A fear-free guide to post-mortems

A post-mortem (also called an autopsy) is an examination performed after someone has died. There are two main reasons for performing a post-mortem in the UK. The most common is a coroner’s post-mortem, performed at the request of the coroner, usually to find out why someone has died when the cause is not known, perhaps because the death was sudden or the deceased had not seen a doctor recently.

The second type is a hospital or ‘consented’ post-mortem. This is done at the request of the family or the doctors of the person who died and can be requested only if the cause of death is known. These look for things like the extent of disease or the response to treatment and help the doctors and family understand better what happened to the person who died.

Do I have to give consent for a family member to have a post-mortem?

 
Consent is not required from the family for a coroner’s post-mortem but the coroner’s officer will usually work closely with relatives to make sure they understand what’s happening and when the funeral can take place. Hospital post-mortems require the consent of the next of kin, and will not proceed without it. Someone from the hospital, often the bereavement officer, will explain why the post-mortem is being requested, what it is hoped to learn, what it involves and when the results will be known. Relatives have a chance to ask questions and may choose to limit the post-mortem to a particular part of the body, such as the head or chest. A standardised consent form has been developed to ensure that relatives have all the information they need and can be very clear about their wishes.

Are post-mortems really necessary?

 
You might think post-mortems are no longer needed now that we have so much information available about people’s health during their lifetime. You might expect modern imaging techniques, such as MRI and CT scans, to enable doctors to find out exactly what’s wrong with someone before they die, and that a post-mortem is unlikely to add anything. Research has repeatedly shown that this is not the case — a significant number of post-mortems identify disease that wasn’t suspected during life and up to a quarter find disease that would have affected the patient’s treatment if it been identified before death. Post-mortems are often called the ‘gold standard’, and are currently the best way to find out why someone died, providing valuable information for doctors and helping families understand exactly what happened.

Do post-mortems delay the funeral?

 
Post-mortems are usually carried out within a day or two of death so they rarely affect the timing of funerals. Pathologists will usually prioritise post-mortems for members of religions that hold funerals quickly after death or if there is another reason why a delay is to be avoided. Coroners’ officers, hospital bereavement officers and pathologists are familiar with these circumstances and will do what they can to expedite the process.

What does a post-mortem involve?

 
A post-mortem is like a surgical operation performed after death. Pathologists (doctors who specialise in the study of disease) work with highly skilled anatomical pathology technologists (APTs) to examine the body in a dignified and respectful way. A long incision is made down the front of the body to enable the internal organs to be removed and examined. A single incision across the back of the head allows the top of the skull to be removed so that the brain can be examined. Organs are examined carefully with the naked eye and dissected to look for any abnormalities such as blood clots or tumours. If further information is required, postage-stamp-sized pieces of tissue may be retained for examination under the microscope or samples of body fluids taken for analysis in the laboratory.

What happens to the organs afterwards?

 
After being examined, the organs are returned to the body. Material is never retained without explicit consent from the coroner or next of kin. The coroner might instruct the pathologist to perform further analysis on blood or a tissue sample; if this is the case the family will be informed. If the pathologist wants to keep tissue for research or teaching, they will only do so with written informed consent from the next of kin. Post-mortem facilities are regularly inspected to ensure that they work to the high standards set out by the Human Tissue Authority. When the examination is completed, APTs reconstruct the body in preparation for viewing by the family or collection by the funeral directors. Once clothed, no sign of the post-mortem is visible.

Is it like on television?

 
There are a surprising number of TV shows featuring pathologists, from CSI and Silent Witness, where pathologists are the main characters, to dramas such as Sherlock and Lewis, where pathologists have important but less central roles. While there’s an element of truth in all these programmes, they are primarily developed for entertainment. I have been involved in checking several scripts for scientific accuracy. My experience is that writers make a big effort to ensure the science is accurate where possible but that storylines often include some science fiction to add to the drama. Even when the science is accurate, the way in which the lives of the pathologists is portrayed is usually some way from the truth. Pathologists don’t spend their time eating or smoking in the post-mortem room, interviewing witnesses or chasing suspects — and they’re not all single!

Will scans replace conventional post-mortems?

 
In recent years post-mortem imaging has emerged as an alternative to the usual type of post-mortem. An MRI or CT scan is performed and a three-dimensional computer-generated image of the body is manipulated by a pathologist and radiologist (specialist in X-rays and other imaging techniques) to look at the internal organs and skeleton. The image can be rotated and viewed from different angles and organs sliced with a virtual scalpel. The cause of death can be found in many of these imaging post-mortems, particularly if it relates to something that’s clearly visible on the scan such as an aneurysm (enlarged blood vessel) or tumour. If no definite cause of death is found on the scan, additional tests may be performed, such as injecting dye into the blood vessels of the heart to look for blockages or taking small samples of body fluids or tissues to examine under the microscope.

Even if the cause of death is not apparent, scans can help target areas for investigation so that a full post-mortem is not required. The accuracy of post-mortem imaging has improved considerably over the past 20 years and is likely to continue to do so. Post-mortem imaging is particularly popular with religious groups who prefer to avoid conventional post-mortems and traditionally hold funerals very quickly after death. The service is sometimes offered to all families but there is often a charge (there is no cost to the family for a conventional post-mortem). Imaging post-mortems represent a significant advance and are likely to become increasingly available and more accurate. Pathologists continue to take ultimate responsibility for the final report and are closely involved in developing this technique further.