A Simple Guide to Post Mortem Examination

Introduction

On behalf of our staff, we would like to express our sympathy to you and your family following your loss.

This leaflet has been given to you to support the discussion you have had with the hospital doctor and/or a member of the Bereavement Team.

The hospital doctor has considered it beneficial for a hospital post mortem examination (autopsy) to take place. We thank you for considering giving your permission for this procedure.

We appreciate that this will be a difficult decision for you. This guide aims to give you practical information about the post mortem examination, which some people may find distressing. However, it is important that you understand all the facts.

A hospital post mortem examination is carried out to further investigate the cause of death.

As a family member, you have a right to know anything about the illness of your relative that may affect your own health. Some illnesses run in families and the post mortem examination may provide you with this information.

A post mortem may also help doctors to improve their treatment for future patients.

If there is anything in this leaflet that you are not sure about, please ask the doctor or member of the Bereavement Team who you have already spoken to. There is a glossary of words used at the back of this leaflet which will also help you.

What is a post mortem?

A hospital post mortem examination is the final step in the investigation of your relative’s illness. It is a careful examination (both internally and externally) of the person who has just died.

This can give valuable information about an illness and its effects on the body.

It may tell us more about why your relative died. However, even the most detailed post mortem investigation may leave some questions unanswered.

Hospital post mortem examinations are carried out by a Pathologist, who is a doctor who specialises in the laboratory study of disease and of diseased tissue. The Pathologist is assisted by a technician, who is a person with specialist training.

Post mortem examinations are carried out with dignity in special facilities, provided in a hospital mortuary. Pathologists perform hospital post mortem examinations to standards set by the Royal College of Pathologists. These standards include carrying out the examinations in a respectful manner and with regard for the feelings of bereaved relatives.

What happens during the examination?

The post mortem examination will take place at James Cook University Hospital.

First, the pathologist carries out a careful external examination of the body.

The internal part of the post-mortem examination then begins. A cut is made down the front of the body and internal organs are taken out for a detailed examination. Sometimes, the examination can be performed through a pre-existing surgical incision.

When the brain is to be examined, an incision is made in the hair at the base of the head.

Small tissue samples are usually taken for further investigations with a microscope. When detailed laboratory investigations require larger pieces of tissue, whole organs or body parts to be kept for some time, you will be asked to give your written agreement.

The form you sign must indicate whether you agree to such specimens being kept. The form will also indicate the purpose of why they are being kept and how you wish them to be dealt with when their examination is complete.

Body fluids may also be sampled for analysis and when investigations are complete, they will be disposed of in the same way as samples from living patients.

Hospital post mortem examinations can be:

Full

This involves a detailed examination of all the internal organs, including the brain, heart, lungs, liver, kidneys, intestines, blood vessels and small glands, which are removed from the body, examined in detail and then returned to the body.

Limited

You may not want to agree to a full post mortem examination. If that is the case, you may be asked to consider agreeing to a limited post mortem examination. This could involve examination only of those organs directly involved in your relative’s illness. For example, if someone has died of a stroke, then only the brain and blood vessels supplying the brain may be examined.

It is important to remember that the pathologist will only examine the parts of the body that have been agreed by you. However, this may mean that no information will be available about possible abnormalities present in other parts of the body, which may have contributed to the death of your relative.

When will the hospital post mortem be carried out?

The hospital post mortem examination is usually carried out within two or three working days after consent has been given. You will be given time to discuss the doctor’s request to carry out a post-mortem examination.

When religious observance requires a funeral within 24 hours, every effort is made to carry out the post mortem within that period.

The actual examination can take up to three hours.

Will a hospital post mortem delay the funeral?

Funeral arrangements should not normally need to be delayed. Your relative’s body is usually ready to be released to the funeral director on the day of the post mortem.

Rarely, however, larger tissue samples, organs or body parts may need to be retained for a further examination. Such examination may take several days or even weeks. This will only take place if you agree to it and will only delay the funeral if you wish the organs to be reunited with the body prior to burial or cremation.

Will the appearance of the body change?

After the hospital post mortem, the technician will prepare your relative’s body for you to see again, should you wish. The internal examination involves an incision down the front of the body, which cannot be seen when your relative is dressed.

There will also be an incision concealed in the hair at the back of the head if the brain has been examined.

Do relatives have to give their agreement to the post mortem examination?

Unless the post mortem is directed by law at the request of the Coroner, your agreement (consent) to the doctor’s request must be obtained before any investigations are carried out. Relatives do not have to give their agreement unless they wish to.

You should give your agreement only after you have had the purpose of the post mortem examination explained to you, and you have had sufficient opportunity to ask questions before reaching a decision.

You may need time to consider whether to give your agreement and to talk to other family members.

Can relatives change their mind?

If you give consent to a post mortem and then change your mind, or wish to discuss the process further, you can do this within 24 hours from signing the consent form.

If this is the case, please telephone the Mortuary at University Hospital of North Tees (please see contact details at the end of this leaflet).

Why are tissue samples and bodily fluids taken at post mortem?

As part of the post mortem examination, small samples of tissue may be taken and made into blocks/slides. Bodily fluids may also be taken. These tissue samples and fluids are taken in order to help the Pathologist in determining the diagnosis or the extent of a disease.

