CORE
Policies and Procedures
POLICY #: GP 004
MANUAL: General Procurement
REVIEWER(S): Director Regulatory
Affairs & Laboratory Services, Chief
Operating Officer, Director of Clinical
Operations
PAGE 1 OF 8
ORIGINAL POLICY DATE: 10/96
REVISION DATE: 08/06, 04/13/10,
09/08/10, 5/19/11, 8/04/11
POLICY NAME: Preserving Evidence for
Coroner/Medical Examiner
APPROVAL DATE:05/04/10, 10/26/10,
6/1/11, 8/9/11
IMPLEMENTATION DATE:05/14/10, 11/8/10,
6/24/11, 8/22/11
Policy
It shall be the policy of CORE to obtain accurate and detailed information from the Coroner/Medical
Examiner’s office to assure a proper investigation can take place on all post mortem organ, tissue and eye donors.
Purpose
The purpose of this policy is to provide standards for photography, video taping, collecting specimens and documentation for coroner/medical examiner cases. Once consent has been secured from all the above individuals, CORE will be responsible for obtaining all requested information on behalf of the coroner/M.E.
Scope
This policy applies to all CORE personnel who have responsibilities for obtaining information or documentation regarding coroner/medical examiner cases.
1.
Digital Photography
1.1.
When leaving for a case, the Recovery Coordinator will:
1.1.1.1.
Sign out a camera and two camera cards

Test the camera – Take a picture of the eastern time-zone clock in the
Donor Referral Coordinator (DRC) office; and review it to be certain the camera is working.
1.1.2.
Once a recovery is completed, the Recovery Coordinator will:
1.1.2.1.
Place the camera card in the envelope found in the DRC office.
1.1.2.2.
Complete information on the envelope.
1.1.2.3.
Place the envelope and camera card in the box provided in the DRC office.
1.1.2.4.
The Data Coordinator will retrieve all photo cards/documents out of the box in
DRC.
1.1.2.5.
The Data Coordinator will be responsible for downloading the pictures and saving them to the network. The IT Department or Associate Director of Recovery
Services will serve as back-up to the data coordinator and retrieve the cards/documents, download the pictures and save them to the network.
1.1.3.
Once the images are downloaded, the images are copied to a CD-R and mailed to the
Medical Examiner’s/Coroner’s Office.

CORE
Policies and Procedures
POLICY #: GP 004
MANUAL: General Procurement
REVIEWER(S): Director Regulatory
Affairs & Laboratory Services, Chief
Operating Officer, Director of Clinical
Operations
PAGE 2 OF 8
ORIGINAL POLICY DATE: 10/96
REVISION DATE: 08/06, 04/13/10,
09/08/10, 5/19/11, 8/04/11
POLICY NAME: Preserving Evidence for
Coroner/Medical Examiner
APPROVAL DATE:05/04/10, 10/26/10,
6/1/11, 8/9/11
IMPLEMENTATION DATE:05/14/10, 11/8/10,
6/24/11, 8/22/11
1.1.4.
The digital memory card will be cleared and returned to the DRC office.
2.
Organ Donors – digital photographs
2.1.
A digital camera with a focus lens will be used for taking all pictures for post-mortem organ and tissue donors that are Coroner/Medical Examiner cases.
2.2.
Identification

Wrist band/ID band

Photo Documentation Sheet across the chest identifying CORE donor
#, age, sex and race, unique identification number, hospital name or
“PG” code and date.

Picture of any clothing on the body
2.3.
There will be one picture of the face with a straight shot down of the entire face.
2.4.
Each side of the face; a picture of the right side of the face and a picture of the left side of the face.
2.5.
A picture of the entire external surface of the body. (Smaller site pictures are preferred over taking a picture of a large surface area. It is better to take several pictures of the body versus one large picture of the body).
2.6.
With gunshot wounds, a picture of the entrance site and exit wound (if present) shall be taken.
2.7.
A ruler will be utilized in showing sizes of abrasions, wounds, lacerations etc…
2.8.
Picture of the abdominal cavity before dissection.
2.9.
Picture of the anterior and posterior of each organ recovery.
2.10.
Picture of the body when the procedure is complete. (Demonstrates that no tubes are removed.)
2.11.
Picture of the specimens obtained and attached to body.
2.12.
Pictures of all the inserted cannulas.
3.
Video Taping (Upon Special Request)
3.1.
Video photography will be coordinated only upon special request by a Coroner/Medical
Examiner.
3.2.
Identification of the donor will be through:

ID band.

