Coroners and medical examiners counter they must balance the need for an unblemished death investigation against the importance of organ donation. In cases of murder or child abuse, some say, they don't want to complicate autopsies or potential trials. Determining an accurate cause of death also affects families financially - some life insurance policies pay more when a death is ruled accidental. Some of the strongest support for organ donation, though, has come from the Office of the Chief Medical Examiner in Chapel Hill. For years, Chief John Butts has encouraged medical examiners to work with organ groups, but says he has little control over the more than 530 examiners in North Carolina.
Inconsistencies affect far more than organ donations.
A recent Observer investigation found some busy county medical examiners seldom investigate death scenes or they order autopsies infrequently, even in cases of suspicious deaths. In South Carolina, the policies and practices of elected coroners also vary. No statistics are kept on the number of people waiting for tissue, but doctors say the need is chronic. Faced with shortages, donation groups nationwide are appealing to death investigators for more flexibility. The American Red Cross, which coordinates one-fifth of the nation's tissue donation, formed a national advisory committee to build stronger relationships with medical examiners and coroners.