Stephen J. Cina, MD, FCAP Chief Medical Examiner Cook County, IL

 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!

 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

 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

 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)?

 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

 “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

 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

 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!

Steve Cina, MD