A written protocol outlines how the eye bank and the coroner can and will work together on cases under the coroner’s jurisdiction when donation of eye tissues is an option.
Yes. The Uniform Anatomical Gift Act (UAGA) in both Colorado and Wyoming requires the coroner to enter into a written agreement with the eye bank to outline how cases under the coroner’s jurisdiction are handled when donation of eye tissues is an option. In Colorado, the District Attorney must also sign. It is an opportunity for us to come to a mutual agreement on how best to work together in your county.
The protocol developed by RMLEB is a template that outlines the basics of what the law requires of coroners in order to maximize donations for transplant. Changes can be made to the template to accomodate special requests of each county coroner, such as calling a different number after hours, how to handle observed abnormalities of the eye, etc. The protocol simply sets expectations for both the eye bank and the coroner for exactly how it should go when there is an eye donor under your jurisdiction.
A coroner may not include a policy that no donations will be allowed when the death is a suspected homicide. The UAGA only allows denial of the donation if the specific tissue’s removal would interfere with determining a cause and manner of death. That requires individual consideration of the forensic value of the tissue. This kind of blanket refusal of donation is contrary to the coroner's obligation to consult with, and cooperate with, procurement organizations under the UAGA to maximize donations.
You may include a clause that, in certain cases such as a gunshot wound to the head, requires the eye bank to take photos prior to recovery or requires a visual inspection by the coroner or investigator. That visual inspection would need to happen within the time periods that still allow recovery of the corneas.
The Rocky Mountain Lions Eye Bank is a separate organization from other recovery agencies. According to the UAGA, the eye bank is the legal custodian of the gift of eye tissues. As such, only the eye bank can represent the interests of maximizing the opportunity for cornea transplants, as the UAGA requires. Only the eye bank has the necessary expertise to work with the coroner toward any decision on the timing of a cornea recovery and the impact on transplant suitability. Likewise, the eye bank is aware of its caseloads at the time of the call and is uniquely positioned to juggle cases to accommodate a coroner's time constraints or logistical needs to move a body. We can cause a recovery to happen faster because we control our resources.
No county coroner would delegate his or her responsibility to investigate a death to another agency. In the same way, the eye bank cannot delegate its responsibility as the custodian of the gift of eye donation.
We’ve tried it, and it simply does not work. It can jeopardize the suitability of a cornea for transplant. The national standard for the time between death and the preservation of corneas is 8 hours. However, a recent study by our technical department found the time between death and the preservation of the corneas averaged 11.5 hours when the tissue bank made a single call to the coroner for release of all donated tissues. When the eye bank called on its own behalf, the time decreased to 5.5 hours. While medical standards allow us to go as far out as 18 hours from the time of death in certain cases, it becomes increasingly more difficult to place the corneas with a suitable recipient as that time lengthens. This has a direct impact on transplant rates of donated corneas. Corneal tissue is unlike any other donated tissues: the delicate endothelial cells on the back of the cornea are crucial to a successful transplant and have a limited viability time with much tighter time constraints.
In nearly all cases, the decision to release corneas for recovery is often an easier decision to make. The transparent cornea has very little forensic value, and the eye bank’s thorough eye exam and vitreous collection are enough for most pathologists. No one will look at more eyes and be able to spot abnormalities than an eye bank recovery technician.
In many cases under a “one call” system, there was a tendency for coroners to consider all donations together when they were presented together. This does not necessarily fulfill the law’s requirement that each tissue be considered separately, taking into account its impact on determining a cause and manner of death.
With our service area having some of the highest registry rates in the nation, it is likely you will have donors under your jurisdiction. In Colorado, the UAGA has a provision outlining the process when a written protocol is not in place. This, however, does not relieve the coroner of the responsibility to enter into an agreement. In Colorado, the law mandates several things in the absence of a protocol, to include:
A written protocol is simply in the best interests of your office because it can be customized to your county and its processes and resources.
In Wyoming, the UAGA does not specify procedures when a protocol is not signed. The law simply requires coroners to enter into written agreements.