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J A M E S R . G I L L , M . D .
C H I E F M E D I C A L E X A M I N E R , C O N N E C T I C U T
L I S A P A O L I L L O , E S Q .
S V P & G E N E R A L C O U N S E L , N E O G
Saving Lives: Organ Donation in Medical-Legal Cases
Agenda
Legal Background
Medical Examiner (and District Attorney) Role
Restrictions in Pediatric Cases
Organ Donation in cases under investigation by MEO
Legal Background
Uniform Anatomical Gift Act
Governs authorization for deceased donation
Governs MEO (and DA) role in organ donation
MEO and OPO shall cooperate to “maximize the opportunity to recover anatomical gifts for transplantation, therapy, research or education.”
Massachusetts: District Attorney approval required
OPO must provide notice to the MEO (and DA) of authorization to recover anatomical gift if donor died under circumstances within jurisdiction of MEO (and DA)
UAGA
The CME (and DA) may approve or deny removal of the anatomical gift
Within a time period that ensures the preservation of the anatomical gift for transplantation
Attend recovery if donation would otherwise be denied
If deny recovery, explain the reasons for determining that the organs may be involved in the cause of death.
Immunity from liability if act in good faith
Medico-Legal Cases 2013-2016
576
49 40 17 3
0
100
200
300
400
500
600
700
PediatricHeartbeating
Referrals
Pediatric OrganDonors
ME Cases ME Restrictions Full Restriction
MEO CASES
MEO investigates the circumstances surrounding deaths due to
Unnatural means
Natural means requiring further investigation
Forensic Pathology
Subspecialty in pathology involved in the examination of the living and the dead in order to provide an opinion concerning the cause, mechanism, and manner of disease, injury, or
death.
Physicians in USA
~1,000,000 Physicians
~500 Board Certified Forensic Pathologists
4 years college
4 years medical school
3-4 years residency in pathology
1 year fellowship in Forensic Pathology
National Examinations
Death Investigation System Needs:
Authority to take charge of the body
Autopsy without permission
Subpoena power (e.g., medical records, HIPAA exemption)
Reportable Deaths (CT)
Accidents, suicides, homicides (All unnatural).
Poisoning, drug abuse, addiction.
Disease with potential public health threat.
Deaths resulting from employment.
Sudden and unexpected deaths not caused by a readily recognized disease.
DOA or within 24 hours of admission to hospital (“No Case”).
Death under anesthesia, in operating or recovery room, following transfusions, or during diagnostic procedures.
Medical Legal Investigators
Death reported and MLI does
initial investigation
Hospital vs. Scene Death
Writes report of circumstances,
scene (photos)
Next morning (9 AM): ME reviews case and decides if autopsy
24/7, 365 days a year
Medical Examiner
Certify Cause and Manner of Death
Identification of decedent
Testify: Homicides, civil actions
Public Health (meningitis, statistics)
Educate
On-Call ME (24/7): Organ/Tissue Donor Permission on OCME deaths
MANNER of DEATH vs.
CAUSE of DEATH
Cause of Death
The Disease and/or injury responsible for
the fatality.
Proximate Cause
That which in a natural and continuous sequence, unbroken by any efficient
intervening cause, produces the fatality and without which the end result
would not have occurred (etiologically specific).
Cause and Manner
There is NO time limit for the cause or manner of death.
Explanation of how the cause arose.
Manner of Death
Manner of Death
Natural
Unnatural
Homicide
Suicide
Accident
Therapeutic Complication
Undetermined
Benefits of Autopsy
Establish Cause of Death
Assist in Determining the Manner of Death
Produce Accurate Vital Statistics
Identify New and Changing Disease
Monitor the Public Health
Benefits of Autopsy
Reassure Family Members
Instruct Medical Students and Physicians
Compare Premortem and Postmortem Findings
Assess the Quality of Medical Practice
Evaluate the Effectiveness of New Therapies
Special Cases
Infant (eyes)
Homicides (stab wound of chest)
Hospital notifies NEOB of
potential donor
Preliminary phone screen & registry checked
Donation Coordinator notified of
referral
Verification of registry, chart
review
Determination of medical
suitability with CDOC
Declaration of Death by
Neurological Criteria/Family
decision to withdraw support.
Huddle with hospital staff:
Pre-family approach huddle
Family meeting/ Obtain
Authorization
Notify/Confirm notification of MEO, DA re:
Potential Donor Under Jurisdiction
Obtain Clearance from MEO/DA
Ongoing support for
family Organ allocation
Organ specific evaluation &
testing
Donor management
Organs accepted by transplant
centers
Coordinate recovery time &
schedule OR
Moment of Silence, family
statement, organ recovery
Post mortem care
Confirmation of organs & follow
up testing
Follow up with MEO/DA on
requested information
Overview of Donation Process For Organ Donation Cases
Organ allocation
Hospital identifies
potential donor
MEO Cases
Reporters
Physicians
Law Enforcement Officers
State's Attorneys
Prosecuting Attorneys
Funeral directors
Embalmers
How do we move forward in pediatric cases under investigation by the MEO/DA cases?
MEO/DA and OPOs both serve important public purposes
Information is the Key
Medical Records (Progress Notes, Imaging Reports)
Imaging (CT, X-Ray, MRI)
Laboratory Testing (Blood Tests, Tox Screens)
Photographs
Attending Physician Discussion
CMO Discussion
Attend Recovery
Cooperation