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FORENSICs CONNECTIONS A REPORT ON ILLINOIS FORENSIC PERFORMANCE IN ORGAN AND TISSUE DONATION

PONNI ARUNKUMAR, MD:

SAVING LIVES AND TAKING ‘NAMEs’ “As forensic pathologists, we can also help families through organ and tissue donation.” When Ponni Arunkumar, MD, Cook County Chief Medical Examiner (CCME), walks into work, she knows each day will be fast-paced and different from the last. A wife and mother of three, Dr. Ponni Arunkumar, MD, Arunkumar thrives Cook County Chief in her everyday Medical Examiner duties whether she is performing examinations and autopsies, testifying in a court case, supervising assistant medical examiners or managing day-to-day operations.

THE ROAD TO ACCREDITAtION

Appointed to the helm of the celebrated office on July 13, 2016, by Cook County Board President Toni Preckwinkle, Dr. Arunkumar has a long affiliation with the county and office where she started as an Assistant Medical Examiner in 2004 and experienced the organization’s previous challenges firsthand. Under the leadership of former Chief Medical Examiner Stephen Cina, MD, Dr. Arunkumar oversaw a complete overhaul of policies and procedures that led to the office receiving full accreditation from the National Association of Medical Examiners (NAME).

Reaching that point required full support from the Cook County Board to effectively address deficiencies in procedures and staffing. The Preckwinkle administration provided increased financial support, which allowed the CCME to hire 12 additional forensic pathologists. Increasing staff was key to obtaining accreditation because NAME’s accreditation criteria limit forensic pathologists to performing no more than 325 autopsies per year. Additionally, Preckwinkle appointed strong leaders to guide the office through aggressive policy and procedure reform.

EXCELLENCE IN THE FAcE OF ADVERSITY Despite the CCME’s past challenges, the office, which handles about 5,600 cases and performs nearly 3,000 autopsies annually, has historically supported the release of tissue and organs for donation whenever possible. Organ refusals have dropped from five in 2011 to zero through October 2016. So far in 2016, the CCME has released 90 cases for organ donation and 236 cases for tissue donation.

Dr. Arunkumar underscores the importance of maintaining open collaboration with Gift of Hope in support of organ and tissue donation. “Although our work involves investigating cause of death with the deceased, donation allows us to save and bring hope to many living people, especially with tissue,” explained Dr. Arunkumar. “In cases where the organs are absolutely necessary to help determine the cause and manner of death, the office would not release the body for organ recovery.

However, we may be able to release the body for tissue donation in such cases. We try to do this prior to the body coming here to ensure that the recovery rate is higher and faster.” Dr. Arunkumar has demonstrated an unwavering commitment to the CCME’s office and the communities it serves and has also been a long-time supporter of organ and tissue donation. “Gift of Hope has had a strong and successful relationship with the Cook County Medical Examiner’s office, which is extremely important to saving and enhancing lives,” said Shaun Martin, who serves as the primary liaison between Gift of Hope and the CCME’s office in his role as Manager of Forensic and Tissue Relations. “She and her office are strong supporters of donation, and we look forward to continuing our work together to offer hope and life to others through donation.” Asked about the positive impact that the forensics industry can bring to organ and tissue donation, Dr. Arunkumar said, “As physicians, we want to help people. Every day I review the cases in which the release of organs for donation was denied in order to make sure that all eligible donations take place. We have an important role in public health, and as forensic pathologists we can also help people through organ and tissue donation.”

GiftofHope.org


County

Organ Tissue Tissue Donors Donors Referrals

Adams County

1

1

0

Champaign County

5

1

0

Cook County

33

15

1

DeKalb County

0

2

2

DuPage County

4

2

0

Ford County

0

1

1

Kane County

1

6

0

Kankakee County

0

0

0

Knox County

0

1

1

Lake County, Illinois

3

4

3

Lake County, Indiana

1

7

29

LaSalle County

0

1

0

McHenry County

1

2

1

McLean County

0

6

60

Mercer County

0

0

0

Montgomery County

0

2

0

Peoria County

4

5

2

Rock Island County

1

0

0

Sangamon County

4

7

0

Stephenson County

0

1

0

Warren County

0

1

0

Will County

2

0

0

Winnebago County

1

4

2

* Counties with at least one organ or tissue donor from 7/1/16-9/30/16

CIRCUMSTANCES OF DEATH OF ORGAN DONORS 14

11

4 9 24

Accident, Non-MVA Homicide MVA Natural Causes Suicide

MECHANISM OF DEATH OF ORGAN DONORS 12 6

18 1

6

15

Asphyxiation Blunt Injury Cardiovascular Drowning Drug Intoxication Gunshot Wound ICH/Stroke Natural Causes Seizure

