Poisoned lottery winner's wife has 'nothing to hide,' attorney says

The widow of a West Rogers Park man who died of cyanide poisoning weeks after winning a $1 million lottery jackpot was questioned extensively by Chicago police last month after the medical examiner's office reclassified the death as a homicide, her attorney told the Tribune on Tuesday.

Authorities investigating the death of Urooj Khan also executed a search warrant at the home he had shared with his wife, Shabana Ansari, according to Steven Kozicki, her attorney. Ansari later was interviewed by detectives for more than four hours, answering all their questions, the attorney said.

"She's got nothing to hide," Kozicki said.

The mystery surrounding Khan's death — first reported by the Tribune Monday — has sparked international media interest.

Cook County authorities said Tuesday that they plan to go to court in the next few days for approval to exhume Khan's remains at Rosehill Cemetery. In a telephone interview Tuesday, Medical Examiner Stephen J. Cina said he sent a sworn statement to prosecutors laying out why the body must be exhumed.

"I feel that a complete autopsy is needed for the sake of clarity and thoroughness," Cina said.

Sally Daly, a spokeswoman for the state's attorney's office, confirmed that papers seeking the exhumation would be filed soon in the Daley Center courthouse.

Khan, who owned a dry cleaning business on the city's North Side, died unexpectedly in July at 46, just weeks after winning a million-dollar lottery prize at a 7-Eleven store near his home. Finding no trauma to his body and no unusual substances in his blood, the medical examiner's office declared his death to be from natural causes and he was buried without an autopsy.

About a week later, a relative told authorities to take a closer look at Khan's death. By early December, comprehensive toxicology tests showed that Khan had died of a lethal amount of cyanide, leading the medical examiner's office to reclassify the death a homicide and prompting police and prosecutors to investigate.

While a motive has not been determined, police have not ruled out that Khan was killed because of his big lottery win, a law enforcement source has told the Tribune. He died before he could collect the winnings — about $425,000 after taxes and because he decided to take a lump-sum payment.

According to court records obtained by the Tribune, Khan's brother has squabbled with Ansari over the money in probate court. The brother, Imtiaz, raised concern that because Khan left no will, his 17-year-old daughter from a previous marriage would not get "her fair share" of her father's estate. Khan and Ansari did not have children.

Al-Haroon Husain, an attorney for Ansari in the probate case, said the money was all accounted for and the estate was in the process of being divided up by the court. Under Illinois law, the estate typically would be split evenly between the surviving spouse and Khan's only child, he said.

Kozicki, Ansari's criminal defense attorney, said his client adored her husband and had no financial interest in seeing harm come to him.

"Now in addition to grieving her husband, she's struggling to run the business that he essentially ran while he was alive," Kozicki said. "Once people analyze it, they (would) realize she's in a much worse financial position after his death than she was before."

Reached by phone Tuesday evening at the family dry cleaners, Ansari denied reports that she had fed her husband a traditional Indian meal of ground beef curry before he died. She said he wasn't feeling well after awakening in the middle of the night. She said he sat in a chair and soon collapsed. She then called 911.

Chicago police Superintendent Garry McCarthy, speaking Tuesday at an unrelated news conference, remarked that he had never seen a case like this in 32 years in law enforcement.

"So I'll never say that I've seen everything," he told reporters.

jmeisner@tribune.com

jgorner@tribune.com

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European businesses slow to go online: study

BRUSSELS (Reuters) – European businesses are not doing enough to use the internet to grow their customer base and promote products, Belgian database and marketing firm Email-Brokers said after studying 13 million websites.

Belgium, Germany and the Netherlands have the highest proportion of companies online but even in these countries 40 percent of business have no internet presence, it found.

The European Commission has estimated that companies which exploit the full potential of the internet create, on average, more than twice as many jobs.

“It is one of the ways to create employment and economic growth and it is not Star Trek, it exists today,” Email-Brokers head William Vande Wiele said.

