Explaining Post-Mortem Examinations
Date issued: February 2014
For review: February 2016
Ref: D-09/Path/DH/PM V2
PDF: Explaining post mortem examinations [pdf] 46KB
Introduction
You have been asked to consider giving your permission for a post-mortem examination (also called an autopsy) to be carried out on your relative. We appreciate that this is a difficult decision to make at a very distressing time.
A post-mortem may help to answer some of the questions you have about the death of your relative, as well as clarifying any points that doctors have already raised. You may later find it helpful that any uncertainties about your loved one’s illness and death have been investigated. In addition to investigating the cause of death, post-mortem examinations can be of great value in our understanding of disease, and for teaching and research, which ultimately will help others in the future.
It is important that you understand what is involved before giving your consent to a post-mortem. This guide has been produced to give you practical information and help you decide whether to consent to a post-mortem. It does not apply to post-mortem examinations requested by the Coroner who has a right to carry out postmortems to investigate sudden, unexplained or unexpected deaths, and deaths not due to natural causes. In these cases the agreement of relatives is not required.
The examination
A post-mortem is the final step in the investigation of your relative’s illness. It involves a careful and thorough external and internal examination of the body by a doctor specialising in laboratory-based medicine (a pathologist). The pathologist removes the internal body organs and carefully examines them, taking any relevant weights and measurements before returning them to the body. Once the examination is complete, and the body is dressed, it is not usually possible to see any evidence of a post-mortem having been carried out.
Sometimes health care professionals, such as medical students, view a post-mortem as part of their training - if you object to this please indicate on the bottom of the form.
You may restrict the examination to a single organ (for example the brain or the heart) or a single body cavity (the abdomen or chest). In these cases, only limited information will be gained from the examination and it may not be possible to answer all questions from this type of post-mortem.
Post-mortem arrangements
Adult post-mortems are carried out at Derriford Hospital, usually within three working days of request. Agreeing to a post-mortem should not affect funeral arrangements as, wherever possible, we try to work round your chosen funeral date.
Your consent
We will only carry out those parts of the examination for which you have given us your written consent, and you will be given a copy of the form you sign as a record.
Unless the deceased specified otherwise, consent should be given by the 'highest-ranking' person available who was in a 'qualifying relationship' with the deceased. The Human Tissue Act 2004 defines these in order of rank as below:
- Spouse or partner
- Parent or child
- Brother or sister
- Grandparent or grandchild
- Child of a brother or sister
- Stepfather or stepmother
- Half brother or half sister
- Friend of longstanding
Tissue retention
It is good practice to retain small (usually no more than 2cm across) tissue samples, particularly from major organs (e.g. heart lungs, liver, kidney etc) for later examination under a microscope. This is so that doctors can detect changes, which may not have been visible at the post-mortem examination. If this is not done it may considerably reduce the amount of information that can be obtained from the post-mortem.
Please note, that by agreeing to the retention of small samples of tissue, you are only giving consent for removal of enough tissue for microscopic examination. Whole organs will not be removed unless you give us additional consent.
After examination of tissue samples is completed the tissue blocks and histological slides are kept as part of the medical record, so that they can be reviewed either in the light of further medical information or on behalf of the family. These samples can also be valuable for medical purposes, such as education and ethicallyapproved research, but these uses require your consent.
Organ retention and disposal
For the investigation of some conditions (particularly brain diseases), doctors can gain more information if they retain the whole organ and ‘harden’ or ‘fix’ it in formalin before they examine it. We will only do this if you give us your explicit consent, and we recommend that you discuss this with the doctor who has asked you to consent to a post-mortem examination.
If whole organs are retained, we need to know how you wish us to deal with them after the examination - which may be some time after the funeral of your relative. There are three options:
- You may donate the organs for research and education, after which they will be disposed of lawfully by incineration (in the same way that we dispose of diseased organs removed in surgical operations).
- We can dispose of the organs by incineration immediately after examination is complete.
- The organs can be returned to you via a funeral director to make your own arrangements for burial or cremation. This may involve you in extra paperwork and cost (in funeral director and cemetery/crematorium fees). After cremation of organs there will be no ashes to scatter, as funeral ashes come almost entirely from the bones, not from the softer organs.
In a few cases, it may be possible to return organs to the body before the funeral. However, it can take up to two months to complete examination of the organs, so your funeral arrangements could be severely delayed. This is also only possible if we have available body storage facilities. This is something you may wish to discuss with the doctor who treated your relative.
Post-mortem reports
When the post-mortem examination is complete, the pathologist will produce a report of the findings and send it to your relative’s GP and hospital Consultant. The report is written in medical terminology, but we will be happy to explain and discuss the findings with you. You will need to make an appointment through the hospital Consultant’s secretary. Their telephone number will be available at your interview with the bereavement officer. You can, if you prefer, contact your GP.
Any other questions
If you would like to ask any further questions before giving your consent to a post-mortem, please ask the staff member who discusses the consent form with you. More detailed information on post-mortems has been published by the Royal College of Pathologists. If you would like to see a copy, please let us know.
