Stephen J Cina MD FCAP Chief Medical Examiner Cook County IL Role of the ME Coroner Determine cause and manner of death Identify threats to the public health IL has one ME County Most coroners contract with FPs for autopsies ID: 811519
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Slide1
Organ/Tissue Donation and the Medical Examiner/Coroner
Stephen J. Cina, MD, FCAP
Chief Medical Examiner
Cook County, IL
Slide2Role 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!
Slide3What 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
Slide4Making 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
Slide5Establish 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)?
Slide6Organ 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
Slide7Organ 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
Slide8Tips 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
Slide9The 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!
Slide10QUESTIONS AND COMMENTS
Steve Cina, MD
Stephen.cina@cookcountyil.gov
312-997-4500