Organ procurement in forensic deaths: A retrospective analysis of the Italian context with a focus on the Puglia Region virtuous experience

• Published in: Journal of forensic and legal medicine Vol. 102; p. 102657
• Main Authors: Sablone, Sara, Musajo Somma, Chiara, Ruta, Federico, Bellino, Mara, Ciciriello, Tommaso, Saracino, Michele, Attimonelli Petraglione, Riccardo, Michelangeli, Giampiero, Gianelli Castiglione, Andrea, Cardillo, Massimo, Introna, Francesco, Gesualdo, Loreto
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.02.2024
• Subjects: Autopsy; Cadaver; Forensic autopsy; Forensic deaths; Humans; Medico-legal expertise; Organ procurement; Organ transplantation; Retrospective Studies; Tissue and Organ Procurement; Tissue Donors; Forensic autopsy; Organ procurement; Organ transplantation; Medico-legal expertise; Forensic deaths
• ISSN: 1752-928X; 1878-7487
• DOI: 10.1016/j.jflm.2024.102657

Organ transplantation is one the most important contributions of modern medicine to society since it provides a unique therapy for terminal organ failure. However, the development of this therapeutic approach is hindered by the limited organ supply. In Italy, organ procurement requires a multidisciplinary medical-surgical approach in which legal medical doctors (LMDs) are generally tasked with ascertaining the reality of death. Sometimes, a medico-legal report is required when the deceased's family deny their consent to the organs and tissues removal from a potential deceased donor. LMDs can also be appointed by law to carry out post-mortem examinations of potential deceased donors. In these cases, the public prosecutors' interest in preserving the corpse integrity for forensic purposes seems to conflict with the ethical-humanitarian interest in promoting, at most, the opportunity to donate; however, a LMD can act as a mediator and allow both goals. This paper aims to illustrate the Apulia Region experience in reconciling the justice interests with those of a culture promoting deceased organ and tissue donation. It has been pursued by analyzing the virtuous regional organ procurement trend in forensic deaths before and after a crucial 2015 initiative, comparing the results with the national ones, and contextualizing them in the relevant literature to show systemic strengths and weaknesses and inform future Italian policy development. •Organ procurement requires a multidisciplinary medical-surgical approach.•Medical-legal expertise is crucial in organ procurement involving forensic deaths.•Forensic investigations only apparently odd with the organ donation culture.•International guidelines are advisable to combine organ donation with justice interests.