Organ/Tissue Donation and the Medical Examiner/Coroner
Stephen J. Cina, MD, FCAPChief Medical ExaminerCook County, IL
Role of the M.E. /Coroner
Determine cause and manner of deathIdentify threats to the public healthIL has one M.E. CountyMost coroners contract with FPs for autopsiesUltimately, the need for the M.E./Coroner to do their job trumps donationThis does not mean we cannot cooperate!
What upsets us?
Procurement agenciesNot understanding why there is a denialPoor M.E./Coroner understanding of DCD (donor after circulatory death)Time delay in approving procurementMedical Examiners/CoronersNo means NoRepeated phone callsCause of death obscured by procurement
Making the M.E./Coroner Happy
One competent call explaining all circumstances of the caseOffering additional imaging prior to procurementCollecting blood/urine/admission samplesHeart consultation reportsStopping if there is anything unusualLeaving injured organs untouchedRecipient follow up if available
Which cases will never be released prior to exam?When does Office want to be contacted for donation requests?Forms: Consent, Med/Soc, Itemized tissue/organ approval/denial, Trauma Checklist, Procurement Op NotePhotos of patient, explanted organsDoes M.E./Coroner want a rep in the OR (and will you pay them for their time)?
Organ Donor Cases I Deny
So-called delayed SIDSSudden unexpected death in healthy children (and some young adults if insufficient clinical workup, EKG)Traumatic deaths in custodyDeaths during restraintTrauma to chest and abdomen not fully documented by imagingBattered children
Organ Donor Cases I Approve
“Shaken babies”Homicide limited to head/neck traumaMVADrug overdoseNear drowningAccidentsSuicidesNaturals (e.g. CVA)-I don’t care it’s not my case
Tips on M.E./Coroner Relations
They have egosThey have to determine COD/MODEducate them through colleagues-they likely will listen more to them than youLose the occasional battle to win the warOffer opportunities for good PR associated with donation (coroners are elected)-donor awareness monthKnow which donations are legal
The Golden Rules
If donation results in an M.E./Coroner not being able to determine the COD/MOD, you will have made an enemyIt doesn’t matter if it is your fault-the M.E./Coroner perception is realityEstablish communication rules in advance in case a surprise is notedintraoperatively-and be ready if thetheM.E./Coroner says stop!
QUESTIONS AND COMMENTS
Steve Cina, [email protected]