Limitations of cadaveric organ donation on judicial cases and problems confronted in autopsy: Istanbul data in comparative perspective

Organ procurement in forensic deaths: A retrospective analysis of the Italian context with a focus on the Puglia Region virtuous experience

Organ transplantation is one the most important contributions of modern medicine to society since it provides a unique therapy for terminal organ failure. However, the development of this therapeutic approach is hindered by the limited organ supply. In Italy, organ procurement requires a multidisciplinary medical-surgical approach in which legal medical doctors (LMDs) are generally tasked with ascertaining the reality of death. Sometimes, a medico-legal report is required when the deceased's family deny their consent to the organs and tissues removal from a potential deceased donor. LMDs can also be appointed by law to carry out post-mortem examinations of potential deceased donors. In these cases, the public prosecutors' interest in preserving the corpse integrity for forensic purposes seems to conflict with the ethical-humanitarian interest in promoting, at most, the opportunity to donate; however, a LMD can act as a mediator and allow both goals. This paper aims to illustrate the Apulia Region experience in reconciling the justice interests with those of a culture promoting deceased organ and tissue donation. It has been pursued by analyzing the virtuous regional organ procurement trend in forensic deaths before and after a crucial 2015 initiative, comparing the results with the national ones, and contextualizing them in the relevant literature to show systemic strengths and weaknesses and inform future Italian policy development.

The Intersection of Death Investigation and Organ Donation Systems: A Scoping Review

Introduction

Death investigators (DIs) such as coroners, medical examiners, and forensic pathologists play important and evolving roles in deceased organ donation. DIs communicate with organ donation organizations (ODOs) to gather case-specific information and release or restrict organs depending on the medicolegal requirements. This scoping review aims to identify the breadth of roles and decision-making processes that may facilitate or hinder deceased donation in DI cases.

Methods

This study was conducted using a scoping literature review and subsequent thematic analysis.

Results

Thirty-one eligible papers described 8 common themes with region-specific nuances. These include: 1) shared (ODO and DI) protocols for early communication around each case; 2) shared standards and education for death investigation practices related to organ donation; 3) DI support staff or teams to facilitate organ donation; 4) DI authority to order additional testing and imaging before organ recovery; 5) donation-specific legislation to enhance DI and/or ODO operations; 6) legally trained DI authority to veto medical decisions to proceed with organ donation; 7) DI attendance at organ recovery; and 8) surgeons recording specific DI evidence during organ recovery.

Conclusion

These findings have cultural and resource-allocation implications and expose gaps in the international literature describing practices at the intersection of deceased organ donation and death investigation. A better understanding of the rationale and execution of various systems for DI and ODO cooperation may serve to advance both organ donation and death investigation.

The impact of organ donation on coronial processes and forensic investigation: A literature review

There are competing requirements between organ donation for transplantation and coronial/forensic investigation. Both require access to the body of the deceased. Optimally preserving physical evidence may reduce availability of organs for life saving transplants. Performing organ retrieval could impact on death determination and at worst could potentially interfere with criminal trial outcomes.

OBJECTIVE

To summarise published literature regarding the interaction between organ donation and coronial/forensic processes.

METHODS

A standard search strategy using the terms organ donation and coroner or medical examiner.

RESULTS

There is a paucity of published literature. The incidence of coronial restriction of donation varies between jurisdictions and between individual practitioners. A significant number of organs are lost to transplantation through coronial restrictions. A number of strategies have been proposed to reduce the rate of coronial restrictions but implementation is inconsistent despite support from forensic professional bodies. There was no published report of a significant impact on death determination or trial outcome caused by organ retrieval.

CONCLUSIONS

Increased consistency in coronial/forensic decision making and implementation of recognised strategies would increase the availability of organs for transplantation.

Turkish validity and reliability of Organ Donation Attitude Scale

AIMS AND OBJECTIVES

To report the translation and adaptation process from English to Turkish and the psychometric estimates of the validity and reliability of The Organ Donation Attitude Scale Turkish. Its aim (1) is to provide data about and (2) to assess Turkish people's attitudes and volunteerism towards organ donation.

BACKGROUND

Lack of donors is a significant problem for organ transplantation worldwide. Attitudes about organ donation and volunteerism are important factors in the lack of donors.

DESIGN

To collect survey data from Turkish participants, a cross-sectional design was used: the classical measurement method.

METHODS

The Organ Donation Attitude Scale was translated from English to Turkish and back-translated into English. The analysis included a total of 892 Turkish participants. The validity of the scale was confirmed by exploratory factor analysis and criterion-relation validity testing. A test-retest procedure was implemented for the reliability of the scale over time.

RESULTS

The Organ Donation Attitude Scale consists of three relatively independent components: humanity and moral conviction, fears of medical neglect and fears of bodily mutilation. Internal consistency of these three components resulted in acceptable Cronbach's α levels. Positive correlation occurred between the volunteerism score and positive attitude about organ donation. The correlation between volunteerism score and negative attitude about organ donation was negative. Fears of bodily mutilation were most significantly related to unwillingness to commit to organ donation. The test-retest correlation coefficients proves that the Organ Donation Attitude Scale were reliable over time.

CONCLUSION

The Organ Donation Attitude Scale Turkish version is both a reliable and valid instrument that can be useful in measuring positive and negative attitudes of Turkish people about organ donation.

RELEVANCE TO CLINICAL PRACTICE

With the Organ Donation Attitude Scale, researchers in Turkey will be able to ascertain important data on volunteerism and attitudes towards organ donation. Thus, positive attitudes towards cadaver organ donations will be able to encourage organ donation in Turkey.