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
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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
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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