Impact of medical examiner/coroner practices on organ recovery in the United States
T. Shafer, L. L. Schkade, H. E. Warner, M. Eakin, K. O'Connor, J. Springer, T. Jankiewicz, W. Reitsma, J. Steele and K. Keen-Denton
LifeGift Organ Donation Center of North Texas, Fort Worth 76107.
OBJECTIVE--The object of this research is to determine the nature and
extent of the loss of donor organs during a 3-year period that are
otherwise medically suitable for organ transplantation owing to nonrelease
by a local medical examiner or coroner. DESIGN AND DATA SOURCES--In a
retrospective study of the effects of medical examiner/coroner donor
release practices, a detailed survey was mailed to every organ procurement
organization (OPO) in the United States. This survey collected specific
data (eg, number of cases denied per year), as well as descriptive
information. RESULTS--Of the 2670 organ donors reported by 39 OPO
respondents in 1990, 62.1% were medical examiner cases, and 129 (7.2%) of
these cases were denied recovery by the local medical examiner/coroner. The
number of denials increased to 181 (9.6% of medical examiner cases) in 1991
and to 251 (11.4% of medical examiner cases) in 1992. It is estimated that
the population of medical examiner/coroner denials from 1990 through 1992
may be as many as 884. Twenty percent of the OPO respondents reported that
no cases were denied recovery by a local medical examiner/coroner. A
comparative analysis reveals that the proportion of total reported
potential medical examiner/coroner cases that were denied increased by 65%
from 1990 to 1992, while medical examiner/coroner cases released declined
slightly. CONCLUSIONS--Since an average of 3.37 organs were recovered per
donor in 1992, it is possible that as many as 2979 people may have been
denied transplants from 1990 through 1992 owing to medical
examiners'/coroners' denials. There were no donor denials in 10
geographical areas of the United States, nor was there any instance of
violation of case law or any documentation of flawed autopsies or
collection of forensic evidence in donor cases released. These two factors
suggest that the loss of human life from denials is not needed to protect
the judicial process. Increased cooperation between medical examiner
offices and OPOs could significantly increase the availability of
transplantable organs.
