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Jeremy Davis' Gift 

In New Orleans, the coroner's duty to investigate causes of death often halts timely organ donations. Why is that not a problem elsewhere?

It was the most horrible day any parent could imagine: the day one of your children dies. Sherry Davis's fourth-oldest child, 23-year-old Jeremy Davis, was a caring and compassionate young man. A first-time mental health patient, Davis was being transferred in an ambulance from one hospital to another Aug. 8, when he fell out of the vehicle. Early the next morning, he lay in a University Hospital bed, on life support, and his mother was asked if she would consider donating her son's organs.

Sherry was ready for this; she knew what her son would have wanted. He had dedicated his life to helping others. As a counselor at Camp Challenge, a camp for kids with cancer or blood disorders, this would be his last act of charity. For Sherry, it meant that, in a sense, her boy would live on.

"Even though his body would be gone," says Michelle Davis, Jeremy's sister, "he would still be walking the earth. It gave my mother comfort."

Her relief was fleeting. She gave her consent for the organ donation, but hours later the Orleans Parish Coroner's Office shut down the donation procedure, saying that Jeremy Davis' case required a full autopsy, which precludes organ harvesting.

The Louisiana Organ Procurement Agency (LOPA) alleges that Jeremy Davis' case represents the eighth time this year that the coroner's office needlessly blocked an organ donation. The coroner says a full autopsy was needed to determine the cause of Davis' death.

Such disputes have soured a normally good relationship between LOPA and the coroner's office, with experts lining up on both sides and the organ procurement agency suggesting that legislation might be the only way to resolve the problem.

Dr. Stacy Drury, a psychiatrist who worked with Jeremy at the camp and who was at University Hospital assisting the Davis family, says Orleans Parish Coroner Dr. Frank Minyard had given LOPA permission to initiate the donation procedure on the morning after Jeremy Davis' death (Aug. 9). However, Minyard later instructed his chief investigator, John Gagliano, to stop the organ donation. Minyard says he had no choice: Davis' cause of death seemed fairly obvious at first -- a closed head injury -- but only a complete autopsy would certify that conclusion. In addition, the circumstances that led to the young man's death -- Did he fall out of the ambulance, did he jump, or was he pushed? -- had yet to be determined.

LOPA spokesperson Chris McCrory says that Minyard's refusals to release organs for transplant operations are unnecessary, because pathologists can use other methods to determine or rule out certain causes of death, such as photographic documentation, that would facilitate organ transplants. McCrory says other coroners use those methods.

According to LOPA, 158 people in Louisiana die each year awaiting organ transplants. Dr. George Loss, a transplant surgeon with Ochsner Health System, agrees with McCrory and says he can't understand why Minyard needed Davis' entire body to determine how he died.

"The question is did he jump or fall, but I don't know what that has to do with his liver," Loss says.

Davis' case and others have prompted the National Association of Medical Examiners (NAME) to issue a paper clarifying its stance on organ procurement. NAME says that most organ and tissue donations -- at least 70 percent -- must first be approved by a coroner, who must determine the cause of death of the potential donor. Often the cause of death and how it happened are clear and an autopsy isn't performed. However, Minyard says, whenever a death involves a criminal or civil case, a "complete autopsy" must be performed.

What constitutes a complete autopsy is where NAME and Minyard, who is a member of the organization, disagree.

The organization's position is clear: "It is the position of the National Association of Medical Examiners that the procurement of organs and/or tissues for transplantation can be accomplished in virtually all cases without detriment to evidence collection, postmortem examination, determination of cause and manner of death, or the conducting of criminal or civil legal proceedings." Minyard says that's "baloney" and dismisses with a terse "no" the idea that some organs, instead of being removed and tested, can simply be photographed.

Jefferson Parish's coroner, Dr. Robert Treuting, supports the NAME viewpoint. He notes that the position paper also reports that there has never been a case where organ procurement interfered with a criminal investigation, a prosecution, a defense, or determining the cause or manner of death via an autopsy. He says that he has denied some organs for transplantation, but only when those organs related directly to his investigation.

"My policy is 100 percent organ donation, especially with major organ donations, which can save someone's life," Treuting says.

Treuting adds that testing organs that are not related to the cause of death wrongly destroys that body part. "It's an absolute waste of resources that could keep people living," Treuting says.

