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Autopsies

Last updated 3rd December 2020

Last updated on16th July 2017 by Chris Isles & John Green

What, When and How?

  1. There are two types of autopsies known as HOSPITAL and FISCAL autopsies. While the hospital autopsy is an optional clinical diagnostic tool, the fiscal autopsy is a mandatory requirement for legal or medico-legal reasons.  See Reporting Deaths to The Procurator Fiscal, Information & Guidance for Medical Practitioners – 2015[pdf]
  2.  You must read and understand “Post Mortems – Guidance for Clinicians”. Copies of this document should be available in every ward and are available on-line from the Scottish Pathology Network
  3. A hospital autopsy should be considered in all difficult cases in order to establish accurate diagnosis, assess the extent of a disease process, assess the effectiveness of therapeutic measures employed, or to evaluate the accuracy of other diagnostic techniques used for establishing the diagnosis.
  4. A hospital autopsy should not be requested if the cause of death is unknown and in this case the deceased must be reported to the Fiscal.
  5. The medical certificate of cause of death must be issued before requesting a hospital autopsy and a copy taken, this copy will then be sent with the consent forms to the mortuary  
  6. Once autopsy deemed necessary;
    1. Complete “relatives’ consent form” (see below)
    2. Prepare a handwritten summary for the pathologist in which you give as much relevant information as possible and specify exactly what you are looking for
    3. Contact the Mortuary Technician via Switchboard or the Voice Activated Directory

Authorisation For Post Mortem Examination

  1. Cannot perform autopsy without legal authorisation
  2. The “Authorisation for the Hospital Post Mortem Examination on an adult who left no formal authorisation” form, also known a “relative’s consent form”, must be completed, signed by the relative, a witness (who can be a member of hospital staff) and by a doctor in every case.
  3. There are three copies of this form: top copy goes to relative, middle copy to Pathology and bottom copy to casesheet.
  4. The Procurator Fiscal (PF) provides such authorisation directly to the pathologist for medico-legal autopsies, i.e. the fiscal autopsy does not require consent by the next of kin.

The Consent Procedure

  1. A senior member of the clinical team is expected to be the person who will make the first contact with the relatives regarding the need for a post-mortem examination.
  2. Relatives of the deceased should not be invited to sign the consent form if staff are aware of objections expressed by the deceased or by other members of the family.
  3. The relative giving the consent should normally be the next of kin or the deceased’s legal representative.
  4. The person obtaining consent must make such reasonable enquiries as may be practical to ensure that the person giving consent, or any other relative, does not object to the post-mortem examination being carried out, or to the removal of any tissue.
  5. Where there are no known relatives, the relatives cannot be contacted, or the distance renders it impractical for a relative to sign the form in person, the authorisation can be signed by the Medical Director or an appropriate clinical consultant. In such circumstances the authorising officer should add the following words after their signature “Despite reasonable enquiry I have been unable to contact any relative”.
  6. To fulfil the legal requirement for an informed consent, the reasons for the post-mortem examination should be explained to the deceased’s relatives in each case.
  7. The implications of each of the four options for the post-mortem examination and subsequent disposal of retained tissue (see below) should be explained to the person signing the agreement on behalf of the deceased’s family.
  8. If the person giving consent does not agree to retention of organs or part of the body, the relevant box in agreement form should be ticked accordingly.
  9. The signature of the person consenting to the post-mortem examination should be witnessed by a member of the hospital staff presenting the form and countersigned by the clinician authorising the examination (see below)

Relatives Should be Asked:

  1. Whether they agree to a full autopsy or to limit the examination to the head, the chest, the abdomen or a single organ – note that the family/NOK have final say on what they want done at an autopsy.
  2. Whether they agree to organs or body parts to be temporarily retained for further detailed examination.
  3. How they wish any retained tissue to be disposed of once the examination is completed.
  4. Whether they agree to tissue, fluids or organs being retained for medical research or education.
  5. NB Any limitations so imposed should be strictly observed by hospital staff.

Organ & Tissue Retention at Autopsy

  1. The Human Tissue (Scotland) Act 2006
  2. No tissues, whole organs or body parts are routinely retained at DGRI for reasons other than establishing diagnosis. Retention of organs for transplantation purposes are governed by different protocols.
  3. Retention of small tissue samples for histological examination is an integral part of an autopsy. This is implied in the signed agreement &, therefore, should be drawn to attention of the person signing it.
  4. If or after the tissue sample is no longer required by the procurator fiscal then it should be bocked in Histology and will form part of the deceased medical record under the human tissue act 2006 (Scotland). 
  5. Retention of a whole organ or body part may be of diagnostic value in some cases to allow detailed examination after fixation or to allow an input from an external expert. Contact the pathologist on duty if doubt. 
  6. If required, the need to retain tissues or organs for medical education or research should be clearly explained to the deceased’s next of kin & explicitly stated on consent form.
  7. Relatives should be aware that if tissue/whole organs are to be returned to the deceased after tests are carried out, then this could hold up the funeral arrangements. 

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