Britain and Liechtenstein were the most advanced in terms of e-commerce – defined as being able to process orders and payments, with 16 percent and 17 percent, respectively, of business sites offering it, compared with 6 percent in Belgium and 9 percent in Austria, Germany and the Netherlands.

Vande Wiele said many corporate websites were badly designed, and did not provide basics such as adequate contact information or company details.

In Belgium, 91 percent of all corporate websites did not meet such basic standards, compared with about 20 percent in Luxembourg and France, the study concluded.

“Sites which do not comply with such minimum standards do not inspire confidence and before buying something online a user will need a minimum level of confidence,” Vande Wiele said.

Many websites are not kept up to date, the study also found, with more than 80 percent of business sites in Belgium, Greece, Italy and Spain not updated for more than a year.

(Reporting by Robert-Jan Bartunek; Editing by Dan Lalor)

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“Lincoln” leads BAFTA film nominations with 10

LONDON (Reuters) – “Lincoln”, the story of U.S. President Abraham Lincoln’s battle to end slavery starring Daniel Day-Lewis in the title role, won 10 BAFTA nominations on Wednesday, putting it ahead of the pack at Britain’s top film honors.

The biopic was shortlisted in categories including best film, actor, supporting actor (Tommy Lee Jones) and supporting actress (Sally Field), but director Steven Spielberg was not nominated.

Added to its domination of the Golden Globe contenders going into Sunday night’s awards ceremony, British critics said the film appeared to be in pole position to sweep Oscar nominations which are announced on Thursday.

“Les Miserables”, the movie version of the global hit stage musical, and shipwreck saga “Life of Pi” followed with nine BAFTA nominations each, while the latest installment of James Bond, “Skyfall”, garnered eight.

Iranian hostage thriller “Argo” won seven nominations and “Anna Karenina”, an adaptation of the Russian novel, earned six.

Quentin Tarantino’s quirky slavery-era Western “Django Unchained” and “Zero Dark Thirty”, about the hunt for Osama bin Laden, were just behind with five nominations apiece.

“Amour”, Austrian director Michael Haneke’s moving portrayal of death, bagged four nominations, an unusually high number for a film in a foreign language.

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Eric Fellner of Working Title Films, the company behind Les Miserables and Anna Karenina, said he was pleased that two potentially risky projects had been recognized.

Les Miserables, by Oscar-winning director of “The King’s Speech” Tom Hooper, was sung live on set, while Joe Wright’s Anna Karenina, starring Keira Knightley and Jude Law, was set against the backdrop of elaborate stage sets.

“We knew that it was a much-loved musical and there was a large part of the world’s population who were also aware of the book,” Fellner said of Les Miserables after the BAFTA nominations were announced.

“But it didn’t stack up as a mainstream movie because over the past decades very few (musicals) have worked. It was a big risk,” he told Reuters, adding that awards recognition could provide a big lift for a picture just hitting theatres now.

Of Anna Karenina, he added: “The minute you do anything different it becomes harder to get it made. But we really believe in our film makers.”

Skyfall’s Judi Dench was nominated for best supporting actress as Bond’s spymaster M and Spanish actor Javier Bardem was nominated for best supporting actor as the villain Silva.

There is likely to be disappointment, however, that the movie which has become the most successful in British box office history, with critical acclaim to match, was not included on the most coveted shortlist – best film.

That award will be contested by Argo, Lincoln, Life of Pi, Les Miserables and Zero Dark Thirty.

Up for best actor alongside Day-Lewis is Ben Affleck (Argo), Bradley Cooper (Silver Linings Playbook), Hugh Jackman (Les Miserables) and Joaquin Phoenix in Scientology tale The Master.

The best actress award is between 85-year-old Emmanuelle Riva (Amour), Helen Mirren (Hitchcock), Jennifer Lawrence (Silver Linings Playbook), Jessica Chastain (Zero Dark Thirty) and Marion Cotillard (Rust and Bone).

As well as Haneke and Affleck, Ang Lee is in the running for best director (Life of Pi) as is Tarantino and Kathryn Bigelow (Zero Dark Thirty).