11 2


CASE STUDY:

WHEN PATIENCE PERSEVERES, HOPE TRUMPS TRAGEDY Earlier this year Johnna Ingersoll, Peoria County Coroner for the past 28 years, worked with Gift of Hope on a referral received from Peoria’s OSF Saint Francis Medical Center where a federal inmate was declared brain-dead. Due to the sensitive circumstances of the case, many entities became involved, resulting in extensive collaboration among the coroner, Gift of Hope staff, hospital staff, corrections facility staff and legal counsel on local and national levels. “From a coroner’s perspective, determining that the cause of death was natural and attributed to ischemic cerebral infarction due to aortic dissection involving the left carotid artery due to hypertensive cardiovascular disease indicated that moving forward with organ donation was possible,” Ingersoll said. “I also realized that there might be challenges because organ donation is probably not something that those in corrections, especially at the federal level, are routinely accustomed to.” The death of the potential donor while he was under federal custody added a layer of complexity to the case. Additionally, a directed kidney donation for the inmate’s father was at stake. “At the onset, Gift of Hope communicated that there were challenges in obtaining donation authorization from federal corrections staff,” said Ingersoll. “I encouraged patience and open collaboration among all involved entities to allow the corrections team to follow their internal process, which included legal obligations. “Coroners see death. It’s good to see another side of it and know that the deceased helped to save and enhance other lives. I refer to those deceased and their families as heroes. We are happy that a successful outcome was achieved and that the donor was able to save his father’s life.” The success of the case surpassed initial expectations. As a result of effective communication and collaboration, three organs were transplanted. One was the directed kidney donation to the donor’s father. Though tragic, this successful case allowed a son to save his father’s life as well as the lives of two others. Moreover, it illustrated that even in the face of tragedy and the most challenging circumstances, patience and open collaboration produce positive results, and a family’s wish to save lives through donation can be honored.

County

# of people waiting for a transplant

Adams 20 Boone 13 Brown 1 Bureau 17 Calhoun 1 Carroll 3 Cass 6 Champaign 52 Christian 5 Clark 3 Clay 4 Coles 14 Cook 3,092 Crawford 2 Cumberland 2 DeKalb 28 Dewitt 4 Douglas 4 DuPage 324 Effingham 13 Fayette 1 Ford 6 Fulton 17 Greene 2 Grundy 25 Hancock 2 Henderson 2 Henry 11 Iroquois 4 Jasper 1 Jo Daviess 3 Kane 218 Kankakee 49 Kendall 22 Knox 23 La Salle 36 Lake, Illinois 291 Lake, Indiana 329 Lawrence 3 Lee 18 Livingston 11 Logan 6 Macon 49 Menard 4 Mercer 1 Morgan 15 Ogle 18 Peoria 104 Piatt 3 Pike 8 Putnam 2 Richland 1 Rock Island 55 Sangamon 79 Scott 3 Shelby 2 Stark 2 Stephenson 13 Tazewell 45 Vermilion 20 Warren 5 Whiteside 13 Will 268 Winnebago 97 Woodford 7


425 Spring Lake Drive Itasca, IL 60143

To learn more about organ and tissue donation, visit GiftofHope.org

ADDRESS CORRECTION REQUESTED

Coroner Connect: Keeping you connected from referral to destination Coroner Connect is a convenient and user-friendly website unique to each county within Gift of Hope’s donation service area. The site displays organ and tissue cases from referral to final destination. Coroners and their staff can log on and view current donation activity in their service areas. Each site displays the county map with pins marking the sites of referrals. When a pin is clicked, the donor information is displayed. That includes name, age, race, gender and hospital unit. It also displays organ status, tissue status and family status throughout the donation coordination process. This technology provides coroners with real-time updates of all donation activity within their counties. It is important to note that request or notification processes have not changed with regard to release or follow-up. This is a helpful tool for Gift of Hope’s forensic partners to obtain up-to-date information. Please contact your Gift of Hope representative to obtain access to Coroner Connect.

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