Embalming III 2306.2 - FINAL

organ and tissue donation

the process of surgically removing an organ or tissue from one person (the donor) and placing it into another person (the recipient)

• Uniform Anatomical Gift Act (UAG Act)

• Organ Procurement and Transplantation Network (OPTN)

• US Food and Drug Administration (FDA)

federal legislation and regulation over organ and tissue donation:

• Hospitals - reporting requirements tied to funding

• Organ Procurement Organizations (OPO's)

local participation for organ and tissue donation:

• Heart

• Lungs

• Liver

• Kidneys

• Pancreas

• Intestines

commonly donated organs (6):

• Eyes (parts or whole)

• Blood vessels

• Cartilage

• Skin (partial and full thickness)

• Bone

• Pericardium

• Soft tissues

commonly donated tissues (7):

organ

Most decedents will not qualify to be an ____________ donor

• Must be brain dead

• Must be on a ventilator

• Heart must be beating (to keep organs viable - then heart is taken last)

• Time is of the essence

• Procurement is done surgically in a medical setting

requirements for organ donation:

• Not on a ventilator

• No cardiac or respiratory activity

• Timeline is more flexible (within limits)

• Procurement is still done surgically

• Procurement takes place in hospital/OPO Procurement Facility/Funeral Home prep room

requirements for tissue donation:

false

open-casket services for organ donors aren't possible (t/f)

• Midline

• U or V (akin to the Y-incision of an autopsy)

recovery incisions for organ donors:

true

preparation of organ donor cases is much like the preparation of autopsied cases (t/f)

higher index/stronger

when embalming an organ donor it is best to use a __________ ________/_________________ embalming solution

subclavian

the _________________ arteries are recommended to reach the shoulders and arms for organ donor cases

common carotid

the ____________ ____________ arteries are recommended to reach the head for organ donor cases

common iliac

the _____________ _________ arteries are recommended to reach the legs for organ donor cases

brachiocephalic and abdominal aorta

the ____________________ and ____________ ________ are recommended to reach many different areas for organ donor cases

vena cava or corresponding veins

the _________ __________ or ___________________ veins are recommended for drainage for organ donor cases

hypodermic and surface embalming

supplemental treatments that may be needed for organ donor cases:

enucleation

removal of the whole eye

- cornea

- sclera

tissue donation of the eyes include:

- protect surrounding area (massage cream)

- use moderate to strong embalming solution

- avoid pre-injection and humectants

- use restricted cervical injection

considerations for eye donors:

- partial/split thickness recovery

- full thickness recovery

the two types of skin donation:

partial/split thickness recovery

- Thin layers of skin

- Completed with a dermatome

- Recovered from numerous locations

full thickness recovery

- Dermal and adipose layers

- Completed free-hand with a scalpel

abdomen, back, and thighs

full thickness recovery is often recovered from:

- Humerus

- Femur

- Tibia

- Fibula

- Iliac crest

- Rib

- Radius

- Ulna

bones typically recovered (8):

- treat area with phenol-based liquid or gel

- use a stronger solution during arterial embalming

- allow treated areas time to dry thoroughly

- supplement with hypodermic and surface embalming

- once dry, treat as needed (absorbent pads, powders, plastic sheeting, plastic garments)

considerations for skin donors:

autopsy

a postmortem examination of the dead human body (organs and tissues) to determine cause of death and/or pathological conditions

no filler/cotton/powder is used in the torso

cavity treatment is done after suturing organ donors if:

filler/cotton/power IS to be used in the torso

cavity treatment is done before suturing organ donors if:

prosthetics

_____________ are used after bone donation for form and rigidity

• Patellar tendons

• Achilles tendons

• Cartilage

• Rotator cuffs

• Saphenous veins and femoral vessels (often recovered along with lower extremity bones – due to same location)

bone/connective tissues recovered:

true

it is much more common to see bone/skin donors than organ donors (t/f)

- prior to embalming, remove any/all sutures (put in place by the recovery team) and open incision sites