The BAFTAs have a patchy record in predicting which films go on to scoop the biggest movie honors, the Oscars, although last year the main winner in London, “The Artist”, also swept to success at the Academy Awards.

The awards ceremony for the BAFTAs, formally called the EE British Academy Film Awards, takes place in London on February 10.

(Reporting by Mike Collett-White, editing by Paul Casciato)

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Gaps Seen in Therapy for Suicidal Teenagers

Most adolescents who plan or attempt suicide have already received at least some mental health treatment, raising questions about the effectiveness of current approaches to helping troubled youths, according to the largest in-depth analysis to date of suicidal behaviors in American teenagers.

The study, in the journal JAMA Psychiatry, found that 55 percent of suicidal teenagers had received some therapy before they thought about suicide, planned it or tried to kill themselves, contradicting the widely held belief that suicide is due in part to a lack of access to treatment.

The findings, based on interviews with a nationwide sample of more than 6,000 teenagers and at least one parent of each, linked suicidal behavior to complex combinations of mood disorders like depression and behavior problems like attention-deficit and eating disorders, as well as alcohol and drug abuse.

The study found that about one in eight teenagers had persistent suicidal thoughts at some point, and that about a third of those who had suicidal thoughts had made an attempt, usually within a year of having the idea.

Previous studies have had similar findings, based on smaller, regional samples. But the new study is the first to suggest, in a large nationwide sample, that access to treatment does not make a big difference.

The study suggests that effective treatment for severely suicidal teenagers must address not just mood disorders, but also behavior problems that can lead to impulsive acts, experts said. According to the Centers for Disease Control and Prevention, 1,386 people between the ages of 13 and 18 committed suicide in 2010, the latest year for which numbers are available.

“I think one of the take-aways here is that treatment for depression may be necessary but not sufficient to prevent kids from attempting suicide,” said Dr. David Brent, a professor of psychiatry at the University of Pittsburgh, who was not involved in the study. “We simply do not have empirically validated treatments for recurrent suicidal behavior.”

The report said nothing about whether the therapies given were state of the art or carefully done, said Matt Nock, a professor of psychology at Harvard and the lead author, and it is possible that some of the treatments prevented suicide attempts. “But it’s telling us we’ve got a long way to go to do this right,” Dr. Nock said. His co-authors included Ronald C. Kessler of Harvard and researchers from Boston University and Children’s Hospital Boston.

Margaret McConnell, a consultant in Alexandria, Va., said her daughter Alice, who killed herself in 2006 at the age of 17, was getting treatment at the time. “I think there might have been some carelessness in the way the treatment was done,” Ms. McConnell said, “and I was trusting a 17-year-old to manage her own medication. We found out after we lost her that she wasn’t taking it regularly.”

In the study, researchers surveyed 6,483 adolescents from the ages of 13 to 18 and found that 9 percent of male teenagers and 15 percent of female teenagers experienced some stretch of having persistent suicidal thoughts. Among girls, 5 percent made suicide plans and 6 percent made at least one attempt (some were unplanned).

Among boys, 3 percent made plans and 2 percent carried out attempts, which tended to be more lethal than girls’ attempts.

(Suicidal thinking or behavior was virtually unheard-of before age 10.)

Over all, about one-third of teenagers with persistent suicidal thoughts went on to make an attempt to take their own lives.

Almost all of the suicidal adolescents in the study qualified for some psychiatric diagnosis, whether depression, phobias or generalized anxiety disorder. Those with an added behavior problem — attention-deficit disorder, substance abuse, explosive anger — were more likely to act on thoughts of self-harm, the study found.

Doctors have tested a range of therapies to prevent or reduce recurrent suicidal behaviors, with mixed success. Medications can ease depression, but in some cases they can increase suicidal thinking. Talk therapy can contain some behavior problems, but not all.

One approach, called dialectical behavior therapy, has proved effective in reducing hospitalizations and suicide attempts in, among others, people with borderline personality disorder, who are highly prone to self-harm.

