Preservation of Evidence during Pediatric Organ Donation: A Modified Thoracotomy Procedure Designed to Increase Consent in Medical Examiner Cases

Abstract

Deceased potential organ donors are often under the jurisdiction of medical examiners/ coroners. In these deaths, the medical examiner/coroner has the statutory responsibility of determining cause and manner of death but is also responsible for presenting findings from the complete autopsy in court. The ability to analyze findings such as location, nature, and age of rib fractures and patterned skin injuries may be crucially important to legal disposition, even though those findings may not be critical to determination of cause and/or manner of death. Potential alteration or destruction of those findings is one reason why a medical examiner/coroner may deny organ donation. We present here a modified surgical approach to accessing thoracic organs in children so that posterior rib fractures, which have particular significance in child abuse cases, can be preserved unaltered for subsequent autopsy. This simple modification of surgical technique has greatly facilitated the mutual goals of the medical examiner and the designated organ procurement organization in our jurisdiction, and it has thus decreased the frequency of denials of organ donation.

Organ Procurement in Forensic Deaths

“…These protocols come in different forms: general protocol form to be completed by transplant coordination teams 14,17 ; organ-by-organ protocols 18 ; and specific protocols concerning precise situations. 19 The international literature has fully exposed this problem: Compliance with the conditions laid down by the regulations and protocols allows to exclude potential bias. 7,15 –17,20 Similarly, it seems simple to argue that organs procured must by definition be healthy and cannot contain evidence of trauma, which would disturb the results of an autopsy performed after the procurement.…”