PrimeTime: Survival of One Conjoined Twin

It’s a gesture from a hand so small that it barely wraps around her father’s finger. The tiny hand belongs to “Jodie,” a baby who is alive only because her twin sister is dead. And the question over whether to save one infant at the cost of the other’s life put their parents and doctors at odds over a heart-wrenching dilemma.

Jodie and Mary — these are the names used in the court cases and the media to protect the babies’ identities — were born Aug. 8, locked together at the spine. They were conjoined, or Siamese, twins — a condition so rare that it occurs just once in a quarter to half a million births.

A Terrible Dilemma

Doctors determined that Mary was being kept alive by Jodie’s heart and lung. But supporting Mary was too much strain for Jodie. Surgery to separate the twins would mean certain death for Mary, but it would be the best chance for Jodie, doctors said. Without surgery, both would die.

Doctors decided that the best course would be to separate the girls and try to save Jodie. When they asked permission to perform the operation, parents Michaelangelo and Rina Attard refused.

“I can’t accept that one of them [has] to die to save the other one because they are both our daughters,” Michaelangelo Attard, known as Michael for short, recalls in an interview being broadcast tonight on ABCNEWS’s Primetime Thursday.

The Attards, Roman Catholics from the Maltese island of Gozo who came to England for their children’s birth, opposed the surgery on religious grounds. In the couple’s home town, about 60 miles south of Sicily in the Mediterranean, live revolves around the Catholic Church.

When the parents refused the operation, the case was referred to the British High Court, which ruled that the surgery would go forward without their consent. In a 20-hour operation last month, the twins were separated and Mary died.

‘We Always Had Faith’

Rina found out she was pregnant with twins last October. Four months into her pregnancy, she had a routine prenatal scan that alarmed doctors. She traveled to the main island of Malta for a second opinion. Doctors there confirmed: The fetuses’ spines were fused into one long spine.

Fearing people’s reactions, Michael and Rina kept their secret to themselves. Doctors in Malta assured the couple their twins could be saved.

“We always had faith that we were going back with our daughters,” says Rina. ”But things changed.”

The twins would need medical care beyond what was available in Malta, so in May, the couple left the island for a hospital in Manchester, England.

A Mother’s Anguish

There, doctors discovered that the condition was far more serious than had been thought. They were concerned that the twins would not survive even until birth.

On Aug. 8, two weeks after her due date, Rina gave birth to Jodie and Mary. The girls were joined at the pelvis, their legs splayed out at right angles.

“I went up in the intensive care to look at them,” says Rina. “I only stayed a few seconds. I couldn’t stand seeing them like that.”

Doctors say Mary’s lungs could not inflate and she showed signs of brain damage. Jodie’s heart was pumping for the two of them, and that was keeping them both alive.

“Jodie has all systems appropriate to survival,” says Dr. Adrian Bianchi, a surgeon at St. Mary’s Hospital in Manchester. “Mary, on the other hand, only survived because she was linked to her viable sister.”

‘A Real Fighter’

Doctors knew that in performing the surgery to separate the twins, they would lose at least one. But if they did not operate, Jodie’s heart would eventually fail, killing both girls.

Mary did not survive the operation, despite doctors’ efforts to revive her. Jodie did — although she required additional surgery to bring her pelvic bones and genital structures into the proper position.

Jodie, now 4 months, 1 week old, feeds from a bottle, breathes without a ventilator and weighs close to 9 pounds. She faces years of corrective surgery and skin grafts, but doctors say she should have an average life expectancy and even be able to have children some day.

“She makes sounds like she is talking with us and she smiles at people and us,” says Rina. “She’s going to be a real fighter.”