Organ and Tissue Donation in Medicolegal Cases
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Transcript Organ and Tissue Donation in Medicolegal Cases
Sharon M. Derrick, PhD
Agency Coordinator
Harris County Institute of Forensic Sciences
ORGAN AND TISSUE DONATION
IN MEDICOLEGAL CASES
Presentation Flow
Medical Examiner legislation in the State of Texas
Chapter 49.25 of the Code of Criminal Procedure
Donation legislation in the State of Texas
Revised Uniform Anatomical Gift Act
Basics of donation (organs/tissue)
Collaboration between HCIFS and the donation
agencies
Standard operating procedures
Preservation of evidence
Two case studies and discussion
Conclusions
Medical Examiner Legislation
Texas Code of Criminal Procedure, Chapter 49.25
Medical examiner cases include deaths:
occurring within 24 hours of admission to the hospital
that are unnatural or unexpected
that are unattended or the attending physician cannot
certify a cause of death
where the decedent is unidentified
where the circumstances are unknown
where the circumstances are suspicious
that are possible suicides
that are unexpected in children under 6 years of age
Donation Legislation
The Uniform Anatomical Gift Act
State-based legislation
The 2009 Texas Legislature enacted the
Revised Uniform Anatomical Gift Act as
Chapter 692A of the Health and Safety Code
In effect September 1, 2009
Same version that was unsuccessful in 2007.
Replaces the 1968 version
Modernized, easier to donate
Revised Uniform Anatomical Gift Act
An anatomical gift donor is:
A person who makes a gift of all or part of his/her
body (organs or tissue).
Or whose next of kin or other person who can
legally authorize donations makes a gift of all or
part of that person’s body.
Multiple individuals and certain institutions may
legally donate the anatomical gifts of a decedent
under the Revised UAGA.
Reasonably available authorization
Donate Life Texas Registry
The Basics of Donation
If death under jurisdiction occurs in a hospital, the
hospital is responsible for notifying HCIFS.
Donation timelines and protocols are different
depending on whether the donation consists of
organs or tissues or both.
Organ donors generally receive mechanical and
pharmacological support to maintain circulation and
organ function until recovery of the organs.
Donation after cardiac death (DCD) cases
Organ and heart valve donations always take place
pre-autopsy. The majority of tissues may be
recovered post-autopsy.
Recovery windows for tissue
Collaboration Between HCIFS and the
Donation Agencies
Donation is important, affecting the lives and
well-being of thousands (organs) and millions
(tissue) of people each year.
Most commonly donated organs: lungs, heart,
kidneys, liver, pancreas, intestines
Most commonly donated tissues: heart valves,
corneas, bone, tendons, ligaments, skin, leg veins,
thigh muscle
The statutory responsibilities of medical
examiners and preservation of evidence is also
important to the lives/well-being of
thousands/millions of people annually.
A Marriage for the “Mission”
HCIFS Agency Coordinator (since 2/15/2006)
Three agencies (organs, tissue, eye bank for
corneal tissue)
Formal standard operating procedures and
agreements
24 hour computer access to discover potential
cases
In certain circumstances, heart valve recovery at
HCIFS prior to autopsy.
Organ Donor Presents to HCIFS Morgue
Cornea Pre-recovery Photography
Donations in 2010
HCIFS maintains agreements with LifeGift
(organs and tissue), Biograft Transplant Services,
Inc. (tissue), and the Lions Eye Bank of Texas at
Baylor College of Medicine (corneal tissue).
92 medicolegal cases were released for single
and paired organ recovery from January 1, 2010
to December 31, 2010.
305 medicolegal cases were released for
multiple tissue recovery from January 1, 2010 to
December 31, 2010.
Issues of Concern in ML Cases
Cases in which the investigation or court testimony
may potentially be complicated by donation
Infant deaths
Certain homicides
Sudden cardiac deaths
Toxicology-related deaths
Timeliness
Death reports
Protocols and medical records
Delivery of decedent to medical examiner office
Poor Vitreous Draw
Note the lack of fluid
Pediatric Rib Fractures
In Cases of Suspected Child Abuse
Evidence Preservation
Case Study #1
White Female, 42 years
Died in emergency department
Pre-autopsy tissue donor
White Female, 42 years
Difficulty breathing
911 was called, EMS arrived, decedent was
transported in severe respiratory distress
Never stabilized, died in ED
No toxicology screens performed
Hx of 2 month illness, bronchitis, sinus
infection, acid reflux, asthma, obese
On external exam, the medical examiner noted the
bruised left eye in a decedent with a presumed
natural cause of death.
The hematoma was not documented in the medical
records nor in the donation records placed with the
decedent.
Upon follow-up, it was discovered that the injury
occurred during cornea recovery.
At autopsy the medical examiner suspected
pulmonary embolism
She made incisions in the lower limbs in order to find
a possible origin of the embolism.
All vessels were also
recovered with the long
bones of the legs.
Evidence Preservation
Case Study #2
Black Female, 16 months old
Died in the hospital after a four day stay
Pre-autopsy multiple organ donor
Black Female, 16 months
The child arrived to the hospital by private
vehicle in an unresponsive state.
The caregiver’s story was inconsistent with the
multiple injuries diagnosed in the ED.
The following traumatic injuries were
documented:
Fractures of the lambdoidal, coronal, and sagittal
sutures
Fractures of the left parietal and temporal bones
Subdural hematoma and a number of postcranial
fractures
No previous medical history
Besides the donation incision:
What is inconsistent in these pictures?
Discussion
Authorization for donation questions
Forensic nursing concerns regarding donor cases and
preservation of evidence
Clinician concerns
Medical examiner success stories
Conclusions
Formalized checks and balances are necessary to preserve
evidence while promoting donation
Needs of law enforcement, pathologist, next of kin and
donation agencies must be managed in a timely manner