InjiJrmation for Relative.I'

North Western Health Board

Post-mortem Examination - Information for Relatives

The staff of the Hospital wishes to offer.>::Q!Iand..your relatives their condo-lences on the death of your loved one.We understand that this a traumatic anddifficulttime for you.

At this sad time it may seem a major imposition to introduce the question of apost-mortem examination but there are very good reasons for this.

Post-mortem examinations (PMs)provide valuableinformation on the cause ofdeath and can provide vital information for future treatment and research. As

relatives you have the right to know anythingabout the illnessof your relativethat may affect you own health. Some illnesses are hereditary and the post-mortem examination may provide you with this information. It is importanthowever that you feel you have enough information before making a decisionabout whether to agree to a post-mortem excmination or to any retention oftissues or organs.

This document aims to provide you with the reasons why a post-mortemexamination is requested and gives details of what is involved.It is intended tosupplement the information you will receive from the doctor who cared foryour loved one. The Nursing, Medicaland Pastoral Care staffwill endeavour toprovide any assistance and support that they can.This information is also provided to you to enable you to make an informeddecision on whether you wish to stipulate any conditions to this permission.

50me relatives may find it difficultto read a document of this nature in a time)f extreme grief.Youshould also be cautioned that the document of it~ nature:ivesexplicit details that some may find it distressing.

IlJIonnalion for Rdatives

Types qf post-mortem examinations

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What is a post-mortem examination?A post-mortem examination (also referred to as an autopsy) is the final step inthe investigation of your relative's illness. It is one of the most informative inves-

tigations in medicine. It is a careful external and internal examination of the per-son who has just died and can give vital information about an illness and its

effects on the body. It may tell us more precisely why your relative died. Modern

diagnostic tests nmx provide a lot of information but they do no provide all the

answers. The post-mortem is the ultimate means of establishing a medical diag-nosis and cause of death.

The Benefits of a Post-mortem ExaminationA post-mortem examination can give valuable information about an illnessandits effects on the body and Jm.Xexplain why your relative died.It mayreveal co-existing and sometimes clinicallyunsuspected disease. It mayalso help to accu-rately classifyinheritable/geneticallytransmitted disorders where early recogni-tion will be of significantbenefit to other family members to come to termswith the death.

Post-mortem examinations can also provide information which can help doc-tors treat other patients with the same kind of illness and can provide vitalinformation for research. Post-mortem exalJ1inationsremain the diagnosticgoldstandard against which the accuracy of other tests are measured.

Who Performs the Post-mortem .Examination?Post-mortem examinations are carried out by a;Pathologist, who is a doctorspecialising in the laboratory study of disease and of diseased tissue. ThePathologist is assisted by a technician (a person with specialist training in thisarea). Examinationsare carried out in special facilities provided in the hospitalmortuary. In certain circumstances they ,!!~ybe carried out in the local publicmortuary or in a regional centre for specialist post-mortem. The body will bemoved respectfullyfrom the place of death to where the examination is to becarried out.A post-mortem examination does not involvedisfigurementof theremains,which may be viewed afterwards in the same manner as if no post-mortem had been performed.

Informntion for Relatil'e.'

Types of post-mortem examination

There are 2 types of post-mortem:

I. Post-mortem examination required by the Coroner

When a death occurs suddenly or unexpectedly or is due to some unnatu-ral cause, the death must be reported to the Coroner. The Coroner is anindependent officialwith responsibility under the law for the medicolegalinvestigation of certain deaths. A Coroner must inquire into the circum-stances of sudden, unexplained violent and unnatural deaths as well asdeaths that occur during/after a surgicaloperation or other medical proce-dure. This may require a post-mortem examination sometimes followed byan inquest.The Coroner's enquiry is concerned with establishingwhether or not deathwas due to natural or unnatural causes. If a death is due to unnatural caus-

es then an inquest must be held by law.If a Coroner directs that a post-mortem take place, the question ofobtaining consent from the next of kin does not arise.

If the Coroner decides that a post-mortem is required, the pathologist willbe asked to carry this out and report findingsto the Coroner. In these cir-cumstances, the pathologist acts for the Coroner and is independent of thehospital. The Coroner will subsequently issue the medical certificate ofdeath.

If an inquest is required, then it will be held at a later date when all of theresults from the post-mortem are available.

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Information for Relatives

2. Consented/Hospital Post-mortem Requested byHospital Doctors

The second type of post-mortem examination is a consented or hospitalpost-mortem. This is completed usuallyat the request of the doctors whohave been caring for your relative.

This type of post-mortem can only be carried out with the writtenagreement of the next of kin.

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)The next of kin may give consent for a full post-mortem or may after dis-cussion with the requesting doctor consent to an examination that is limit-ed to a specific region. (chest, abdomen etc.)

Consented post-mortem examinations can be:

FullThis will include both an external and internal examination.

The skin and body surface are carefullyexamined and any abnormalities orlesions are noted.

The internal examination is like a major surgical operation. This involvesadetailed examination of all the internal organs including the brain, heart,lungs, liver, kidneys, intestines, blood vessels and small glands which areremoved from the body examined in detail and returned to the body.