But suicidal teenagers who have a mixture of mood and behavior issues are difficult to reach. In one 2011 study, researchers at George Mason University reduced suicide attempts, hospitalizations, drinking and drug use among suicidal adolescent substance abusers. The study found that a combination of intensive treatments — talk therapy for mood problems, family-based therapy for behavior issues and patient-led reduction in drug use — was more effective than regular therapies.

“But that’s just one study, and it’s small,” said Dr. Brent of the University of Pittsburgh. “We can treat components of the overall problem, but that’s about all.”

Ms. McConnell said that her daughter’s depression had seemed mild and that there was no warning that she would take her life. “I think therapy does help a lot of people, if it’s handled right,” she said.

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Lampert plans to be a new kind of merchant

He's been a big-time investor in the retail sector for more than 15 years and was chairman of Kmart after it emerged from bankruptcy about a decade ago. A few years later, he paired it with once-dominant Sears.

Yet even as Eddie Lampert is poised next month to add the role of chief executive to that of chairman at retail giant Sears Holdings, he's still characterized generally as just a hedge fund guy.

This, Lampert suggested in a rare interview Tuesday, fails to acknowledge changes in the 21st century retail industry as well as the Hoffman Estates-based company he seeks to revive.

"The most successful guy in retail right now is Jeff Bezos, and he was a (Wall Street) hedge fund guy," Lampert, 50, said by phone. "I think a lot of times when people talk about merchants it's almost a nostalgic look back at the time where the world moved at a very different pace and information was very different."

Lampert has decided to succeed Lou D'Ambrosio, who is leaving to tend to a family health issue. Critics complain that this is just the latest missed opportunity to have a world-class merchandiser run the struggling company.

"So it's Eddie Lampert who's going to be there, and he's a smart guy and insightful when it comes to doing deals, but he doesn't have a track record at running a retail operation," said Evan Mann, an analyst with Gimme Credit.

Lampert argues that a new kind of sales, one that encompasses e-commerce, traditional bricks-and-mortar, mobile and more, requires a new kind of merchant.

"Trying to move the volume of products we're talking about from place to place to get it ultimately into the customer's hands, to price these items, to market these items, I think the retail business is incredibly complex," Lampert said. "But if you get it right, it's a beautiful thing."

"I'm not denying that there are still great merchants," he said. "But to operate a company of the size of Sears Holdings or Wal-Mart or Target or Home Depot or Lowe's, you need a combination of skills, and each of those skills needs to be sufficiently strong."

Lampert can make the case that he is a modern-day merchant. He still hasn't proved he's a good one. For six successive years, Sears Holdings has seen no top-line growth, due to slipping sales and store closings.

"I understand and I appreciate people looking at same-store sales as an indicator," D'Ambrosio said during the call. "I think when you look at the financial shape of the company, there's clear progress."

D'Ambrosio noted four consecutive quarters of EBITDA growth and the fact the company raised $1.8 billion of liquidity in 2012 while reducing net debt by $400 million.

Overshadowed in Monday's news of the leadership change were other glimmers of hope: Sears' domestic comparable-store sales for the nine weeks ended Dec. 29 were up 0.5 percent.

Meanwhile, the strategy of technological convergence, which included a loyalty program, has yielded a wellspring of consumer data and changed customers' relationship with the retailer. Kmart and U.S. Sears' online sales are up 20 percent.

"It's never a good time for a transition, but what I would tell you is, five years ago, we put in place a more distributed leadership structure," Lampert said. "Despite what people may have said or written, there is a difference between a chairman role and a CEO role, and I've never been in the CEO role in this company."

D'Ambrosio predicted Lampert will offer strategic continuity. But handicappers have long questioned whether the old horse had any giddy-up left in its step to catch up to and keep pace with Wal-Mart, Target and Amazon.

And not to beat a dead metaphor, but the suspicion among many all along has been that Lampert saw neither a thoroughbred nor tireless workhorse in the parent of Sears and Kmart as so many parts to be cut up, boiled down and sold off.