Minyard says he doesn't care what coroners do elsewhere. It is his legal responsibility to ascertain the cause of death -- and that requires a complete autopsy.

"Being the coroner in a city like this, especially a city that has problems with crime, we cannot afford not to do a full autopsy on every criminal case that comes up," Minyard says. "We can't afford to let some perpetrator get off because we haven't done a complete autopsy."

Dr. Randolph Williams, Winn Parish's coroner and the president of the Louisiana State Coroner's Association, defends Minyard's rationale for complete autopsies. Williams says LOPA doesn't understand that a coroner's office is a "criminal investigative agency/law enforcement agency" and is not directly involved with public health. Williams says coroners don't want to deny organ transplantations, but sometimes they have to.

"No coroners are opposed to organ transplantations and procurement, but you have to protect the integrity of the criminal justice system itself," Williams says. "They (organ procurement agencies) are not the angels of life and mercy and the bad ol' coroners are not the devil or angel of death."

Williams claims that the practice of photographing body parts and then allowing organs to be harvested has led to problems "across the river" from New Orleans. When asked if he is referring to Jefferson Parish, Williams replies, "Essentially. I don't want to point fingers at anybody because there's been enough of that going on. We're aware of things that haven't made the papers."

Williams declined to clarify what those "things" are, but Jefferson Parish's Treuting says he is willing to answer any accusations of problems arising from using photography during an autopsy in order to preserve organs for transplantation. "To my knowledge, and I've been coroner for the last 20 years, that's absolutely false," Treuting says.

One thing that these three Louisiana coroners agree on is they don't want legislation regulating organ and tissue donation and coroners' investigations. In Mississippi, for example, a coroner cannot block organ procurement even when the medical examiner determines that an organ is necessary for an investigation. In such cases, the coroner can only "be present while the organs and/or tissues are removed for the purpose of transplantation."

If Louisiana were to adopt such a law, coroners say, criminals could avoid jail time. Minyard says that one of his pathologists, Dr. Paul McGarry, who also performs autopsies in Mississippi, claims this already happened.

"He told me there have been a couple of cases where (someone) has gotten off because he (McGarry on the witness stand) was asked one question and one question alone: 'Doc, did you examine the heart of Mr. So-and-so, who had the gunshot wound to the head?' And he said, 'No, it was a transplant.'"

However, Sam Howell, Mississippi's acting state medical examiner, says that hasn't happened in his state. At least, not yet.

"Right now we've come to the understanding with the procurement people that if the need to autopsy outweighs the transplant, then the complete autopsy takes precedence," Howell says. "The greater public interest will outweigh those of the few."

LOPA's McCrory says his agency supports some sort of legislation "that would prevent the wholesale denial of organ donation." LOPA wanted lawmakers to pass a bill addressing its concerns during this year's legislative session. When state Rep. Charles Lancaster (R-Metairie) incorporated some but not all of LOPA's ideas into his House Bill 888, LOPA abandoned its legislative effort -- for now. McCrory says Treuting has agreed to discuss new legislation with the organization, but Treuting warns that he will not "look at anything that's going to impinge upon the responsibility and authority of the coroner."

Despite the differences of opinion between Minyard's office and LOPA, Minyard is unequivocal in his praise for the procurement agency. He feels LOPA is doing a "great job" and he says he has no written policy about autopsies and organ donations. "My policy is we give everything to LOPA that we can possibly give," Minyard says.

As of late last week, Jeremy Davis' death remained unsolved. Minyard says he will interview the ambulance driver and the attendant, and he hopes to get some answers as to how the young man died. Michelle Davis hopes that someone traveling on the interstate that tragic day saw her brother fall. She asks potential witnesses to contact her at 606-0290 and leave any information on her voicemail.

She adds one final request on behalf of her brother: "And please become an organ donor -- that was his gift."

click to enlarge "There has never been a case where organ procurement - interfered with a criminal investigation, a prosecution, a - defense, or determining the cause or manner of death - via an autopsy." -  - NAME position paper
  • "There has never been a case where organ procurement interfered with a criminal investigation, a prosecution, a defense, or determining the cause or manner of death via an autopsy."
    NAME position paper
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