A Photo Documentation Sheet across the chest that identifies: o CORE Donor #

CORE
Policies and Procedures
POLICY #: GP 004
MANUAL: General Procurement
REVIEWER(S): Director Regulatory
Affairs & Laboratory Services, Chief
Operating Officer, Director of Clinical
Operations
PAGE 3 OF 8
ORIGINAL POLICY DATE: 10/96
REVISION DATE: 08/06, 04/13/10,
09/08/10, 5/19/11, 8/04/11
POLICY NAME: Preserving Evidence for
Coroner/Medical Examiner
APPROVAL DATE:05/04/10, 10/26/10,
6/1/11, 8/9/11
IMPLEMENTATION DATE:05/14/10, 11/8/10,
6/24/11, 8/22/11 o Sex/age/race o hospital name or “PG” code o date o unique identifier number

Shall include clothing found on the body.
3.3.
At the beginning of the video, verbally state the CORE Donor #, age, sex, hospital or “PG” code and date.
3.4.
Video the entire external surface of the body from head to toe.
3.5.
Video inserted cannulas.
3.6.
Video all organs recovered
3.7.
Video the right and left side of the body
3.8.
With the liver, be sure to include the following:
 the superior surface of the liver ligament
 the inferior surface of the liver ligament
 backtable of the liver
3.9.
With the kidneys, be sure to include the following:
 a picture of the anterior surface
 a picture of the posterior surface
 clear verbalization if the kidney is decapsulated

Where tagged- left kidney ureter
3.10.
3.11.
3.12.
With the lungs, be sure to include the following:
 an anterior panning of the lung surface
 posterior panning of the lung surface
With the mediastinum, extend up to the neck of the mediastinum.
With the intestine, ideally, all layers of the intestines should be videoed due to the better quality of the intestine versus a still shot. Be sure to include:
 a mesenteric view
 video as they go through the different layers of the intestine

Verbalization if any trauma is noted on the intestinal trace as the dissection is performed.

CORE
Policies and Procedures
POLICY #: GP 004
MANUAL: General Procurement
REVIEWER(S): Director Regulatory
Affairs & Laboratory Services, Chief
Operating Officer, Director of Clinical
Operations
PAGE 4 OF 8
ORIGINAL POLICY DATE: 10/96
REVISION DATE: 08/06, 04/13/10,
09/08/10, 5/19/11, 8/04/11
POLICY NAME: Preserving Evidence for
Coroner/Medical Examiner
APPROVAL DATE:05/04/10, 10/26/10,
6/1/11, 8/9/11
IMPLEMENTATION DATE:05/14/10, 11/8/10,
6/24/11, 8/22/11
4. Organ/Tissue/Eye Donor Images

Utilize a digital camera, Skype or Audio/Visual Conferencing

Identification of the donor via:

Wrist band/ID band

CORE form identifying the CORE Donor #, sex, race, hospital name or “PG” code and date. o Images from the donor which will assist in the placement of organs, tissues or corneas for transplantation will be taken and transmitted to transplant surgeons as needed o Any lacerations, bruises or clinically pertinent defects on the donor or organs will be captured as needed. o A ruler will be utilized in showing sizes of abrasions, wounds, lacerations etc.

Any lacerations or bruising over the body of which an incision will be made for the removal of the tissue shall be shown on the image next to a ruler prior to making the incision.

Heart Valve Donor

Anterior and posterior view of the heart.
 Gun Shot Wounds

A close up of the gunshot entrance and exit wounds.

Scraping: i.e., from being dragged along the road

A clear picture of the entire scraping on the skin.

There will be one picture straight on of the face with a straight shot down of the entire face.

A picture of each side of the face, right side and left side.

A picture of the entire external surface of the body. (Smaller site pictures are preferred over taking a picture of a large surface area. It is better to take several pictures of the body versus one large picture of the body).

Picture of the body when procedure is complete.

