The role of police and pathologists in organ donation

In some cases, police and pathologists may inform the coroner or procurator fiscal (PF)'s final decision about which organs and tissue can be retrieved.

Police may be involved due to an ongoing investigation into circumstances that have contributed to the cause of death. In the circumstance of a postmortem examination being required, the pathologist will consider the impact of organ or tissue retrieval on establishing the cause of death.

Specialist nurses and medical teams can facilitate donation while supporting a complex judicial decision in a number of ways. Read more about how NHS Blood and Transplant can support a complex judicial decision.

Police

Even in suspected homicide cases, donation should be presumed possible if the coroner or PF, in conjunction with the pathologist and senior investigating officer (SIO), confirms it will not compromise the investigation.

As set out in the Major Crime Investigation Manual (MCIM) 2021, the SIO must weigh investigative implications, but organ and tissue donation is generally compatible with criminal investigations.

Specialist nurses for organ donation (SNODs) or specialist nurses for tissue donation (SNTDs) lead donation assessment and discussions with families to confirm donation decisions. Police family liaison officers (FLOs) play a supporting role and should not initiate or lead donation conversations.

If a family raises the topic of donation, a FLO should simply facilitate timely communication between the family and NHS Blood and Transplant. This approach guarantees families receive accurate information and compassionate guidance from trained specialists.

In circumstances where there may be a criminal prosecution, the coroner or PF will liaise with the police before deciding on their lack of objection (or otherwise) to donation. 

An example of a complex criminal case where organ donation was supported by the judicial multi-agencies can be viewed on the BBC website:

Crimewatch Live, Series 21, Organ Donation – BBC One

Pathologists

In complex cases where an autopsy (postmortem examination) is a possibility, a pathologist may be contacted to impart expert advice to a coroner or PF. This includes in the case of a Home Office forensic postmortem.

The primary purpose of the autopsy is to establish an accurate cause of death, to identify and document patterns of injury, and to address potential medicolegal implications. Securing premortem evidence may inform the cause of death and support the coroner or PF's decision on donation.

The Royal College of Pathologists have published guidance for completing an autopsy following any agreed organ and tissue donation, titled 'Guidelines on autopsy practice: Autopsies on donors following tissue and organ donation'. These can be found as part of the autopsy guideline series on the Royal College of Pathologists website.

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