Despite his skyrocketing reputation as a rock star surgeon and pioneer of regenerative medicine in the early aughts, Italian stem cell scientist Paolo Macchiarini's patients just kept dying after receiving his experimental trachea transplants.
The increasing scrutiny surrounding the embattled researcher and his alleged web of lies is laid out by his former fiancée and NBC News producer Benita Alexander in a new three-part Netflix docuseries "Bad Surgeon: Love Under the Knife," which was directed by Emmy-nominated Ben Steele and debuted on Nov. 29.
Macchiarini, 65, became world-renowned for offering patients a second chance at life with the very first plastic organs – coating plastic or cadaver-sourced windpipes in the recipient's own stem cells.
At least eight of Macchiarini's transplant recipients died after their surgeries – the brand-new procedure had never been tested on animals, and instead debuted on desperate "human guinea pigs," ex-fiancée Alexander claims.
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At least 20 patients in a slew of countries, including Spain, Russia, Iceland, Britain and the United States, received the doctor's windpipes, per the Associated Press.
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Although there are no guarantees in innovative medicine, the doctor repeatedly lied about his research, according to the findings of the Karolinska Institutet in Stockholm, Sweden, where he once taught and conducted his studies. Eleven of his published papers have since been retracted, Esquire reported.
Ultimately, Macchiarini was charged by a Swedish appeals court in 2022 with aggravated assault and bodily harm against three of his former patients, per the institution.
Last June, the court sentenced Macchiarini to 2 ½ years for the charges, the Associated Press reported. Prosecutors reportedly requested a longer sentence.
"It seems clear to me that these have been completely unlawful human experiments and the penalty should be a long prison sentence, given the nature of the crime and the high penal value."
It was not immediately clear whether Macchiarini is currently behind bars.
The institute, which initially backed Macchiarini, had expressed concern that the doctor was misrepresenting his successes years before the sentence was handed down, in 2014.
In 2016, Swedish police investigated whether the doctor had committed involuntary manslaughter, per BBC News. But after a yearlong investigation, the country's attorney general determined that although Macchiarini was medically negligent in four of five cases reviewed, a crime could not be proven because his patients would have died under any other treatment.
Three years earlier, in 2019, per the AP, the Italian doctor was sentenced to 16 months in prison in his own country for forging documents and abuse of office – but he was ultimately acquitted of the charges.
When he was fired from the Karolinska Institutet, he went on to research at Russia's Kazan Federal University. But according to the outlet Science, the university revoked the doctor's funding after learning he had operated without a Russian medical license in 2017.
But despite the criminal charges and controversies, the documentary claims Macchiarini is still licensed to practice – although it is unclear in what countries he maintains his license.
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Alexander, who met the so-called "supersurgeon" in 2013 while she was filming a documentary on regenerative medicine, said that the George Clooney lookalike "fooled his patients very much the same way he fooled [her]."
"They were convinced that he was the greatest hope of their loved ones surviving," she said in the docuseries. "He made them believe that he could help them the way he made me believe that he loved me and that he loved my daughter, and he was going to take care of us for the rest of our lives."
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But Alexander would later learn the truth about the doctor who charmed her – and bring her findings to the Swedish institute.
Macchiarini was preparing to outfit 3-year-old Hannah Warren, who was born without a trachea, with a plastic replacement from Harvard apparatus when he and Alexander met.
Alexander and her coworkers were charmed by the doctor, and began joking that Macchiarini had "George Clooney" vibes due to his looks and love of motorcycles. After renting one to film windswept b-roll of the surgeon, he took Alexander on a ride with extra time on the rental. The ride turned into dinners after shoots and, finally, a whirlwind romance.
The girl's surgery appeared to be a resounding success, with the doctor saying at a press conference that new cells could be seen growing on the plastic trachea.
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Macchiarini took Alexander on lavish trips to Russia, Greece and the Bahamas, stunning the journalist with "giant, grandiose gestures" and promises of a fairy tale lifestyle before NBC's production aired.
On Christmas of the next year, before NBC had aired their documentary, Macchiarini proposed to Alexander, telling her that he would plan their opulent wedding in Italy and Pope Francis would officiate.
But, she would later learn, the surgeon was already married and had two children.
In addition to the leader of the Catholic church, the surgeon told his fiancée that he had operated on the likes of Barack Obama, Bill Clinton, Hillary Clinton, Emperor Akihito of Japan and other powerful figures.
"There's a lot of gaslighting and brainwashing," Alexander said of the conniving surgeon. "It's a slow, meticulous process. It's not like he hits you over the head with these lies all at once. It's a very cunning weaving of a web like a spider."
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Hannah died within a year of the procedure, becoming one of eight fatalities Macchiarini left in his wake. At least three patients who underwent the doctor's knife had already died before the girl was operated on in September 2013.
Macchiarini was "absolutely insistent that her death had nothing to do with the windpipe failing," and was instead the result of other complications, Alexander said.
The girl's parents insisted that their daughter's death was not in vain, and that she was a pioneer for a surgery that could help others in the future. In the same spirit, NBC shifted its documentary's focus to Macchiarini and began uncovering more of the deaths left in his wake.
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The family of Chris Lyle, a Maryland cancer patient who also died after receiving one of Macchiarini's synthetic windpipes, were ardent supporters of the doctor at the time. Less than a year after the surgery in Sweden, an expert said in the documentary, he developed an infection in his airway.
"Chris joked about it to Paolo the night before his surgery, he said 'tell me doc, I'm a guinea pig, right?' But Paolo didn't want to hear that," Lyle's mother recalled. "He didn't want Chris to feel that way. And I believed him – he's world renowned, he's the best."
Before her death in 2014, former patient Yulia Tuulik wrote of the "rotting" of her replaced windpipe and that people "shuddered away" because she smelled so badly after her surgery, per the documentary.
Another patient, Yesim Cetir of Philadelphia, died in 2017 after suffering through 191 corrective surgeries and two strokes following her transplant.
Her mother told documentary makers that her daughter "went through pure horror" until her death, "coughing up pieces of her flesh" and needed her airway cleared manually multiple times per day. She decried Macchiarini's procedure as "torture and murder."
For Alexander, the doctor's facade began to crack when a friend told her that Pope Francis would be out of the country on their proposed wedding date.
"In that moment, I just knew," she recalled. "All those little red flags that had been nagging me exploded to the surface."
But at that point, Macchiarini doubled down, telling her that his career in medicine was a cover and that he was actually a sniper for the CIA.
"Clearly, something was very seriously wrong, and he's a pathological liar," Alexander recalled. "But when he told me that, I thought, ‘This man’s crazy.' I mean, legitimately crazy or so demented… I didn't know what to think."
She would hire a private investigator and confront Macchiarini – meeting his wife and children – in Barcelona on the planned day of their wedding.
Suspicion surrounding the doctor came to a head when she shared her story – both her findings surrounding his patients and her own experience with his pathological lies – to Vanity Fair in 2016.
Years later, in 2022, Alexander traveled to Sweden to see his prison sentence handed down in court.
Despite the brevity of his sentence, Alexander said, she still found satisfaction in his prosecution.
"It's very difficult to prove that he intentionally killed these people," she said. "He hides behind the fact that these are experimental procedures."
