Organ procurement in forensic deaths: French developments

Abstract

Organ procurement and transplantation have grown steadily, and the need for organs will only rise in the future. Increasing the number of potential donors is therefore paramount. However, transplant coordination teams face refusals that can be linked to the contexts of the deaths, especially when they involve legal issues. In France, deaths involving legal proceedings are not uncommon (7-10%). In these cases, the prosecutor is immediately contacted, and makes the decision of whether to remove the involved organs. Refusals of this type represent 4% (approximately 30 cases per year) of obstacles to organ removals, and are governed by specific legislation. Thus, the prosecutor must arrange contact with a forensic pathologist and with the organ transplant teams to assemble all of the necessary elements for him to take the decision. To assist prosecutors in their decision making and to ensure them scientific rigour, the French Society of Forensic Medicine sought to develop a national recommendation to harmonise practices; it emerged in early 2013. The guideline makes practical recommendations, including among others: nominating local referents; writing regional protocols between judicial authorities, forensic pathologists and transplant teams; establishing terms for the forensic pathologist's intervention on the donor's body before and after a procurement. This recommendation by the French Society of Forensic Medicine aimed to combine two interests: addressing the shortage of organs, and fulfilling the requisites of a criminal investigation by standardising practices and encouraging communication.

Organ Procurement in Forensic Deaths

“…3 It is for this reason that the French Society of Forensic Medicine set out to develop a national recommendation. This recommendation 5,6 sought to combine 2 interests: first, addressing the shortage of organs and second, fulfilling the requisites of a criminal investigation by standardizing practices. The guideline emerged in early 2013 and is available online at our society's website.…”

Contemporary Legal Issues In Forensıc Cadaver Organ Donors: A case report

“…The prevalence of forensic deaths is 7-10% in France, and refusal rate of attorney for removal of organs is 4% 16 . French Forensic Medicine Society published an advisory guideline in 2013 for attorneys to help them to make their decisions.…”

“…According to this guideline, agreement protocols are prepared for legal authorities, forensic pathologists, transplant teams and attorney. Thus, forensic physician and transplant teams can act in coordination and forensic pathologist may interfere the process before and after removal of the organs 16 .…”

The Intersection of Death Investigation and Organ Donation Systems: A Scoping Review

“…In most jurisdictions, the legal DI authorized organ donation while the medical DI played a consulting role. This was the case in Australia, France, the United Kingdom, and some states in the United States (11,13,15,23,28,29,30). Depending on the system, legal bodies may have relied completely on the medical opinion or they may have decided in opposition.…”

“…Examining the decedent preorgan recovery or attending the organ recovery could facilitate both organ donation and death investigations when there were resources to support this approach. In France, the same DI examined the decedent in the ICU, during the organ recovery surgery, and at autopsy (13,29,30). Protocols from states such as New Jersey, Texas, and Tennessee indicated that DIs could not deny organ donation without attending organ recovery (2,12,17).…”