OSAC 2023-N-0004 Standard for Interactions Between 

Medical Examiner, Coroner and all other Medicolegal Death 

Investigation Agencies and Organ and Tissue Procurement 

Organizations and Eye Banks

1

OSAC 2023-N-0004

Standard for Interactions Between

Medical Examiner, Coroner and all

other Medicolegal Death 

Investigation Agencies and Organ 

and Tissue Procurement 

Organizations and Eye Banks

Medicolegal Death Investigation Subcommittee 

Medicine Scientific Area Committee 

Organization of Scientific Area Committees (OSAC) for Forensic 

Science 
OSAC 2023-N-0004 Standard for Interactions Between 

Medical Examiner, Coroner and all other Medicolegal Death 

Investigation Agencies and Organ and Tissue Procurement 

Organizations and Eye Banks

2

OSAC Proposed Standard

OSAC 2023-N-0004 Standard for 

Interactions Between

Medical Examiner, Coroner and all 

other Medicolegal Death 

Investigation Agencies and Organ 

and Tissue Procurement 

Organizations and Eye Banks

Prepared by 

Medicolegal Death Investigation Subcommittee 

Version: 2.0 

March 2023

Disclaimer:

This OSAC Proposed Standard was written by the Organization of Scientific Area Committees (OSAC) 

for Forensic Science following a process that includes an open comment period. This Proposed Standard 

will be submitted to a standards developing organization and is subject to change. 

There may be references in an OSAC Proposed Standard to other publications under development by 

OSAC. The information in the Proposed Standard, and underlying concepts and methodologies, may be 

used by the forensic-science community before the completion of such companion publications.

Any identification of commercial equipment, instruments, or materials in the Proposed Standard is not a 

recommendation or endorsement by the U.S. Government and does not imply that the equipment, 

instruments, or materials are necessarily the best available for the purpose.
OSAC 2023-N-0004 Standard for Interactions Between 

Medical Examiner, Coroner and all other Medicolegal Death 

Investigation Agencies and Organ and Tissue Procurement 

Organizations and Eye Banks

3

Foreword 

This standard addresses relationships and communication among Medical Examiner, Coroner 

and all other Medicolegal Death Investigation agencies, and organ, eye, and tissue procurement 

and processing agencies to improve processes and enhance mutual understanding around organ, 

eye and tissue donation. The following communication standard was developed to preserve the 

integrity of medicolegal death investigations, while balancing the needs of organ, eye, and tissue 

procurement and processing agencies, which include quality, safety, transparency, consistency, 

and timeliness. 

The following definitions apply to this document: 

the term ‘shall’ indicates that a provision is mandatory, and can be audited for compliance. 

the term ‘should’ indicates that a provision is not mandatory, but recommended as best 

practice. 

All hyperlinks and web addresses shown in this document are current as of the publication date 

of this standard. 

 

Keywords: medicolegal death investigation, organ donation, organ procurement, tissue donation, 

eye donation, autopsy, Uniform Anatomical Gift Act, transplant, forensic, coroner, medical 

examiner, brain death, cardiac death, donation after cardiac death 
OSAC 2023-N-0004 Standard for Interactions Between 

Medical Examiner, Coroner and all other Medicolegal Death 

Investigation Agencies and Organ and Tissue Procurement 

Organizations and Eye Banks

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Table of Contents 

Foreword 3

1 Scope 5

4 Requirements 8

Annex A 13

Informative References 13
OSAC 2023-N-0004 Standard for Interactions Between 

Medical Examiner, Coroner and all other Medicolegal Death 

Investigation Agencies and Organ and Tissue Procurement 

Organizations and Eye Banks

5

Standard for Interactions Between Medical Examiner, Coroner and all other Medicolegal Death 

Investigation Agencies and Organ and Tissue Procurement Organizations and Eye Banks 

1 Scope 

This document is a standard for relationships and communication among Medical Examiner, 

Coroner and all other Medicolegal Death Investigation Offices and organ, eye, and tissue 

procurement and processing agencies. This document will not specifically address issues that 

may arise with respect to donation in the context of a mass fatality event. 

2 Normative References

There are no normative references. Informative references are included at the end of this 

document. 

3 Terms and Definitions

For purposes of this document, the following definitions apply. 

