FACTS FOR CORONERS:
Release for cornea donation post-autopsy is too late. Time is our worst enemy. The national average between death and preservation of the cornea is 8 hours. While the eye bank can, on a case-by-case basis, extend that to 18 hours, most autopsies are not completed in that time frame. At the Rocky Mountain Lions Eye Bank, the average death to preservation time on eye-only donations under the coroner with PRE-AUTOPSY release is 5.5 hours (when the eye bank works directly with the coroner). The average death to preservation on cases that are eye AND tissue/organ cases released PRE-AUTOPSY average 14.2 hours between death and preservation. The average death to preservation of NON-CORONER cases at RMLEB is 8.5 hours.
Pre-autopsy release prior to moving the body to your facility gives the cornea the best chance for a successful transplant. Coroner involvement in an eye donor case automatically extends the death to preservation time because of the extra work involved for our staff and the coroner. Authorizing the recovery of corneas before the autopsy and while the body is still at the hospital gives the lowest death to preservation time and gives the cornea the best chance for success.
Drawing vitreous fluid BEFORE cornea recovery often destroys the endothelium because the eye collapses. Please, if you intend to allow the recovery of the cornea, do not draw vitreous fluid. Let the eye bank collect it at the time of recovery. See #5 below.
The cornea is rarely useful in determining a cause or manner of death. The National Association of Medical Examiners advocates release for cornea doantion in all cases. Have a conversation with your pathologists to determine which cases a cornea would have bearing on determining a cause of death (ex. suspected shaken baby syndrome is one example where the intact eye could be helpful). Check out the webinar by Dr. Samantha Wetzler, chair of the National Association of Medical Examiners' ad-hoc comittee on eye, organ and tissue donation for a rundown on what the cornea can and can't tell you. Watch it here.
The eye bank's procedure does not destroy evidence:
The eye bank will look for and document petechiae, iris color, pupil sizes and abnormalities in the eye at the time of recovery.
The eye bank will collect vitreous fluid as evidence, seal it in tamper-evident envelopes and leave it with the body (or deliver however you like).
No tubes/lines or bandages are moved or removed. If our technician feels any of that is in the way or is unable to establish a proper sterile field, he or she will call the administrator/supervisor on call to discuss the options. Most likely, that would be to ask the coroner/investigator to conduct a visual inspection of the body to see if the obstruction could be moved prior to us going forward.
We could not do a recovery with a helmet in place. If we encountered this situation, we would call the investigator to make a plan and get advice on how (and if) we should proceed.
A noose would most likely not hinder us.
The eyes are rinsed with saline to remove any debris. We then use isopropyl alcohol wipes to clean the area, including an inch above the brow to the upper eyelid line (including lashes) and the lower lid to an inch below the lower lid. That is followed by swabbing with povidone iodine in concentric circles to that same dimension (about 2 inches in all directions from the center of the eye). Our sterile field consists of a fenestrated drape where the hole is about 2" in diameter. It covers the brow ridge and only the eye is visible. For prep of the eye, 10-15 drops of Betadine are placed in the eye for a period and then rinsed with sterile saline. After the recovery is complete, we put in eye caps and clean the area of the iodine with sterile saline soaked gauze. We also use massage cream around the eyes to keep the lids from drying out, a complaint often heard from funeral homes. Your staff is welcome to observe any eye recovery.
For trauma cases, we would walk away if there was obvious, gross trauma to the corneas (ex. glass shard in the eye). Dirt or other loose debris is not a concern for us right away because we cannot assess the damage to the cornea until it is under our microscope. Broken orbital bones from trauma can often make the position of the eye odd, but aren't usually a problem. We do sometimes have problems if the eye is really swollen because we can't insert a speculum. Each of these is assessed by the technician on the case, who would then consult the supervisor/administrator on call and the coroner, if necessary. A request of the coroner to do a visual inspection prior to proceeding may be made (see the Uniform Anatomical Gift Act for information on this important duty of the coroner).