The bodily fluids are usually disposed of after diagnosis.

The tissue samples can prove valuable for the education and training of healthcare professionals, ethically approved research and other purposes, such as audit.

As part of the post mortem consent procedure, you will be asked for your wishes regarding the storage and possible use of any tissue blocks/slides.

It is important that you record on the consent form what you agree to. You will be given a copy of the consent form to keep.

Why are relatives asked if some organs can be kept?

When a hospital post mortem examination is first discussed with you, you may be asked whether the pathologist can keep a specific organ, such as the heart, to enable medical staff to carry out a more detailed examination.

The pathologist, on behalf of the hospital, would become custodian of the organ, which would be kept in safe and secure conditions in the hospital. The identity of the organ and the diagnosis would be confidential, treated in the same confidential manner as all medical records.

Sometimes, the doctors would like to keep the organ indefinitely. This is because the long-term availability of the organ provides an opportunity to learn important information about the underlying condition and its treatment both now and in the future.

If you agree to an organ being kept indefinitely, you will be asked to confirm your agreement in writing. Should the organ no longer be required, it will be disposed of respectfully by the hospital by cremation.

If you do not wish for us to keep an organ indefinitely, you will be asked whether you would allow us to keep it for several weeks, so that the pathologist can examine it in detail before issuing the post-mortem report. We can then respectfully dispose of the organ or return it to you for cremation or burial as you wish.

It is important that, if you do not wish us to retain large tissue samples, organs or body parts at all, you inform us when we seek permission to carry out the post mortem. It is important that you record on the consent form what you agree to. You will be given a copy of the consent form to keep.

Will the relatives be able to find out the results of a post mortem examination?

A report on the hospital post mortem examination will be sent to the Consultant who looked after your relative. A report may also be sent to your relative’s General Practitioner.

As these reports are usually written in medical terminology, it may be helpful to have the results explained to you. You can ask for an appointment with the Consultant who had looked after your relative, or with your relative’s GP. They can then discuss the results with you.

Also, if you wish, the Pathologist will be available to discuss the post mortem findings with you.

Glossary of terms

Body parts

Body parts are groups of organs or a limb or part of a limb.

Coroner

The Coroner is required by law to investigate deaths due to unknown, suspicious or unnatural causes. In some cases, the Coroner may hold an inquest. The Coroner is assisted by Coroner’s Officers.

Coroner’s post-mortem examination

Most post mortem examinations in the UK are performed at the request of Coroners. The agreement of relatives is not required. Attendance at an inquest is necessary in only a minority of cases.

Full post mortem examination

The full post mortem examination involves examination of the brain and of all the contents of the chest and abdomen.

Hospital post mortem examination

Post mortem examinations performed with the agreement of relatives are called consented or hospital post mortem examinations.

Incision

An incision is a cut in the skin, enabling the body to be opened. The incision is made in the same way as for a surgical operation. The incision is sewn up at the end of the post mortem examination.

Limited post mortem examination

A post mortem can be limited, in consented post mortem examinations and if relatives so wish, to one body cavity (for example, the chest). This may not provide all possible information about the cause of death.

Mortuary

The mortuary is a group of rooms, usually in a hospital, where bodies are respectfully kept in purpose-built refrigerators before collection by funeral directors. The mortuary also includes the post mortem room where the post mortem examination is performed.

Organ(s)

The body contains many organs such as the brain, heart, kidneys, lungs and liver. Each organ carries out different functions. The organs are connected in the body by nerves, blood vessels and fibres.

Pathologist

A pathologist is a medical doctor trained in the diagnosis and study of disease. Pathologists who perform post mortem examinations usually work in hospitals and are also involved in the diagnosis of disease in living patients; these pathologists are called Histopathologists. Pathologists work to standards laid down by the Royal College of Pathologists and Human Tissue Authority (HTA).

Technician

A technician is a person, often a scientist, with special training to assist pathologists in the diagnosis of disease. Some technicians help the pathologist carry out the post mortem examination; others prepare any tissue that has been kept, for study using a microscope.

Tissue

Organs contain tissue, collections of cells which given organs their special functions. For example, the heart contains muscle tissue, composed of cells which contract to pump the blood. Samples of tissue (typically small slices about 2x1cm in diameter and 2-3mm thick) are usually taken during a post mortem examination for examination with a microscope; this involves treating the tissue with chemicals and embedding it in wax; this embedded tissue is then kept safely and securely so that it can be re-examined later.

Contact numbers

If you have any further concerns or questions you should:

• Talk to one of the healthcare professionals involved in the care of your relative.

• Talk to one of the Medical Examiner Officers or Bereavement Support Officers.

North Tees and Hartlepool NHS Foundation Trust

Outside these hours please telephone the hospital switchboard on 01642 617617 and ask to speak to the Mortuary Staff on call.

Non-urgent messages can be left on the answering machine.

If your call is urgent you can contact the hospital switchboard on 01642 617617 and ask the operator for the Mortuary Manager or Pathology Services Manager.

Further information is available from:

Comments, concerns, compliments or complaints