in organ procurement for 15 years, is concerned potential organ donors will look at this situation and be deterred from donating.

Stocks said her initial reaction when she heard about the situation was disappointment, but she believes this was an isolated incident, and it is not becoming nor has been a common practice.

She believes more stringent auditing practices by UNOS and increased oversight in the last 15 years have made the process fair.

Stocks said that both the transplant center and organ procurement organizations report on transplants within 30 days of the operation to UNOS. Reports include information such as who an organ was allocated to, where they were based on the list, and why recipients ahead of them on the list were denied the implant.

Stocks added that when reports are inconsistent, UNOS sends a memo to both parties to explain the variance.

“The variances go out about quarterly. It is stringently monitored. It’s created to have be fair and equitable,” Stock said. Silva also expressed confidence in the transplant process.

“They system works,” Silva said. “In a good system there are good players and a bad players. We’ve got to identify the bad players.”