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Published: Thursday, 7/17/2003

A risk willingly taken

SADLY, the deaths of 29-year-old conjoined Iranian twins during surgery prove that despite numerous strides in medical science, such delicate and risky surgery has a long way to go.

More than 50 hours into what was to have been four days of surgery in Singapore, Ladan Bijani died. Her sister Laleh died 90 minutes later. Both deaths were blamed on blood loss.

The sisters understood that the risks of surgery were high. Joined at the head, with brains that not only shared a vein but had fused over the years, the women so desperately desired to live separately that they willingly and courageously faced the possibility that one, or both of them, could die in the process.

That should be stressed more than trying to fix blame.

The adoptive father of the two was bitter. “When they took them to Singapore I knew they would bring back their bodies,” Alireza Safian said. “They took them there and killed them.”

His emotional state is understandable if way off the mark.

Other adult conjoined twins - there are fewer than a dozen of them today - have shunned such surgery. Among the conjoined twins separated as infants and young children since the 1920s, the death rate is about 50 percent and the survivors often suffer brain damage.

But the Bijani sisters wanted so badly to go about life as individuals that they tried to defy death. Their divergent interests showed that remaining conjoined was “clearly intolerable to them,” said Alice Dreger, a Michigan State University professor who has written about conjoined twins.

Laleh loved newspapers and books and wanted to be a journalist. Ladan had planned to continue pursuing law, and spent time reading the Koran and praying. Their biological father, who lives in Iran, tried in vain to convince the women not to go through with the surgery.

Doctors didn't view these women as lab mice, as the adoptive father said. They were bright, intelligent women with different personalities, and their decision to proceed with the surgery gives medical science more insight about the risks involved in separating conjoined twins.

Ladan and Laleh did not die in vain. Science will learn from them.



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