Picture of specimens obtained and attached to the body.
 Pictures of all personal effects.
4.
Coroner/Medical Examiner Booklet
4.1.
It will be CORE policy to complete a Coroner/Medical Examiner report (CORE Form ME-
1) and appropriate donor specimens on all Coroner/Medical Examiner cases regardless of request by Coroner/Medical Examiner.

CORE
Policies and Procedures
POLICY #: GP 004
MANUAL: General Procurement
REVIEWER(S): Director Regulatory
Affairs & Laboratory Services, Chief
Operating Officer, Director of Clinical
Operations
PAGE 5 OF 8
ORIGINAL POLICY DATE: 10/96
REVISION DATE: 08/06, 04/13/10,
09/08/10, 5/19/11, 8/04/11
POLICY NAME: Preserving Evidence for
Coroner/Medical Examiner
APPROVAL DATE:05/04/10, 10/26/10,
6/1/11, 8/9/11
IMPLEMENTATION DATE:05/14/10, 11/8/10,
6/24/11, 8/22/11
4.2.
Booklets are returned with the charts.
4.2.1.
If the donor is an organ donor, the Coroner/Medical Examiner booklet (CORE Form
ME-1) is returned to the CORE office with CORE Form D-3.
4.2.2.
If the donor is an organ/tissue donor, the Coroner/Medical Examiner booklet (CORE
Form ME-1) is delivered to CORE by the recovery coordinator.
4.2.3.
If the donor is a tissue/eye donor, the Coroner/Medical Examiner booklet (CORE
Form ME-1) is delivered to CORE by the recovery coordinator.
4.2.4.
When the Coroner/Medical Examiner booklet (CORE Form ME-1) is delivered to the
CORE office, a cover letter (CORE Form ADM-11) to the Coroner/Medical Examiner is drafted. This cover letter and booklet goes to the Coroner/Medical Examiner in the county/state where the patient died, refer to CORE Form ADM-9.
4.2.5.
Photocopy pages 2 and 3 of CORE Form D-3 to be included in the Coroner/Medical
Examiner booklet (CORE Form ME-1). The last page of the report is also typed with the following information:

Name of the donor

Hospital in which the recovery took place

Date of the recovery

CORE's patient/donor number

Coroner/Medical Examiner office that will receive the report.
4.2.6.
Upon completion
4.2.6.1.
The report will be approved by the Director of Regulatory Affairs & Laboratory
Services or designee.
4.2.6.2.
The report will be signed by all of the parties.

Recovery surgeons

Tissue team

Coordinator(s)

Member of Leadership
4.2.6.3.
The report is delivered with digital photos to the Coroner/Medical Examiner’s office in the most expeditious manner.
4.2.6.4.
A photocopy of the report and cover letter is filed with CORE Form D-3.

CORE
Policies and Procedures
POLICY #: GP 004
MANUAL: General Procurement
REVIEWER(S): Director Regulatory
Affairs & Laboratory Services, Chief
Operating Officer, Director of Clinical
Operations
PAGE 6 OF 8
ORIGINAL POLICY DATE: 10/96
REVISION DATE: 08/06, 04/13/10,
09/08/10, 5/19/11, 8/04/11
POLICY NAME: Preserving Evidence for
Coroner/Medical Examiner
APPROVAL DATE:05/04/10, 10/26/10,
6/1/11, 8/9/11
IMPLEMENTATION DATE:05/14/10, 11/8/10,
6/24/11, 8/22/11
5.
Collecting Specimens
5.1.
Consent: Obtain Coroner/Medical Examiner consent. Document name of Coroner/Medical
Examiner, date and time permission granted on CORE Form D-3.Determine if
Coroner/Medical Examiner is doing autopsy versus visual inspection.
5.2.
Documentation: Complete Coroner/Medical Examiner booklet (CORE Form ME-1).
5.3.
Subject to change depending on the request

Obtain approximately 60 cc of blood = (10-12 grey-top tubes,1 purple-top EDTA & 1 red-top tube)

Obtain 15 cc bile (organ donor only)

Obtain 50 cc urine (organ donors only)
5.3.1.
Obtain 1 red-top tube of vitreous for eye/corneal donors on coroner/medical examiners cases.
5.4.
Take still photos and/or videotape
5.5.
Tape specimens to body & take pictures
5.6.
Extract 2 -5 cc of blood from right and left atrium (If a drowning victim)
5.7.
Label all blood, urine and bile specimens which will include:

