Medical Examiner Transplantation

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Position Paper on the Medical Examiner Release of Organs and Tissues for Transplantation
J. Keith Pinckard, M.D., Ph.D., Charles V. Wetli, M.D., and Michael A. Graham, M.D.
Board of Directors Approved February 21, 2006 – Expires February 21, 2011
From the Department of Pathology, Division of Forensic Pathology, University of Texas
Southwestern Medical Center and the Southwestern Institute of Forensic Sciences,
Dallas, Texas (J.K.P.); Department of Health Services, Division of Medical Legal
Investigations and Forensic Sciences, Suffolk County, New York (C.V.W.); and
Department of Pathology, Division of Forensic Pathology, St. Louis University Health
Sciences Center and the Office of the City of St. Louis Medical Examiner, St. Louis,
Missouri
In cases falling under his/her jurisdiction, the medical examiner must balance the medicolegal responsibility centered on the decedent with the societal responsibility to respect the wishes of the decedent and/or next of kin in order to help living patients. Much has been written on this complex issue in both the forensic pathology and the transplantation literature. Several studies and surveys of medical examiner practices as well as suggested protocols for handling certain types of cases are available for reference when concerns arise that procurement may potentially hinder medicolegal death investigation. It is the position of the National Association of Medical
Examiners (NAME) that the procurement of organs and/or tissues for transplantation can be accomplished in virtually all cases without detriment to evidence collection, postmortem examination, determination of cause and manner of death, or the conducting of criminal or civil legal proceedings. The purpose of this position paper is to review the available data, the arguments for and against medical examiner release, and to encourage the release of organs and tissues in all but the rarest of circumstances.

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Approximately 30-50% of children less than 2 years of age will die waiting for an organ transplant (3).
The medical examiner is one of the most important components of organ and tissue procurement and thus the transplantation process because the majority of persons who are suitable donors fall under medical examiner jurisdiction. Indeed, it has been estimated that as many as 70% of potential donors may fall under medical examiner/coroner jurisdiction (4), and thus the medical examiner/coroner must give authorization before organ or tissue procurement may proceed in these cases.
Medical examiners are charged first and foremost with the responsibility of determining and certifying the cause and manner of death. To this end, they are given the legal authority and control over the body which generally begins when the person is pronounced dead and ends after the medical examiner has completed a medicolegal death investigation and in many cases, an autopsy examination. During this period of time the medical examiner must ensure that the integrity of the body is maintained such that the