3.1 

autopsy

Postmortem diagnostic medical procedure conducted by a pathologist, consisting of external and 

internal examination of a decedent, and may include other ancillary tests 

3.2 biospecimen 

Any biological specimen derived from a decedent 

3.3 cause of death

Medical opinion of the disease or injury that resulted in a person’s death 

3.4 chief medicolegal 

officer 

Medical examiner, coroner, justice of the peace, or other official who oversees the operation of a 

medicolegal death investigation office and/or system 

3.5 coroner 

Elected or appointed official responsible for overseeing medicolegal death investigations, usually 

for a single county, and for certifying the cause and manner of death in these investigations; 

duties vary based on local enabling statutes 
OSAC 2023-N-0004 Standard for Interactions Between 

Medical Examiner, Coroner and all other Medicolegal Death 

Investigation Agencies and Organ and Tissue Procurement 

Organizations and Eye Banks

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3.6 external 

evaluation 

Physical assessment of the decedent by a medicolegal death investigator

3.7 external examination

Diagnostic medical procedure conducted by a pathologist that consists of physical inspection of 

the decedent without internal examination; can include ancillary tests 

3.8 eye bank (eye recovery organization)

Entity that provides or performs one or more eye banking functions involving ocular tissue from 

living or deceased individuals for transplantation, research, and/or educational purposes and is 

licensed, accredited, or regulated under federal or state law to engage in the recovery, screening, 

testing, processing, storage, or distribution of human eyes or portions of human eyes 

3.9 first person consent donors 

First Person Authorization makes the indication of an adult's intent to donate some or all organs 

and/or tissue via a driver's license, a donor card, or other documents legally binding 

3.10 forensic autopsy

Autopsy authorized by law and typically performed under the jurisdiction of a medical examiner 

or coroner for criminal justice, civil, and/or public health purposes

3.11 forensic pathologist 

Physician who is board-certified in forensic pathology by an accredited credentialing body; 

currently American Board of Pathology and American Osteopathic Board of Pathology

3.12 jurisdiction 

(1) Legal authority to make legal decisions and judgments regarding a death, including 

performance of autopsy, as well as investigation and certification of cause and manner of 

death 

(2) Geographic area in which a medical examiner or coroner’s authority applies 

3.13 manner of death

Classification system based on the circumstances under which death occurred; usually consists of 

accident, homicide, natural, suicide, and undetermined. These manners of death are then used for 

public health and vital statistics purposes 

3.14 medical examiner

Appointed forensic pathologist whose duty is to oversee medicolegal death investigations, 

perform postmortem examinations, and certify cause and manner of death. In some jurisdictions, 
OSAC 2023-N-0004 Standard for Interactions Between 

Medical Examiner, Coroner and all other Medicolegal Death 

Investigation Agencies and Organ and Tissue Procurement 

Organizations and Eye Banks

7

individuals with other qualifications hold the title “Medical Examiner”, but for purposes of this 

document those individuals are considered medicolegal death investigators 

3.15 medicolegal death investigation

Formal inquiry into the circumstances surrounding the death of a human being; investigative 

information is considered with autopsy findings and adjunctive studies (if performed) to 

determine the cause and manner of death

3.16 medicolegal death investigation authority 

Person or persons whose duty it is to perform medicolegal death investigations for a designated 

jurisdiction, and ensure certification of cause and manner of death; duties vary based on local 

enabling statutes

3.17 medicolegal death investigation office

Physical location of an agency (usually a medical examiner or coroner office) with the authority 

to perform medicolegal death investigations

3.18 medicolegal death investigator 

Individual who has completed the requirements for Certification (Registry or Board) by an 

accredited credentialing body or performs medicolegal death investigations

3.19 next of kin

Legally determined hierarchy of interested parties who have authority over the decedent 

3.20 organ procurement organization (OPO) 

Organization that engages in various aspects of organ donation and recovery and supports organ 

placement within their federally designated service area and the transportation of organs to other 

regions. An OPO may also function in areas of tissue recovery, tissue banking, eye recovery, and 

eye banking. The OPO works with transplant centers and the United Network of Organ Sharing 

(UNOS) to appropriately place organs with patients awaiting a transplant 

3.21 tissue procurement organization (TPO) (tissue recovery organization, tissue bank) 

Organization that engages in various aspects of tissue donation and is licensed, accredited, or 

regulated under federal or state law to engage in the recovery, screening, testing, processing, 

storage, or distribution of tissue 

3.22 universal anatomical gift act (UAGA) 

One of the Uniform Acts drafted by the National Conference of Commissioners on Uniform 
OSAC 2023-N-0004 Standard for Interactions Between 

Medical Examiner, Coroner and all other Medicolegal Death 

Investigation Agencies and Organ and Tissue Procurement 

Organizations and Eye Banks

8

State Laws (NCCUSL), also known as the Uniform Law Commission (ULC), in the United 

States with the intention of harmonizing state laws between the states. The UAGA governs 

organ donations for the purpose of transplantation 

4 Requirements 

4.1 Medical Examiner, Coroner and all other Medicolegal Death investigation agencies 

(MEC/MDI) shall cooperate and communicate with organ, eye, and tissue procurement and 

processing agencies to facilitate availability of donated organs and tissues. Likewise, organ, 

eye, and tissue procurement and processing agencies shall work to preserve MEC/MDI evidence 

to aid in determining cause and manner of death. This may include, but is not limited to, 

forensic, scientific, and medical information, documentation, and samples/specimens as 

required for a forensic autopsy and medicolegal death investigation. 