- remove any/all prostheses

- determine vessel accessibility and disruption

- pack and treat the area with a cauterant

- embalm as usual but raise additional arteries when needed

- clamp leaking vessels to ensure adequate distribution and vascular pressure

- supplement with hypodermic and surface embalming

- after embalming, ensure all areas are treated and dry

- replace prostheses

- pack with hardening/preservative compounds and cotton

- suture all areas and use plastic garments to guard against leakage

considerations for bone donors:

necropsy

autopsies are also known as:

a hospital

medical autopsies take place in:

medical examiners or coroners

medicolegal/forensic autopsies are performed by:

- to confirm or verify a diagnosis

- when death follows unexpected medical complications

- when death follows use of an experimental drug, treatment, or therapy

- when death follows a surgery

- when death follows childbirth

- when there are concerns about a disease (contagious, hereditary, etc.)

situations in which a medical autopsy is performed:

false

families do not have to consent to a medical autopsy (t/f)

true

families do not have to consent to a forensic autopsy (t/f)

- to determine the cause of death

- to determine the manner of death

- establish the time of death

- confirm identification

- provide evidence and information to legal authorities

situations in which a forensic autopsy is performed:

- partial autopsies

- full autopsies

the two types of autopsies:

- specific region

- specific cavity

the types of partial autopsies:

- external

- cranial cavity

- abdominal and thoracic cavities

- pelvic cavity

- neck

- eyes

- spine

full autopsies include examination of:

- Y-incision

- cranial/scalp incision

autopsied cases will often have these two types of incisions when you receive them:

stronger

autopsied cases require a _____________ than normal solution due to the likely greater preservative demand

waterless

consider a _________________ solution for autopsied cases

inferior; superiorly

start ____________ and work ________________ when injecting autopsied cases

legs - standard to high pressure

arms - standard to higher pressure

head - lower pressure

types of pressure used for each segment of the body:

• R/L external iliacs (or common iliacs)

• R/L common carotids

• R/L axillaries (or subclavians)

the 6 arteries necessary for injection for autopsied cases:

- remove temporary sutures and open cavities (abdominal and cranial)

- remove the breastplate, treat, and set aside

- remove the bag containing the viscera (if present)

- locate and ligate the 6 arteries for injection

- raise additional arteries if needed

first treatment steps for autopsied cases:

true

by default, embalming is delayed for autopsied cases (t/f)

active/cosmetic

use an __________/_______________ dye for autopsied cases

- adhesive

- musculature sutures

- calvarium clamps

methods of reattaching the calvarium:

- breasts

- buttocks

- shoulders/neck

- flaps of the open cavity

treat certain areas with hypodermic and/or surface embalming to ensure preservation:

- bag method

- stack/layer method

the two options for returning the treated viscera to the body:

- baseball suture

- worm/inversion suture

options for suturing the scalp closed:

right; left

when suturing the cranium start behind the __________ ear and finish (tie it off) behind the ________ ear

true

inject each section (legs, arms, head) separately for autopsied cases (t/f)

pulse

consider using the __________ function for autopsied cases (especially on the face)

intermittent drainage

consider using _______________ drainage (by clamping open veins) for autopsied cases

clamp leaking arteries with hemostats

if having trouble with diffusion and distribution you can do this to ensure proper distribution of autopsied cases:

false

drainage devices are needed for autopsied cases (t/f)

autopsy aspirator

drainage material will flow directly from the severed vessels into the open body cavities for autopsied cases therefore an _____________ ___________ must be used to keep the volume of drainage to a minimum (are reduce fumes)

- reflect the scalp, remove the calvarium (skull cap), and disinfect cavity

- during injection, support and massage the scalp to reduce the likelihood of a forehead crease

- clamp the internal carotid arteries inside the cranial cavity during the arterial injection of the R/L common carotids

- once injection of the head is complete, dry and pack the cranial cavity

- reattach the calvarium (several methods)

treatment of the cranial cavity includes:

