IMPACT OF MEDICAL EXAMINER CORONER PRACTICES ON ORGAN RECOVERY IN THEUNITED-STATES

Objective.-The object of this research is to determine the nature and extent of the loss of donor organs during a 3-year period that are oth erwise medically suitable for organ transplantation owing to nonreleas e by a local medical examiner or coroner. Design and Data Sources.-In a retrospective study of the effects of medical examiner/coroner donor release practices, a detailed survey was mailed to every organ procur ement organization (OPO) in the United States. This survey collected s pecific data (eg, number of cases denied per year), as well as descrip tive information. Results.-Of the 2670 organ donors reported by 39 OPO respondents in 1990, 62.1% were medical examiner cases, and 129 (7.2% ) of these cases were denied recovery by the local medical examiner/co roner. The number of denials increased to 181 (9.6% of medical examine r cases) in 1991 and to 251 (11.4% of medical examiner cases) in 1992. It is estimated that the population of medical examiner/coroner denia ls from 1990 through 1992 may be as many as 884. Twenty percent of the OPO respondents reported that no cases were denied recovery by a loca l medical examiner/coroner. A comparative analysis reveals that the pr oportion of total reported potential medical examiner/coroner cases th at were denied increased by 65% from 1990 to 1992, while medical exami ner/coroner cases released declined slightly. Conclusions.-Since an av erage of 3.37 organs were recovered per donor in 1992, it is possible that as many as 2979 people may have been denied transplants from 1990 through 1992 owing to medical examiners'/coroners' denials. There wer e no donor denials in 10 geographical areas of the United States, nor was there any instance of violation of case law or any documentation o f flawed autopsies or collection of forensic evidence in donor cases r eleased. These two factors suggest that the loss of human life from de nials is not needed to protect the judicial process. Increased coopera tion between medical examiner offices and OPOs could significantly inc rease the availability of transplantable organs.