Name of deceased

Unique Identification Number

Institution where drawn

Date / Time sample was drawn

Location of body from which sample was drawn

Name of person obtaining sample
5.8.
Post Recovery
5.8.1.
Assure body is not released until after autopsy, if autopsy being done at recovering institution.
5.8.2.
Leave pathologist form (CORE Form B-2) with body, if an autopsy is being performed.
5.8.3.
Leave Coroner/Medical Examiner specimens attached to the body & take pictures.
5.8.4.
Notify the Coroner’s office/Medical Examiner’s office to pick up body, if autopsy being conducted at the Coroner’s office/Medical Examiner’s office or another institution at the request of the Coroner/Medical Examiner. Only CORE staff is to notify Coroner/Medical Examiner.

CORE
Policies and Procedures
POLICY #: GP 004
MANUAL: General Procurement
REVIEWER(S): Director Regulatory
Affairs & Laboratory Services, Chief
Operating Officer, Director of Clinical
Operations
PAGE 7 OF 8
ORIGINAL POLICY DATE: 10/96
REVISION DATE: 08/06, 04/13/10,
09/08/10, 5/19/11, 8/04/11
POLICY NAME: Preserving Evidence for
Coroner/Medical Examiner
APPROVAL DATE:05/04/10, 10/26/10,
6/1/11, 8/9/11
IMPLEMENTATION DATE:05/14/10, 11/8/10,
6/24/11, 8/22/11
6.
Pathology Report
6.1.
A pathology report of the myocardium will be available on every donor in which LifeNet receives the Heart for Valves.
6.2.
Upon receipt, the report will be forwarded to the Coroner/Medical Examiner for their examination.
6.3.
If the Coroner/Medical Examiner requests the return of the myocardium, the donor referral coordinator shall request that the myocardium be returned to CORE following heart valve removal by the tissue processor..
6.3.1.1.
The CORE coordinator will document in the donor electronic medical record where the myocardium is to be sent. Clarity is important when the myocardium is to be sent for purposes of a Coroner/Medical Examiner case and when the
Coroner/Medical Examiner IS NOT the pathologist.
6.3.1.2.
The myocardium should be requested to be returned to CORE via next-day service.
6.3.1.3.
Once received, CORE ensures delivery of the myocardium to the
Coroner/Medical Examiner for completion of their investigation in the most expeditious manner. The myocardium is never sent directly to the pathologist.
(The myocardium is packaged in a formaldehyde solution and usually does not require re-packaging).
6.3.1.4.
A note will be added to the donor chart regarding request and delivery of the myocardium to the Coroner/Medical Examiner.
7.0
Coroner/Medical Examiner Body Bag Seal
7.1.1
If at any time the chain of custody seal is broken for pre-autopsy recovery, the recovery coordinator will replace the seal and fill out proper paperwork.
8.0
Restrictions
8.1
Anytime there are ME/Coroner restrictions other than the routine requests for specimens etc. a STOPP call will be initiated prior to an incision.
9.0
Abdominal Organ Recovery for Coroner/Medical Examiner Cases
9.1
On all abdominal only organ recoveries that are ME/Coroner cases, the surgeon will not open or enter the chest cavity.

CORE
Policies and Procedures
POLICY #: GP 004
MANUAL: General Procurement
REVIEWER(S): Director Regulatory
Affairs & Laboratory Services, Chief
Operating Officer, Director of Clinical
Operations
PAGE 8 OF 8
ORIGINAL POLICY DATE: 10/96
REVISION DATE: 08/06, 04/13/10,
09/08/10, 5/19/11, 8/04/11
POLICY NAME: Preserving Evidence for
Coroner/Medical Examiner
10.0
APPROVAL DATE:05/04/10, 10/26/10,
6/1/11, 8/9/11
IMPLEMENTATION DATE:05/14/10, 11/8/10,
6/24/11, 8/22/11
Coroner/Medical Examiner Communication with Surgeon
10.1.1
The OPC will ask the medical examiner office if they are requesting that the surgeon speak directly to the pathologist prior to recovery.