Fatal traffic accident in a post– heart‑transplant driver – opportunities and limitations in forensic evaluation = Śmiertelny wypadek komunikacyjny kierowcy po przeszczepie serca – możliwości i trudności opiniodawcze

Forensic medical evaluation of deaths in individuals after heart transplantation is rare. Such cases pose a challenge for the forensic expert, as they require consideration of potential causes of death related to impaired graft function. This paper presents the case of a driver who, for unknown reasons, veered off the road and struck a streetlight, sustaining fatal injuries. Toxicological analysis revealed the presence of mycophenolic acid and amlodipine, while cyclosporine was not detected. Histopathological examination demonstrated moderate graft vasculopathy/arteriopathy. Analysis of the pacemaker recording, performed by a cardiology expert, showed, among other findings, that the type of device used protected the patient only against bradyarrhythmias. The experts also noted that they could not exclude the possibility that the behavior leading to the fatal traffic accident resulted from morphologically undetectable arrhythmias of the transplanted heart. Determining the cause of death in a heart‑transplant recipient requires close cooperation between the forensic pathologist, toxicologist, a pathologist experienced in cardiac pathology, and a cardiology expert. If the individual had an implanted pacemaker, it should always be secured, as analysis of its recording may prove highly valuable for forensic medical assessment.