- thoroughly dry the entire abdominal/thoracic cavity

- ligate any/all injected arteries

- ligate the esophagus and rectum

- pack cotton into the neck area to create natural form/contour once sutured closed (think RA)

- pack the pelvic area/cavity to deter leakage

- coat the cavity in preservative powder and/or hardening compound

steps of preparing the cavity of autopsied cases:

the bag method

• Aspirate excess gas/liquid from the viscera bag and seal it (tied with ligature)

• Place the sealed bag into the open cavity – maneuver bag to fill cavity

• Hint: place towels on the ribs during placement to prevent rips/tears

stack/layer method

• Remove treated viscera from bag one piece at a time and pat dry

• Stack it in the cavity in layers – place hardening compound between layers

• Basically, create a “lasagna”

shaving/trimming a small strip of hair on both margins of the incision; this will keep hair from getting caught in the suturing

when suturing the cranium consider:

wax restoration and cosmetics

may be necessary for bald/balding cases to conceal sutures:

retrieve the treated breastplate and place into correct position, atop the viscera bag or layered viscera

the first step when suturing a Y-incision:

double-curve postmortem needle

use a ____________-____________ postmortem needle for Y-incisions

knot (bridge suture) or gathering forceps

when suturing a Y-incision gather all three flaps and secure together with a ________ (_____________ _________) or _________________ ___________

baseball

_________________ suture is recommended for Y-incisions- but not required

pubic bone

for Y-incisions start at the _________ ________ and work superiorly – then do the other branch of the Y (the opposite, top to bottom, is also acceptable)

glue; cotton strips

after completion of your Y-suture ________ the sutures and place ____________ ________ on top for security

aspirate

______________ may be necessary if there is air trapped in the cavities after suturing, if so carefully ______________ (just below the surface)

- bathe the deceased

- perform terminal disinfection

- use plastic garments (with absorbent powder) to guard against leakage

- check features

- perform any additional treatments necessary

final steps of preparing an autopsied case (post embalming)

- cover sharp or broken bones inside the cavity

- continually aspirate the cavities

- clamp leaking arteries and veins

- use running water on the table

- pack and/or tie off external orifices

- treat the viscera, breastplate, and calvarium early in the embalming process

considerations for autopsied cases:

true

if bagging the viscera, then consider using a new/fresh bag or double bagging (t/f)

true

autopsies are not difficult - just time consuming (t/f)

which of the following is not a commonly donated tissue?

intestines

3 multiple choice options

which of the following is not a commonly donated organ?

bone

3 multiple choice options

R/L external iliacs (or common iliacs)

We want to first utilize arteries that are exposed when preparing an autopsied case, so, with that in mind, what arteries would be preferred to inject the legs?

dermatome

partial thickness skin recovery is achieved using a surgical instrument called a:

all of these are recommended when injecting the head of an autopsied case except for:

increasing the rate of flow

3 multiple choice options

Organ Procurement Organizations

OPO stands for:

solution diffusion (arterial solution diffusion)

passage of some components of the injected arterial solution from an intravascular to an extravascular location; movement of the arterial solution from the capillaries into the interstitial fluids and subsequently the cells

solution distribution (arterial solution distribution)

movement of solution from the point of injection throughout the arterial system and into the capillaries

organ donation

these types of donations must take place surgically in a medical setting:

Vena cava

What vein would you primarily use for drainage on an organ donor?

lower extremity bones

Saphenous veins and femoral vessels are often recovered along with ____________ _____________ _________ – due to same location)

swelling

What would you be concerned about while embalming if an enucleation has been performed?

Organ Procurement and Transplantation Network

OPTN stands for:

moderate to strong

eye donors require what strength embalming solution?

pre-injections and humectants

what should be avoided with eye donors?

restricted cervical injection

what type of injection is used for eye donors?

so that the embalming fluid that leaks out does not burn the skin

why should you use massage cream to protect the eye for eye donors?

donor

the person who gives up their organs or tissue; may be living or deceased

recipient

the person who receives the organs or tissue from the donor