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National Association of Medical Examiners Position Paper on the Medical Examiner Release of Organs and Tissues for Transplantation

Pinckard, J Keith MD, PhD*; Wetli, Charles V. MD; Graham, Michael A. MD

The American Journal of Forensic Medicine and Pathology: September 2007 - Volume 28 - Issue 3 - p 202-207
doi: 10.1097/PAF.0b013e3180f616b0
Original Article

The medical examiner community plays a key role in the organ and tissue procurement process for transplantation. Since many, if not most, potential organ or tissue donors fall under medicolegal jurisdiction, the medical examiner bears responsibility to authorize or deny the procurement of organs or tissues on a case-by-case basis. This responsibility engenders a basic dichotomy for the medical examiner's decision-making process. In cases falling under his/her jurisdiction, the medical examiner must balance the medicolegal responsibility centered on the decedent with the societal responsibility to respect the wishes of the decedent and/or next of kin to help living patients. Much has been written on this complex issue in both the forensic pathology and the transplantation literature. Several studies and surveys of medical examiner practices, as well as suggested protocols for handling certain types of cases, are available for reference when concerns arise that procurement may potentially hinder medicolegal death investigation. It is the position of the National Association of Medical Examiners (NAME) that the procurement of organs and/or tissues for transplantation can be accomplished in virtually all cases, without detriment to evidence collection, postmortem examination, determination of cause and manner of death, or the conducting of criminal or civil legal proceedings. The purpose of this position paper is to review the available data, the arguments for and against medical examiner release, and to encourage the release of organs and tissues in all but the rarest of circumstances.

From the *Department of Pathology, Division of Forensic Pathology, University of Texas Southwestern Medical Center and the Southwestern Institute of Forensic Sciences, Dallas, Texas; †Department of Health Services, Division of Medical Legal Investigations and Forensic Sciences, Suffolk County, New York; and ‡Department of Pathology, Division of Forensic Pathology, St. Louis University Health Sciences Center and the Office of the City of St. Louis Medical Examiner, St. Louis, Missouri.

Manuscript received April 16, 2006; accepted May 18, 2006.

Reprints: J. Keith Pinckard, MD, PhD, Southwestern Institute of Forensic Sciences, 5230 Medical Center Drive, Dallas, TX 75235. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.