As required by Colorado and Wyoming law, the Rocky Mountain Lions Eye Bank has begun negotiations with coroners in 86 counties across two states to develop protocols that will dictate what happens when a donor's death is under a coroner's jurisdiction. Laws in both Colorado and Wyoming mandate that coroners cooperate with recovery agencies like the eye bank in order to maximize the number donations that are recovered for transplant.
The Uniform Anatomical Gift Act says the only circumstances where a coroner can deny a donation is if the coroner feels that "the recovery of the part could interfere with the post-mortem examination into the decedent's cause or manner of death." While the National Association of Medical Examiners (NAME) advocates allowing the recovery of donated eyes, organ and tissues in every case, Robert Austin, the eye bank's manager of public and professional relations, said that donations are often denied for reasons other than forensic science.
"We've begun asking for the specific reason a coroner will not allow a recovery and many of the stated reasons don't fit into what the law allows," Austin said. "One common area is simple inconvenience. For example, several eye donations have been lost due to refusals by investigators to confer with pathologists or the coroner at night, asking the eye bank to call back in the morning when it is too late for a successful recovery to occur. Other examples are cases where the donation is denied because the coroner's office perceives the eye bank has "called too many times" or because the office has received requests from both the eye bank and the tissue bank and the coroner believes the agencies should coordinate with just one call.
Austin points out that the latter is simply not possible. "We are not a tissue bank and the tissue bank is not an eye bank. Those are two entirely different things with different medical criteria, time frames and with vastly different forensic values. No one would expect one hospital to call the coroner on behalf of another hospital. We are two agencies with different needs that require interaction with the coroner in order to get a decision mandated by law. We can't delegate that to another agency."
Another common reason given for denial of an eye donation is that the coroner had to collect evidence so the recovery is only allowed after the autopsy. Austin said that, too, presents problems. "First, that is simply too late. We have only 12 hours from the time of death to do a recovery and 8 hours is really the national standard. Secondly, the law requires coroners to conduct their post-mortem examination within a time compatible with recovery of the donated organs and tissues. Waiting for the autopsy to happen in three days is not fulfilling that mandate." Austin notes that in more rural areas, the autopsy is often performed in another county or even in another state. Nonetheless, he believes that if the will was there to enable donations, a way could be found. "There are a few states where the coroner is barred from denying a donation. It works in those states and it can work here," Austin said.
One fear often expressed by coroners and District Attorneys is that a prosecution will be jeopardized if a donation is allowed. However, there is no evidence of that having ever happened. Dr. Edmond Donoghue is a past president of NAME and the former Cook County, Illinois (Chicago) chief medical examiner, now with the Georgia Bureau of Investigation. Dr. Donoghue noted that the fear is an irrational one. "Thirty years' experience with organ transplantation in the united States offers absolutely no evidence that this is true." As the Cook County medical examiner, Dr. Donoghue instituted a "no denial" policy when it came to donations.
Dr. Samantha Wetzler, a medical examiner in Virginia, authored the latest NAME position paper on eye, organ and tissue donation. She believes that the coroner's role is one of a public health official. "The need for organs and tissues is a public health issue and coroner's play a role in addressing that." She can think of no case where the cornea would be beneficial in determining a cause of death and sees no reason why a cornea recovery should ever be denied. As for prosecutorial fears that a case will be jeopardized, Dr. Wetzler agrees that there has never been a single documented case of any donation — organ, eye or tissue — that really interfered with a death investigation. "Partly," she said, "it's just the experience level of the prosecutor or the attorney involved."
Austin said the eye bank's goal would be a "zero denial" zone for Colorado and Wyoming. "It is possible and it has happened in other areas. I would love us to be a shining example of how a donor's wish to help another is not overshadowed by the coroner's need to determine a cause of death. Both can happen every single time if we want it to."