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Organ/Tissue Donation and the Medical
Examiner/CoronerStephen J. Cina, MD, FCAP
Chief Medical ExaminerCook County, IL
Role of the M.E. /Coroner Determine cause and manner of
death Identify threats to the public health
IL has one M.E. County Most coroners contract with FPs for
autopsies Ultimately, the need for the
M.E./Coroner to do their job trumps donation
This does not mean we cannot cooperate!
What upsets us? Procurement agencies
• Not understanding why there is a denial• Poor M.E./Coroner understanding of DCD
(donor after circulatory death)• Time delay in approving procurement
Medical Examiners/Coroners• No means No• Repeated phone calls • Cause of death obscured by procurement
Making the M.E./Coroner Happy
One competent call explaining all circumstances of the case
Offering additional imaging prior to procurement
Collecting blood/urine/admission samples
Heart consultation reports Stopping if there is anything unusual Leaving injured organs untouched Recipient follow up if available
Establish Protocols 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 Note
Photos of patient, explanted organs Does 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 SIDS Sudden unexpected death in healthy
children (and some young adults if insufficient clinical workup, EKG)
Traumatic deaths in custody Deaths during restraint Trauma to chest and abdomen not
fully documented by imaging Battered children
Organ Donor Cases I Approve “Shaken babies” Homicide limited to head/neck trauma MVA Drug overdose Near drowning Accidents Suicides
Naturals (e.g. CVA)-I don’t care it’s not my case
Tips on M.E./Coroner Relations
They have egos They have to determine COD/MOD Educate them through colleagues-
they likely will listen more to them than you
Lose the occasional battle to win the war
Offer opportunities for good PR associated with donation (coroners are elected)-donor awareness month
Know 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 enemy
It doesn’t matter if it is your fault-the M.E./Coroner perception is reality
Establish communication rules in advance in case a surprise is noted intraoperatively-and be ready if the the M.E./Coroner says stop!
