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Coroners

Study: Coroner Decisions Affect Transplant Rates

A goal that is clearly stated in the Uniform Anatomical Gift Act for interactions between recovery agencies and coroners is  “to maximize the opportunity to recover anatomical gifts for the purpose of transplantation or therapy.”

With a view to this purpose of maximizing transplants, the Public & Professional Relations Department conducted the following retroactive study. 

METHODOLOGY:
For the period of July 1, 2018 to December 31, 2018, a total of 193 eye donation cases that were recovered under a coroner's jurisdiction were individually reviewed and the case notes read to determine the sequence of events. We sought to answer the following questions for each case:
1.    Was the coroner release before or after the autopsy?
2.    What was the time between death and preservation?
3.    Where did the recovery take place?
4.    Was it a shared case with Donor Alliance?
5.    Were the corneas transplanted?
6.    What was the transplant rate?
7.    Were there any complicating factors (difficulty reaching family, delays for transport to DARC, etc.)?

FINDINGS:

Transplant rate
•    The transplant rate for all coroner cases is significantly higher than other cases
•    Pre-autopsy released corneas have the highest transplant rate. 
•    Post-autopsy released corneas still have a higher transplant rate than other cases. 

The time between death and preservation of the tissue is a critical part of corneal viability. Lower times generally lead to higher transplant rates.

For the purpose of the study, cases that had a complication were categorized apart from other cases. For this study, a case was considered "complicated" if it had one or more of the following issues:
•    The next-of-kin identification or notification was delayed.
•    The donor was not immediately positively identified.
•    The body was moved to the Donor Alliance recovery center.
•    The body was moved to the coroner’s office, and the eye bank could not have access.
•    There were jurisdictional questions that had to be ironed out.
•    Any other extraneous factors that unexpectedly delayed the coroner from making decisions.   
 
Conclusions:

Study results clearly indicate the following:
1.    As a group, cases under the jurisdiction of the coroner have a higher transplant rate (68% vs 48%). Much of this is attributed to the fact that these deaths are often younger and sudden or unexpected. They lack the often-long disease process found in many hospital deaths. Even though they have longer death to preservation times on average, they are healthier corneas to begin with because, in most cases, the donors were alive and blinking, ensuring a constant tear film right to the moment of death. 
2.    Pre-autopsy released corneas have the lowest time between death to preservation and, subsequently, highest transplant rate. Pre-autopsy released corneas recovered at DARC have significantly longer DtoP times comparable to post-autopsy recovered corneas.
3.    Even in cases where there are complications, a pre-autopsy release is still the next-lowest death to preservation time. Transplant rates for these corneas are the second highest, as a group. 
4.    Across the board, post-autopsy recoveries have the same basic death to preservation time, whether complicated or not.