4.2 MEC/MDI shall ensure processes are available for sharing information, including referral, for 

potential tissue and eye donors by MEC/MDI when deaths occur outside of hospitals and other 

referring institutions. 

4.3 The interactions between MEC/MDI and organ, eye, and tissue procurement and processing 

agencies shall be guided by written agreements/memorandums of understanding 

(MOU) among the MEC/MDI and organ, eye, and tissue procurement and processing agencies. 

4.4 Factors to consider when creating an MOU include the standards of the organ, eye, and tissue 

procurement and processing agencies, recognized medicolegal death investigation guidelines and 

standards, and any applicable local, state, and federal regulatory authorities. 

4.5 This agreement or MOU shall address the following: 

a) Procedures for notifying the MEC/MDI or their representative of potential tissue, eye, or 

organ donation cases falling under the jurisdiction of the MEC/MDI. 

b) How the issues of restrictions will be negotiated and resolved. 

c) Necessary specimens to be obtained, retained, and documented (including chain of 

custody issues). 

d) Acceptable documentation to include medical imaging, photographs, procedures, and 

description of the body. 

e) Proper authorization for procurement. 

f) Handling of next-of-kin communications, to include sequence of next of kin notification 

of death and eligibility, first person consent, next of kin consent, and MEC/MDI 

authorization. 

g) Location of procurement and resolution of related jurisdiction issues. 
OSAC 2023-N-0004 Standard for Interactions Between 

Medical Examiner, Coroner and all other Medicolegal Death 

Investigation Agencies and Organ and Tissue Procurement 

Organizations and Eye Banks

9

h) Transportation of remains. 

i) Relevant training and education for both the MDI authority and OPO/TPO. 

j) Timing of procurement. 

k) Any potential fees, costs or payment. 

l) Liability and insurance issues. 

m) Privacy and confidentiality concerns. 

n) Processes for referral of potential tissue and eye donors by MEC/MDI when deaths occur 

outside of hospitals and other referring institutions. 

o) Resolution of identification issues. 

p) Reports and/or residual tissue or specimens from consultations or additional studies. q)

Timeliness of reports. 

r) Access to decedent. 

s) Personnel who are the designated liaison or point of contact from each agency. 

t) Scenarios in which restrictions may apply. 

u) The issue of potential competing contracts for tissue procurement in cases in which an 

individual dies in a hospital and falls under the jurisdiction of the MEC/MDI. 

v) How jurisdiction will be handled in cases of transportation to an organ or tissue recovery 

center across jurisdictional boundaries, in anticipation of donation after cardiac death. 

4.6 Organ, eye, and tissue procurement shall be allowed to take place in an expeditious 

manner that addresses the needs of both the MEC/MDI and organ, eye, and tissue procurement 

and processing agencies. Recovery of tissue should occur prior to autopsy, thereby reducing 

potential for contamination, unless evidence preservation, staffing issues, or other compelling 

circumstances exist. 

4.7 The option of performing an external inspection or examination by the MEC/MDI or 

their representative shall be provided to the MEC/MDI prior to procurement. Trace evidence 

may be collected at this time and fingerprints and/or photographs may be taken. Time limits for 

organ/eye/tissue shall be considered. If requested, the MEC/MDI, or representative, shall be 

allowed to attend the procurement. 

4.8 The MEC/MDI shall request any necessary additional procedures or testing be 

performed prior to procurement. Examples include, but are not limited to, full body 
OSAC 2023-N-0004 Standard for Interactions Between 

Medical Examiner, Coroner and all other Medicolegal Death 

Investigation Agencies and Organ and Tissue Procurement 

Organizations and Eye Banks

10

photography, skeletal trauma survey, whole body computed tomography, special laboratory 

testing, organ biopsy specimens and/or interpretation, and coronary angiogram. 

4.9 Samples for toxicological analysis shall be collected by the procurement agency for the 

MEC/MDI when requested. Such specimens shall be taken in accordance with the 

MEC/MDI’s requested practices and procedures and labeled as to name/unique identifier, date, 

time and site from which obtained. Blood specimens from the body of the decedent shall 

include femoral vein blood whenever possible. The procurement agency shall document and 

notify the MEC/MDI if any drugs, such as papaverine, were used in the procurement process. 