"I was very clear why we put these companies together and what our goals were," Lampert said. "It was really to allow both Sears and Kmart to compete in what I thought was going to be a more challenging but evolving industry. The framework which was placed upon me and the company was: 'OK, this was all about real estate. It's about selling real estate.' Then when we didn't sell real estate, it became: 'Well, they missed the opportunity in 2006, 2007 to sell the real estate.'

"I've never denied there was substantial real estate value in the company," he said. "Suffice it to say that … the most value can be created if we actually transform it."

Fortune in 2006 called Lampert "the best investor of his generation." A Forbes contributor last year ranked him No. 2 on a list of the worst CEOs, and while acknowledging Lampert was Sears Holdings' chairman and not CEO, the contributor argued that "Lampert has called the shots, he's missed every target" and that he had "destroyed Sears."

D'Ambrosio said he doesn't recognize the Lampert he sometimes sees described by critics.

"I've never worked with somebody who understands business models and how to re-imagine a business model and has a view on the way buying will change going forward better than Eddie," D'Ambrosio said.

It turns out, his image is the thing he's least interested in selling at Sears Holdings.

"I do think what we've been trying to do at the company has been very clear," Lampert said. "If people want to doubt it or put a spin on it, they're entitled to do it. We just have to perform."

philrosenthal@tribune.com

Twitter @phil_rosenthal

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Field Museum team helps uncover T. rex of the sea

Research and planning are often key factors scientists cite when they make a great discovery. Only rarely does being out of shape play a role.

But Field Museum scientist Jim Holstein said being dog-tired after a long day of trekking through a Nevada mountain range led to his find of a new type of prehistoric marine reptile that on Monday was laid out, in fossil form, on a table in the Chicago museum.

The 28-foot-long animal is now known as Thalattoarchon saurophagis, "lizard-eating ruler of the seas," a member of the very successful ichthyosaur family that lived, for the most part concurrently with dinosaurs, for 160 million years.

It died roughly 244 million years ago and is the earliest type of ichthyosaur — and only the second on record — to show signs of being a "superpredator" that ate animals of its own size atop the marine food chain in a manner similar to a killer whale, said Nadia Frobisch, lead author of the paper describing the new species that appeared in Monday's electronic issue of the Proceedings of the National Academy of Sciences.

Before getting its new scientific name, it was known simply as "Jim," after Holstein, who credits his discovery to being the most exhausted of the original search party 141/2 years ago.

He was in central Nevada's Augusta Mountains, returning to camp along a high ridge after a day of searching for fossils in an ancient seabed turned mountainside.

His colleagues, Martin Sander and Olivier Rieppel, were seasoned climbers, cheery as they contemplated dinner. Holstein was not, and was especially tired after a long hot day toward the end of an exhausting expedition.

"They both walked over this animal," Holstein said Monday. "My head hung low."

And because of that he saw in the rock, near some juniper bushes along a wild mustang trail, the skull of the ichthyosaur that, upon closer examination, turned out to have a distinctive feature.

Ichthyosaurs — from the Greek for "fish lizard" — were once plentiful in what is now Nevada. The creature, a reptile that evolved from a land to sea animal and resembled a dolphin, is the official state fossil.

But most had more modest teeth, suitable only for dining on smaller marine life. The teeth of the specimen Holstein found were large and had two cutting surfaces, suggesting it might have killed and eaten other large animals.

Finding a big specimen is one thing. Excavating it is quite another.

"It's very, very difficult terrain, very difficult to get these fossils out of these mountains," said Rieppel, the Field's Rowe Family Curator of Evolutionary Biology.

In addition to that, the trio didn't fully understand the potential significance of what they had found, Sander said in an email. So "Jim" was entered into Sander's field notes for the expedition on July 24, 1998 and essentially forgotten for seven years, when it caught the attention of some of Sanders' students at the University of Bonn in Germany.

