[Important contribution to tissue donation and transplantation by departments of forensic medicine (DFM) in Sweden 2011-16]. / Rättsmedicins viktiga bidrag till vävnadsdonation och transplantations­verksamheten.

The number of organ donors in Sweden is not enough to cover the need of tissues for transplant purposes. Other sources have to be defined. Young and healthy potential donors can be identified within DFM. Without precise written agreements and a well-educated and trained organization those donations will not be realized. With the purpose to evaluate national efforts to establish close cooperation between tissue establishments and DFM, two surveys were conducted at two time periods, 2011-13 and 2014-16. A total of 2118 pieces of tissue were retrieved within 6 years, 1799 for transplant purposes and 319 for research or education. Most common tissues were heart valves and cornea but also skin and ear bones were collected. 23% of all retrieved tissue from deceased donors in Sweden came from DFM. In the first period 19 % of all transplanted tissue came from DFM and in the latter period it had increased to 26%. Education and national courses for employees in DFM as well as logistic and economical support from national authorities are important factors for building a stable organization and for sustainable progress.

Contribution by Departments of Forensic Medicine to Tissue Donation for Transplant Purposes.

BACKGROUND: A department of forensic medicine (DFM) can be a valuable source for tissue donation, but logistics can prove difficult to overcome as it pertains to obtaining tissues for donation. This article describes the potential of tissues that can be procured for transplantation. MATERIALS AND METHODS: Sweden has 9.7 million inhabitants, with an annual mortality rate of 90 000 and 5500 medicolegal autopsies per year. Cooperation between tissue banking and 2 DFMs began in the mid-1980s. Recently, cooperation has expanded to include all six DFMs. All tissue establishments (TEs) were asked to complete a questionnaire concerning their cooperation with DFMs from 2011 through 2013. RESULTS: A total of 298 actual donors were identified; 1090 tissues were procured including cardiovascular tissue, cornea, sclera, ear bones, and skin for transplantation. Of the tissues distributed, 553 were for transplantation and 72 for other medical purposes. Twenty-three percent of the tissues were discarded. Reasons for tissue rejection included deficient tissue quality (65%), positive serology tests (9%), positive bacteriology tests after decontamination procedures (7%), technical errors (<1%), and other reasons (18%). CONCLUSION: Nineteen percent of all tissues distributed for transplantation came from donors in DFMs. The cooperation between DFMs and TEs was described as well functioning and excellent. Education and national courses in tissue procurement for employees in DFMs are contributing factors to such positive interactions. The support from the National Board of Forensic Medicine is an important factor for sustainable progress.

Comparison of ethyl glucuronide in hair with phosphatidylethanol in whole blood as post-mortem markers of alcohol abuse.

Ethyl glucuronide (EtG) is a direct metabolite of ethanol and has been used as a marker of alcohol abuse in both urine and hair. This study investigated the value of EtG testing in post-mortem hair for diagnostic improvement of alcohol abuse in forensic medicine. Material from 70 consecutive medico-legal autopsies was collected in accordance with the recommendations on ethics by the Swedish National Board of Forensic Medicine. A method for determination of EtG in hair samples was developed using ultra performance liquid chromatography/electrospray tandem mass spectrometry (UPLC/ESI-MS/MS; LOQ, 2.5 pg/mg). The result of the EtG analysis was compared with the findings of phosphatidylethanol (PEth) in femoral whole blood, as measured by high performance liquid chromatography with an evaporative light-scattering detector (HPLC-ELSD; LOQ, 0.22 micromol/l). Evaluation of liver histology and anamnestic evidence of alcohol abuse of the deceased were taken in consideration for the interpretation. Measurable levels of EtG were present in 49 of the 70 autopsy cases whereas PEth was present in 36. Thirty-nine cases had EtG levels above the cutoff limit (> or = 30 pg/mg) compared with 29 for PEth (> or = 0.7 micromol/l). Fifteen cases had EtG as exclusive indicator for alcohol abuse compared with four cases for PEth. These findings suggest that measurements of EtG in hair may provide improved diagnostic information on alcohol abuse, due to a long retrospective time-window for detection and stability of EtG in hair in the decaying cadaver. However, an EtG level below the cutoff does not completely exclude previous alcohol abuse.