All agreed upon body fluid samples shall be returned to the MEC/MDI. Admission blood and

urine, or samples from the earliest dates in the hospital laboratory shall be reserved for 

toxicological analysis by the MEC/MDI except for the minimal amount necessary for 

infectious disease testing by the procurement agencies; this may include agreements to 

proactively retain samples prior to involvement of the MEC/MDI. Procurement agencies shall 

share testing results to minimize the amount of blood needed for testing. 

4.10 Samples for blood and other cultures shall be collected by the procurement agency for 

the MEC/MDI when requested. Such specimens shall be taken in accordance with the 

MEC/MDI’s requested practices and procedures and labeled as to name/unique identifier, date, 

time and site from which obtained. 

4.11 At the time of procurement, detailed notes and photographs shall be taken and provided 

to the MEC/MDI describing any evidence of injury or disease encountered during the 

procedure. Any deep venous thrombi or pulmonary thromboembolic encountered shall either 

remain in situ or be photographed, collected, and submitted with the body to the MEC/MDI. 

The procurement agency shall notify the MEC/MDI immediately if other abnormalities (such 

as hemopericardium) are found during the procurement procedure and await further 

direction/instruction by the MEC/MDI. Telemedicine / video calls may allow real time 

intraoperative consultation with the forensic pathologist. 

4.12 If whole organs are recovered/procured, such as the heart or kidney, the MEC/MDI 

shall be provided with a report and potentially photographs and microscopic slides, describing 

said organs as mutually agreed upon. When requested, the entire remainder of the heart tissue 

shall be returned to the MEC/MDI for examination. In all other cases the heart tissue shall be 

referred to a cardiac pathologist of the MEC/MDI’s choosing for complete assessment; the 

expense shall be paid by the TPO. All reports generated shall be routed to the MEC/MDI of 

record in a timely manner. If any frozen sections, biopsies, or other diagnostic procedures are 

performed during procurement, a copy of the pathology report shall be provided to the 

MEC/MDI. 

4.13 If an organ is removed and subsequently not transplanted, the non-transplanted organ 

shall be returned to the MEC/MDI, when requested. If not requested, the disposition of the 

organ shall be provided in writing to the MEC/MDI. 
OSAC 2023-N-0004 Standard for Interactions Between 

Medical Examiner, Coroner and all other Medicolegal Death 

Investigation Agencies and Organ and Tissue Procurement 

Organizations and Eye Banks

11

4.14 If a lesion, suspicious for occult malignancy, infection or other conditions that may 

affect potential recipients, is discovered during autopsy or external examination, these findings 

shall be communicated to the organ procurement/tissue agency in a timely manner. This 

information is vital to those making decisions related to surveillance of organ recipients and to 

prevent release of unsuitable tissues. 

4.15 In cases of declaration of death by circulatory criteria (Donation after Cardiac Death) 

under MEC/MDI jurisdiction, arrangements are made for rapid procurement of organs after 

cardiac arrest. The MEC/MDI or their representative shall be notified by the organ 

procurement organization as early as possible and prior to or upon next of kin consent for 

donation, so that efficient and timely medicolegal investigation can take place. An effort shall 

be made to allow the MEC/MDI investigation to occur prior to death pronouncement. 

4.16 The goal of MEC/MDI agencies shall be to allow procurement in all cases. 

Restrictions of individual organs or tissues from procurement shall occur only when 

procurement of those organs/tissues would impede the investigation of cause of death, destroy 

physical evidence, or potentially compromise the ability to accurately determine the cause and 

manner of death; such cases have been reported. Resolution of investigative concerns may be 

possible to allow for some donation, even if procurement is limited. Some examples of 

reasonable restrictions of preautopsy procurement might include: restriction of skin 

procurement or organ procurement related incisions when patterned injuries are present 

requiring further documentation and examination; lower extremity long bone procurement in 

pedestrian fatalities with bumper fractures that may aid in identifying a vehicle; specific organ, 

eye, or skin procurement in child abuse or restraint/in-custody deaths; and eye/corneal 

procurement in strangulation homicides. 

Skin, bone, and eye procurement would still be possible in most cases following autopsy. 

Complete denials of procurement should be rare, occurring in complicated and select cases only. 

4.17 Regarding first person consent donors, it is important to recognize that these 

individuals may have special status regarding authorization of procurement. MEC/MDI 

professionals shall familiarize themselves with the laws in their state of jurisdiction regarding 

this special case. 