"Lars (Schmitz) and I stumbled over the notes that Martin had taken on that last field day ... which said 'large ichthyosaur discovered with cutting edges on the teeth,'" Frobisch, then a University of Chicago postdoctoral scholar who now works at a museum in Berlin, recalled via email.

"This immediately gripped our attention, as there is only one very poorly preserved ichthyosaur known from the Himalaya region to have cutting edges on the teeth."

Sander recalled Schmitz, Frobisch and another student "storming into my office one day and demanding to go" and see this animal.

After a 2005 scientific conference in Arizona, Sander, Frobisch and Schmitz returned to the scene and confirmed the finding. "We knew it was quite likely it was a new taxon," or population group, said Schmitz, who now teaches at the Claremont Colleges in California

The National Geographic Society's Committee for Research and Exploration provided a $20,000 grant to excavate the fossil, a spokeswoman said. An almost monthlong trip in 2008 brought the skeleton, encased in an estimated 3,000 pounds of rock, to the Field, where preparators have been working on separating it from earth since.

The Field hopes to eventually put the relatively intact skeleton on display, Rieppel said, but the top priority has been to examine the most significant parts of the fossil in order to identify it definitively as a previously unknown ichthyosaur.

For now, the head and a roughly 3-foot vertebrae section from near the tail are in a third-floor office at the museum. Chunks of rocks containing other bones rest on an adjacent table.

It looks a little rough. Holstein described the head, flattened and condensed by fossilization, as looking "like a killer pancake right now." But it is a killer pancake with scientific significance.

"Our 'Jim' was the first in a long row of 'T. rexes' of the sea," Sander said. "At the level of the ecosystem, the discovery is important because the presence of a top predator indicates that (roughly) 242 million years ago, 8 million years after the catastrophe (when life on earth nearly ended at the end of the Permian period, 250 million years ago), the modern ecosystems had evolved in the sea. Nothing fundamentally happened since then. The food web remained the same, only the players changed.

"To put it in one sentence, the discovery shows two new things: What the first top predator in the sea was like and how quickly it evolved after the catastrophe."

sajohnson@tribune.com

Twitter @StevenKJohnson

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Conn. lawmaker apologizes over Facebook post

HARTFORD, Conn. (AP) — A Connecticut lawmaker has apologized after saying in a Facebook post that shooting victim and former Arizona U.S. Rep. Gabrielle Giffords should “stay out of my towns.”

Giffords last week visited Newtown, Conn., where a gunman killed 20 young children and six adults at an elementary school last month. The Democrat, who met with families of the victims, was critically wounded two years ago in a deadly mass shooting in Tucson, Ariz.

The Hartford Courant posted images Sunday showing Republican state Rep. DebraLee Hovey‘s Facebook comments. In one dated Friday she says, “Gabby Giffords stay out of my towns!!”

Hovey released a statement Monday saying her comments were insensitive and that she apologizes if she offended anyone.

Hovey had said in another post that the visit was political.

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Mariah Carey increased security in feud with fellow “Idol” judge

NEW YORK (Reuters) – Pop diva Mariah Carey said she hired increased security following what she described as threats reportedly made against her by fellow ‘American Idol‘ judge Nicki Minaj, according to an interview on ABC News.

Carey, 42, one of three new judges to join the “American Idol” panel for the hit talent show’s new season on January 16, told Barbara Walters in an interview airing on Monday, “it felt like an unsafe work environment.”

“Anytime anybody’s reeling threats at somebody, you know, it’s not appropriate,” Carey said.

“I’m a professional. I’m not used to that type of environment,” she said, adding that she hired extra security.

The diva was alluding to widely reported tension between her and Minaj, who were seen arguing with one another in a video from the show’s audition phase.

Walters has reported that, according to Carey, others on the “Idol” set heard Minaj go further and say, off-camera, “If I had a gun, I would shoot that bitch.”

Minaj, a Trinidadian-born singer and songwriter, previously denied making any remarks about firearms, but Carey told Walters that beefing up her security “was the appropriate thing to do.”

