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July 11, 2003 -- TONIGHT'S FOCUS: What could be a more wrenching decision? Patients plead for an elective operation that could either dramatically improve the quality of their lives or abruptly end their lives. There is no emergency. The patients don't suffer from a life-threatening illness. What's a brain surgeon to do? If you're Dr. Ben Carson, the famed neurosurgeon at Johns Hopkins Hospital, you answer the call.

The Iranian conjoined twins had lived for nearly three decades fused at the head, but were determined to live separate lives -- at all costs. Along the way, Laleh and Ladan Bijani had searched in vain for doctors willing to perform the unprecedented, risky surgery that would separate them but could also kill them. All they wanted, they said, was to be able to look at each other without a mirror.

These kinds of surgeries had been performed before, but typically on infant twins -- sometimes successfully, often not. But until this week, reportedly there had never been a surgery to separate adult conjoined twins. Some doctors have been adamant that this kind of surgery is misguided. As sympathetic as anyone would be about the plight of conjoined twins, surgeons who refused the risky operation observed that neither twin had a medical illness demanding this kind of experimental operation. Seven years ago, German doctors had balked at performing the dangerous surgery on the Iranian women because they shared a thick vein, called a sinus, which drained blood from the brain.

So what changed? The surgical team in Singapore, led by Dr. Keith Goh and Dr. Ben Carson, had designed a plan to create a new sinus for one sister by using a blood vessel taken from her right thigh. When Dr. Carson met the twins earlier this month, he was impressed with the twins' determination to live separate lives. "The reason I felt compelled to become involved is because I wanted to make sure they had their best chance," he said.

After more than 50 hours of surgery this week, the twins died on separate operating tables after they lost massive amounts of blood. Dr. Carson has just returned to Baltimore and will sit down with Chris Bury to discuss why he was willing to take the risk, how he's coping with the loss of the twins and the myriad ethical issues that grow out of this pioneering surgery. In our opening report, Nightline's Dave Marash will explain why this operation was so fraught with danger but was an imperative for the twins.