4.18 MEC/MDI agencies shall have a policy that proactively addresses and minimizes 

potential or perceived conflicts of interest regarding relationships with OPO/TPOs. Potential 

conflicts include but are not limited to secondary employment of an MEC/MDI employee by 

an OPO/TPO; positions resulting in a personal financial relationship with the OPO/TPO; gifts 

or monetary donations; or positions of decision-making such as Board of Directors of an 

OPO/TPO. Advisory roles without compensation are often appropriate but shall be addressed 

within individual jurisdictions. 

4.19 It may be beneficial for continuing education presentations to be made by MEC/MDI 

staff to OPO/TPO staff, and vice versa. Topics might include pathologic findings which may 
OSAC 2023-N-0004 Standard for Interactions Between 

Medical Examiner, Coroner and all other Medicolegal Death 

Investigation Agencies and Organ and Tissue Procurement 

Organizations and Eye Banks

12

be discovered during procurements and be of interest to the forensic pathologist, or the steps 

required of OPOs prior to procuring organs (which explains timeframes and challenges faced). 
OSAC 2023-N-0004 Standard for Interactions Between 

Medical Examiner, Coroner and all other Medicolegal Death 

Investigation Agencies and Organ and Tissue Procurement 

Organizations and Eye Banks

13

Annex A 

Informative References 

Uniform Anatomical Gift Act 2006 [Internet]. Uniform Law Commission. [cited 2022 Sep 15]. 

Available from: 

https://www.uniformlaws.org/committees/communityhome?attachments=&communitykey=015

e18ad-4806-4dff-b011-

8e1ebc0d1d0f&libraryentry=38015d5a-bcef-4944-9e49-

555ffbd21c37&pageindex=0&pagesize=12&search=&sort=most_recent&viewtype=card.

Anatomical Gifts Act [Internet]. airSlate Legal Forms, Inc. c2017-2022. [cited 2022 Sep 15]. 

Available from: https://uniformacts.uslegal.com/anatomical-gifts-act/.

Standards for Interaction Between Medical Examiner/Coroner Offices and Organ and Tissue 

Procurement Organizations and Eye Banks [Internet]. Scientific Working Group for 

Medicolegal Death investigation c2013. [cited 2022 Sep 19]. Available from: 

https://www.swgmdi.org/images/organ1.standardsforme.c.opo.eyebankinteractions.published620

-13.pdf . 

Pinckard JK, Wetli CV, Graham MA. National Association of Medical Examiners position

paper on the medical examiner release of organs and tissues for transplantation. Am J Forensic 

Med Pathol. 2007 Nov; 28(3):202-207. 

Pinckard JK, Geiselhart RJ, Moffatt E, et al. National Association of Medical Examiners 

Position Paper: Medical Examiner Release of Organs and Tissues for Transplantation. Acad 

Forensic Pathol. 2014 Dec ; 4(4): 497-504. 

Centers for Medicare and Medicaid Services, Department of Health and Human Services. 42 

Medicare and Medicaid Programs; Conditions for Coverage for Organ Procurement 

Organizations (OPOs) [Internet]. CFR Parts 413, 441, 486 and 498; 2006 May 31 [cited 20 Sep 

2022]. Available from: https://www.cms.gov/Regulations-and-Guidance/RegulationsandPolicies/QuarterlyProviderUpdates/Downloads/cms3064f.pdf .

Position Statement: Medical Examiner Release of Organs and Tissues for Transplantation 

[Internet]. National Association of Medical Examiners 2019. [cited 2022 Sep 19]. Available 

from: 

https://www.thename.org/assets/docs/Organ%20and%20Tissue%20Statement%20July%202019. 

pdf. 
OSAC 2023-N-0004 Standard for Interactions Between 

Medical Examiner, Coroner and all other Medicolegal Death 

Investigation Agencies and Organ and Tissue Procurement 

Organizations and Eye Banks

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International Association of Coroners and Medical Examiners, IACME Accreditation Standards, 

A10. 2022. http://iacme.orainc.com 

NAME Inspection and Accreditation Checklist [Internet]. National Association of Medical 

Examiners 2018. [cited 2022 Sep 19]. Available from: 

https://name.memberclicks.net/assets/docs/NAME%20Accreditation%20Checklist%202019%20 

-%202024%203%2018%202022.pdf

Wolf DA, Derrick SM. Undetermined Cause and Manner of Death After Organ/Tissue 

Donation. Am J Forensic Med Pathol. 2010 Jun; 31(2):113-116. 

Shafter T, Schkade LL, Warner HE, et. al. Impact of Medical Examiner/Coroner Practices on 

Organ Recovery in the United States. JAMA 1994 Nov; 272(20):1607-1613.