The Role of HM Coroner in relation to Organ Donation: England, Northern Ireland and Wales

Coroners are independent judicial officers who enquire into those deaths reported to him or her. It is the Coroner’s duty to find out the medical cause of the death, if it is unknown, and to enquire about the cause of it if it was due to violence or otherwise appears to be unnatural. There are a number of occasions when a death will need to be reported to the Coroner or the Coroner’s officer (the deputy supporting the Coroner) by the hospital staff caring for the patient; where the potential donor has expressed the wish to donate, this will usually be done in collaboration with the Specialist Nurse – Organ Donation (SN-OD).

Reporting of deaths to the coroner in usually done by the medical staff and death should be reported to the Coroner if:

  • The cause of death is unknown.
  • Death cannot readily be certified as being due to natural causes.
  • The deceased was not attended by a doctor during his last illness or was not seen within the last 14 days (28 days in Northern Ireland) or viewed after death.
  • There are any suspicious circumstances or history of violence.
  • The death may be linked to an accident (whenever it occurred).
  • There is any question of self neglect or neglect by others.
  • The death has occurred or the illness arisen during or shortly after detention in police or prison custody (including voluntary attendance at a police station).
  • The deceased was detained under the Mental Health Act (in England and Wales) or the Mental Health Northern Ireland Order (in Northern Ireland).
  • The death is linked with an abortion.
  • The death might have been contributed to by the actions of the deceased (such as a history of drug or solvent abuse, self injury or overdose).
  • The death could be due to industrial disease or related in any way to the deceased’s employment.
  • The death occurred during an operation or before full recovery from the effects of an anaesthetic or was in any way related to the anaesthetic (in any event a death within 24 hours should normally be referred).
  • The death may be related to a medical procedure or treatment whether invasive or not.
  • The death may be due to a lack of medical care.
  • There are any other unusual or disturbing features to the case.
  • The death occurred within 24 hours of admission to hospital, unless the admission was for the purposes of terminal care.
  • It may be wise to report any death where there is an allegation of medical mismanagement.
The list is not exhaustive – if in doubt contact the Coroner.

In the situations described above, or if the clinician caring for the patient is unable to issue a death certificate, the SN-OD must gain permission from the Coroner for organ donation to proceed. This will be done in collaboration with the medical team caring for the patient.

It will often be the Coroner’s officer who the SN-OD will be liaising with. Outside of working hours some larger city areas may have an official on-call rota to aid contacting the Coroner’s officer, if this is not the case the local police station will be able to advise.

To help their investigation and to determine the cause of death the Coroner or their officer may place some restrictions as to what organs can be retrieved. This all needs to be agreed before donation can proceed. There may be certain circumstances when a home office pathologist may need to attend the retrieval procedure to document events and take photographs to help the Coroner with their investigation.

In England, the Coroner cannot give consent for organ or tissue donation but can agree to organ or tissue donation proceeding if she/he believes that donation will not interfere with their legal responsibilities to establish the cause of death.

However, in Scotland the Procurator Fiscal is required to give consent in writing which is usually faxed to the ICU. For both, the primary concern will be to establish whether there are any grounds for an inquest/fatal accident enquiry.

Coroner’s cases may require an autopsy, after retrieval has occurred therefore it is important that retrieval surgeons clearly document the all details of the operation and note any abnormalities. Occasionally blood samples will be required by the Coroner.

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