Coroners in Catalonia Also Work as Tissue Donors: Leading in Transplants and Low Refusal Rates

Few people know it, but on the floor except one of the Institute of Legal Medicine and Forensic Sciences of Catalonia (IMLCFC), in addition to autopsies y recognition of corpses, coroners are also engaged in tissue removal with those that are later made transplants. In fact, this institution, attached to the Ministry of Justice, Rights and Memory, is the first center in Catalonia for obtaining musculoskeletal tissue, cardiovascular vessels and skin. Their work is added, thus, to that already carried out by the hospitals, and all together they place Catalonia not only as a world leader in transplants, but also as one of the regions with less refusal to give

Unlike what happens in hospitals, all the corpses that enter the Institute of Legal Medicine They do not have a death certificate. That’s why you have to make one autopsy: why the cause of death is unknown. “Alone here [en la sede del organismo en la Ciutat de la Justícia, en Barcelona] we make about 3,000 autopsies a year. Throughout Catalonia, we do more than 4,000 [el IMLCFC tiene seis divisiones en todo el territorio]”, points out Marisa Ortega, head of the Forensic Pathology Service from the high school.

In addition to leader in obtaining musculoskeletal tissue, vessels and skin for transplantation, the IMLCFC is the fourth Catalan center that has the most horniness obtained, behind the hospitals of Bellvitge, Vall d’Hebron and Clínic. Last year, medical examiners extracted tissue from 170 cadavers of the total 3,292 they examined. This is the It him 5% were donors, while the rest were mostly discarded due to clinical contraindications o because too many hours have passed from the moment of death. The IMLCFC has made public this Friday these figures on the occasion of the International Organ and Tissue Donor Day. According to studies from past years, 100% of families would donate again. “to many helps them to overcome the grief”, says this medical examiner.

“Los criteria to be tissue donor is that the person has died in the last 24 hours and do not suffer no contagious or oncological disease”, continues explaining Ortega. Precisely these criteria made tissue extractions at the IMLCFC totally paralyzed during the first months of the covid-19 pandemic, “as a precaution”. It’s been three years since all this and the organism has returned to pre-pandemic figures of extractions and has even exceeded them.

Of the 170 corpses who were donors last year (and taking into account that the same corpse can be multidonor), the coroners got 167 cornea donations, 100 musculoskeletal tissue donations (bones, joints, menisci and tendons), two valve donations, 30 vessel donations and 97 skin donations. Regarding the data for the year 2021, the institution registered significant increases in donations of vases (66.6% more), from fur (34.7% more) and musculoskeletal tissue (25% more). These donations are especially important because Catalonia is deficient in some fabrics, as valves and corneas.

Natural and violent deaths

He 60% of corpses which bequeathed to the Institute of Legal Medicine and Forensic Sciences of Catalonia suffered one natural death, principally for cardiovascular reasons. In the remaining 40% the causes are violent. Here the deaths in which there was a third person come into play (homicides or murders: the IMLCFC registers about 50 a year, a very low figure), traffic, work and domestic accidents, drowning and suicides. “These are the big groups out there and we have to do autopsies by law,” says Eneko Barbería, director of the IMLCFC.

Both he and Dr. Ortega explain that sometimes deaths occur “suddenly” in individuals “relatively young”. “When a rapid and unexpected death occurs in a healthy individual, we have to analyze the death to find out the cause. Here We look to see if there are causes of death that we can prevent,” points out Ortega, who highlights how, in this sense, the IMLCFC contributes “doctors and information” to work in the “preventive medicine”.

Activity since 2016

The Institute of Legal Medicine performs this tissue extraction service (to later be transplanted) since 2016, when he signed an agreement with the Catalan Health Service (CatSalut), he Blood and Tissue Bank (which stores all those tissues obtained), he Clinical Hospital of Barcelona and the Medical Emergency System (SEM). The IMLCFC began by extracting ocular tissue (corneas), but in 2017 the professionals also incorporated the obtaining of other types of fabrics (skin, bones, tendons, arteries and heart valves). Since then, forensics have recorded more than 1,800 donations.

“The donation is important and, in addition, does not influence the autopsy”, Ortega account. The agency he works for only removes tissue, but does not transplant, work that corresponds to hospitals. This tissue extraction is performed in the necrooperating room of the institution.

A notice from the EMS

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Tissue procurement begins with a EMS notice for the death of a person, For example, on the street. Next, a nurse ‘Donor Center’, located at the IMLCFC headquarters, a first assessment of the donor. that nurse is Pedro shines. “If you meet the medical requirements, I call relatives because we need family consent”, account. If the family decides that the donation goes ahead, the Coordination with the coroner on duty and judicial authorization.

Once these requirements are met, the extractor team on duty moves to the operating room of the City of Justice to carry out the extraction, always in agreement with the coroner responsible for the autopsy. As Barbería points out, the donation is a “altruistic, generous act”, at a “very difficult time for the family”. And, despite this, these professionals stand out, most of them give their approval.