“Sitting there on the road with two babies, I’m not going to take any chances,” she said, referring to her 20-month old twins with husband Nick Cannon.

But in a sign of media savvy, she noted that “for all the drama, I hope it helps the show.”

Walters also asked Carey about reports she is being paid $ 18 million for each “Idol” season.

“I think we’re in the ballpark, (but) I can’t even talk about those things,” the singer replied.

(Reporting by Chris Michaud; Editing by Piya Sinha-Roy and Paul Simao)

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The New Old Age Blog: Who Should Receive Organ Transplants?

Joe Gammalo had been contending with pulmonary fibrosis, a scarring of the lungs, for more than a decade when he came to the Cleveland Clinic in 2008 seeking a lung transplant.

“It had gotten to the point where I was on oxygen all the time and in a wheelchair,” he told me in an interview. “I didn’t expect to live.”

Lung transplants are a dicey proposition, involving a huge surgical procedure, arduous follow-up, the lifelong use of potent immunosuppressive drugs and high rates of serious side effects. “It’s not like taking out an appendix,” said Dr. Marie Budev, the medical director of the clinic’s lung transplant program.

Only 50 to 57 percent of all recipients live for five years, she noted, and they will still die of their disease. But there’s no other treatment for pulmonary fibrosis.

Some medical centers would have turned Mr. Gammalo away. Because survival rates are even lower for older patients, guidelines from the International Society for Heart and Lung Transplantation caution against lung transplants for those over 65, though they set no age limit.

But “we are known as an aggressive, high-risk center,” said Dr. Budev. So Mr. Gammalo was 66 when he received a lung; his newly found buddy, Clyde Conn, who received the other lung from the same donor, was 69.

You can’t mistake the trend: A graying population and revised policies determining who gets priority for donated organs, have led to a rising proportion of older adults receiving transplants.

My colleague Judith Graham has reported on the increase in heart transplants, but the pattern extends to other organs, too.

The number of kidney transplants performed annually on adults over 65 tripled between 1998 and last year, according to data from the Scientific Registry of Transplant Recipients. In 2001, 7.4 percent of liver transplant recipients were over 65; last year, that rose to 13 percent.

The rise in elderly lung transplant candidates is particularly dramatic because, since 2005, a “lung allocation score” puts those at the highest mortality risk, rather than those who’ve waited longest, at the top of the list.

In 2001, about 3 percent of those on the wait list and of those transplanted were over 65; last year, older patients represented almost 18 percent of wait-listed candidates and more than a quarter of transplant recipients. (Medicare pays for the surgery, though patients face co-pays and considerable out-of-pocket costs, including for drugs and travel.)

The debate has grown, too: When the number of adults awaiting transplants keeps growing, but organ donations stay flat, is it desirable or even ethical that an increasing proportion of recipients are elderly?

Dr. Budev, who estimated that a third of her program’s patients are over 65, votes yes. As long as a program selects candidates carefully, “how can you deny them a therapy?” she asked. So the Cleveland Clinic has no age limit. “We feel that everyone should have a chance.”

At the University of Michigan, by contrast, the age limit remains 65, though Dr. Kevin Chan, the transplant program’s medical director, acknowledged that some fit older patients get transplanted.

“You can talk about this all day — it’s a tough one,” Dr. Chan said. Younger recipients have greater physiologic reserve to aid in the arduous recovery; older ones face higher risk of subsequent kidney failure, stroke, diabetes and other diseases, and, of course, their lifespans are shorter to begin with.

Donated lungs, fragile and prone to injury, are a particularly scarce commodity. Last year, surgeons performed 16,055 kidney transplants, 5,805 liver transplants and 1,949 heart transplants. Only1,830 patients received lung transplants.

“What if there’s a 35-year-old on a ventilator who needs the lung just as much?” Dr. Chan said. “Why should a 72-year-old possibly take away a lung from a 35-year-old?” Yet, he acknowledged, “it’s easy to look at the statistics and say, ‘Give the lungs to younger patients.’ At the bedside, when you meet this patient and family, it’s a lot different.”

