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Allegations raised by a Swedish television documentary may prompt the Karolinska Institute to reopen a misconduct investigation involving surgeon and tissue engineering pioneer Paolo Macchiarini.

Allegations raised by a Swedish television documentary may prompt the Karolinska Institute to reopen a misconduct investigation involving surgeon and tissue engineering pioneer Paolo Macchiarini.

Conan Fitzpatrick/SVT

Karolinska Institute fires fallen star surgeon Paolo Macchiarini

The curtain has finally fallen for trachea surgeon Paolo Macchiarini at the Karolinska Institute (KI) in Stockholm. Today, the renowned university announced that Macchiarini will be dismissed effective immediately after its disciplinary board found that he "engaged in conduct and research that is incompatible with a position of employment at KI."

But Macchiarini, who has shaken off misconduct allegations several times before, vows to fight on. "I do not accept any of the findings of the Disciplinary Board," he wrote in an email to Science this afternoon. "I have instructed lawyers and will be taking immediate steps to restore my reputation."

Once hailed as a surgical pioneer for attempts to replace damaged tracheae with artificial ones that combined stem cells with polymer scaffolds—or decellularized donor tracheae—Macchiarini survived a misconduct investigation at KI last year. But a troubling three-part documentary aired on Swedish television in January ripped the scandal wide open again and triggered serious questions about the way KI had handled its investigation.

The series, called The Experiments, suggested that Macchiarini had exaggerated the success of his operations in published papers and that one patient at Kuban State Medical University in Krasnodar, Russia, died after she received his artificial trachea, even though she could have lived a long life.

“It’s impossible for KI to have any kind of collaboration with Paolo Macchiarini any longer,” the institute's human resources manager, Mats Engelbrektson, said in today's statement. “He has acted in a way that has had very tragic consequences for [patients] and their families. His conduct has seriously damaged confidence in KI and for research in general.”

The dismissal doesn't come as a surprise. The affair had already led to several resignations from top management at KI, which said that it had "lost confidence" in Macchiarini in early February, and that it was considering sacking him a few weeks later. Today's dismissal "was inevitable," says Pierre Delaere of the Catholic University in Leuven, Belgium, one of the earliest critics of Macchiarini's work.

A spokesperson for KI declined to explain why the disciplinary board didn't await the outcome of a new formal investigation into Macchiarini's alleged misconduct, which KI launched after The Experiments ran. But the KI statement issued today identifies "numerous reasons" to let him go. Macchiarini's activities in Russia "were in breach of KI’s fundamental values and have damaged KI’s reputation," it says; Macchiarini "failed to truthfully and fully report his extra-occupational activities;" he "supplied false or misleading information in the CV he submitted to KI;" and he "demonstrated scientific negligence, according to KI’s investigation in 2015."

"This was an adequate decision," says Bengt Gerdin, a professor emeritus of surgery at Uppsala University in Sweden, who concluded in a report last year that Macchiarini's published research articles painted a flattering picture of his patients' health, and thus constituted scientific misconduct. (Gerdin's report was later dismissed by KI Vice-Chancellor Anders Hamsten, who said it was based on "incomplete information." Hamsten was among those who recently resigned.)

Macchiarini declined to comment in detail on today's announcement. Given his plan to fight his dismissal, "I'm sure you will understand that it would be inappropriate for me to comment further at this point," he wrote in his email to Science.

The Macchiarini affair has led to deep soul-searching in the Swedish scientific community, which is left asking itself why it took a team of journalists to get to the bottom of the affair. So far, The Experiments has triggered more than a dozen investigations and reviews at KI, the Karolinska University Hospital, other public organizations, and the government. (Here's an overview.)

"There's still a long road to go before there's complete clarity," Delaere says. So far, none of Macchiarini's papers have been retracted; Delaere says retraction may be in order for many. The situation of transplant recipients treated by Macchiarini in Barcelona, Spain, and London also warrants further investigation, Delaere says. "They are still seen as success stories in trachea regeneration," he says—but how they are really doing is unclear.