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Limited

Youmay be uncomfortable with the idea of a fullpost-mortem examination.If that is the case you may be asked to consider agreeing to a limited post-mortem.This may,however,mean that no information willbe availableaboutpossible abnormalities present in other organs, but which may have con-tributed to the death of your relative.

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Information for Rdatives

Some of your questions answered ...When will the post-mortem be carried out?The initial post-mortem examination is carried out as soon as possible afterdeath, usuallywithin two to three working-tlays.Where the' post-'h1ortemdoesnot fall into the jurisdiction of the Coroner, you will be given time to discussthe request for the examination with the requesting doctor.The actual examination can take up to three hours. However some post-mortem examinations may take longer,particularly if tissues or organs are keptfor detailed examination. This would only delay the funeral if you wanted thetissues or organs to be reunited with the body before burial or cremation.Some laboratory investigations that are carried out after the post-mortemexamination may take several weeks.

Will a post-mortem delay the funeral?As the post-mortem is carried out as soon as possible after death, funeral

arrangements should not need to be delayed.Your relative's body is usuallyreleased to the undertaker on the day of the post-mortem. When the post-mortem has been carried out late in the afternoon, this will happen usually inthe following morning. However, sometimes the investigations are very com-plex. requiring a very detailed examination of the organs.This may take severaldays or even weeks, thus risking a delay to the funeral but only if you wish tohaveany retained tissue,organs or body parts reunited with the body.

Will the body be disfigured?After the post mortem the technician will prepare your relative's body for youto see again,should you wish. The internal examination involves an incisiondown the front of the body, which cannot be seen when your relative isdressed.There will also be an incision concealed in the hair at the back of thehead if the brain has been examined.

Do relatives have to give their agreement to thepost-mortem examination? .

Unless the post-mortem is directed by law at the request of the Coroner, theagreement of the next of kin must be obtained before any investigationsarecarried out. Relativesare not forced to give their consent for such a procedure.You should give your agreement only after you have had the purpose of thepost-mortem examination explained to you and you havehad sufficient oppor-tunity to ask questions before reaching a decision.You may need time to con-

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Information for Relatives

sider whether to give your agreement and to talk to other family members.Youshould not giveyour agreement ifyou know that the deceased or any close rel-ative would object, or has already objected to the post-mortem examination.

Why do we ask if we can keep some organs?In most post-mortem examinations it is not necessary to retain any organs.However organs are sometimes difficultto examine accurately at the time of

post-mortem and the examination is much more informative if it is put in a liq-uid preservative and re-examined after a period of time.

When a post-mortem examination is first discussed with you, you may be askedwhether the pathologistcan keepa specificorgansuch as the heart, to enable

medical staff to carry out a more detailed examination. The pathologist onbehalf of the hospital would become custodian of the organ which would bekept in safeand secure conditions in the hospital.The identity of the organ andthe diagnosiswould be confidential, treated in the same confidential manner asall medical records.

Often the doctors would like to keep the organ indefinitely.This is because thelong-term availability of the organ provides an opportunity to learn importantinformation about the underlyingcondition and its treatment both nowand inthe future. Ifyou agree to an organ being kept indefinitely, you will be asked toconfirm your agreement in writing.

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The reasonswhythe pathologistsmaywish to keep an organ,tissueor bodyparts must be explained to you.These reasons may include:

to determine the cause of death

specific current research projects· archiving for future research projects , .

medical museums for the education and training of medical students anddoctors

· discussions between other cliniciansand pathologists

You may:

· wish to ask about the implicationsfor agreeing to these uses· liketo askwhether tissue,parts of the organswill be sent to medical muse-ums,or used for genetic research or commerciallywish to know whether parts will be sent to another laboratory, to tissue ororgan banks or abroad

· wish to know whether you are likelyto be involved in any extra expenses7

1~/iJrmnti(}lI.li". Relntil""

It is important that, jf you do not wish us to retain an organ or anyorgans at all, you inform us when permission to carry out a post-mortem examination is discussed with you. It is important that yourecord on the specially prepared consent form what you agree to.

Youmay prefer to agree to the pathologist carrying out the post-mortem andkeeping what is considered necessary without going into specific details.Thisoption will be offered to you.

What will happen to any organs retained during apost-mortem?When the body is released to the undertaker following post-mortem, thepathologist will provide a notice to indicate what tissue and organs, if any,havebeen retained. In most cases it will be at least 2 months before the organs areavailable.Relatives will indicate on the consent form if they wish the hospitalmake arrangements for sensitive disposal of the organs or alternatively maketheir own arrangements.

Blood.tissue swabs and small tissue samples are disposed of by incinerationin line with clinicalguidelines.Any retained organs following completion of examinations will either beoffered to you (ifyou have indicated this on the consent form ... for burialor cremation) or by disposal in line with hospital health and safety guide-lines.

Will the relatives be able to find out the results of thepost-mortem examination?A report on the post-mortem examination will automatically be sent to the

JConsultant who looked after your relative.A report may also be sent to yourrelative's general practitioner. As these reports are usuallywritten in medical I

terminology it may be helpfulto have the results explained to you.Youcan askfor an appointment with the Consultant, who looked after your relative,or withyour relative's GP or with the pathologist who carried out the post-mortemexamination.They can then discuss the results with you.

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