These questions about who deserves scarce resources — those most likely to die without them? or those most likely to live longer with them? — will persist as the population ages. They’re also likely to arise when the International Society for Heart and Lung Transplantation begins working towards revised guidelines this spring. (I’d also like to hear your take, below.)

Lots of 65- and 75-year-olds are very healthy. Yet transplants themselves can cause harm and there’s no backup, like dialysis. Without the transplant, they die. But when the transplant goes wrong, they also die.

More than four years post-transplant, the Cleveland Clinic’s “lung brothers” are success stories. Mr. Conn, who lives near Dayton, Ohio, can’t walk very far or lift more than 10 pounds, but he works part time as a real-estate appraiser and enjoys cruises with his wife.

Mr. Gammalo, a onetime musician, has developed diabetes, like nearly half of all lung recipients. But he went onstage a few weeks back to sing “Don’t Be Cruel” with his son’s rock band, “a highlight of both our lives,” he said.

Yet when I asked Mr. Conn, now 73, how he felt about having priority over a younger but healthier person, he paused. “It’s a good question,” he said, to which he had no answer.

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Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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Sears CEO D'Ambrosio to step down

Sears Holdings Corp. said Monday night that Chief Executive Officer Louis D'Ambrosio will step down Feb. 2, due to family health matters, and Chairman Edward Lampert will add the role of CEO.

The surprise move fuels uncertainty at the Hoffman Estates-based company, which has struggled for years to re-establish itself as a department store in an ultracompetitive retailing industry dominated by low-price giant Wal-Mart and big box and specialty stores.

Shares of Sears Holdings were up 2.3 percent in premarket trading on the news.

The decision by Lampert, a hedge fund operator who is the company's biggest shareholder, to take over day-to-day control represents a reversal from his naming of D'Ambrosio as chief executive nearly two years ago after operating with an interim CEO.

"In light of Lou's decision to step down, the board feels it is important that there is continuity of leadership during this important period of transformation and improvement at Sears Holdings," Lampert said in a statement. "I have agreed to assume these additional responsibilities in order to continue the company's recovery and sustain the momentum we are experiencing, as well as further the development of the management team under the distributed leadership model, which provides our business unit leaders with greater control, authority and autonomy."

Sears Holdings, which operates Sears and Kmart, also updated its fourth-quarter earnings outlook Monday night. The company said it expects to report a net loss $280 million to $360 million, or $2.64 to $3.40 per diluted share, for the quarter ending Feb. 2. The loss includes a charge of about $450 million because of pension settlements and an additional $42 million in pension expenses.

Excluding pension expenses, Sears said it expects to earn $132 million to $212 million, or $1.25 to $2 per share.

Analysts polled by Bloomberg had been expecting adjusted net income of about $137 million.

For the fiscal year, Sears said it expects to lose $721 million to $801 million, or $6.80 to $7.56 per diluted share, which includes pension-related costs and other adjustments reported late last year. Excluding those items, the company said it expects to lose $123 million to $203 million, or $1.16 to $1.92 per share.

D'Ambrosio became CEO after working for the company as a consultant. The 16-year veteran of IBM Corp. had been CEO of a telecommunications company before joining Sears.

"I have worked very closely with Eddie over the past two years. I can say this: there is simply no one in the world that cares more about Sears Holdings and has thought more deeply about our company than Eddie," D'Ambrosio wrote to employees.

Lampert gained control of Sears in 2005 after engineering the merger between Kmart and Sears Roebuck & Co. For years, speculation about Lampert's intentions for the company focused on the value of its real estate, but under D'Ambrosio, Sears appeared to pay more attention to retail aspirations.

The company reported improved performance — it beat Wall Street expectations — in the previous quarter, but Sears stock has lost more than 35 percent of its value since November, closing Monday at $42.92, up 1.7 percent.

 Crshropshire@tribune.com | Twitter: @corilyns 

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