What is a post-mortem?

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A post-mortem examination or autopsy is an examination of the body following death. It is carried out by a pathologist. These are doctors who are experts in finding out the cause of death. The examination is carried out as soon as possible after death and every effort is made to minimise any delay. 

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The pathologist will start with an external examination of the body followed by an internal examination. The major internal organs will need to be removed and examined. In most cases the organs are returned to the body afterwards.

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Although some information can be obtained from looking directly at organs in a post-mortem examination, often the only way to understand properly what has happened is:

• to look at part of an organ under the microscope

• carry out special tests

• get a second medical opinion

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Tissue samples, blocks and slides

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It is usually necessary to retain small tissue samples for further examination and for further tests such as looking at chromosomes or genes and searching for infections due to bacteria or viruses that may have caused the death.

Small samples of tissue are removed from the organs and placed in small plastic containers. The samples measure around 1.5 x 1.5 cm (smaller than a postage stamp) and are up to 5 millimetres thick.

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The tissue is chemically treated to remove water, which is replaced with wax. This process creates tissue blocks. Very thin slices (sections) a tenth of the thickness of a human hair are then cut from the surface.

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The sections are placed on glass slides so that they can be examined under a microscope. More than one slide can be cut from each block.

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These techniques are the same as those used to examine tissue from living patients.

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The tissue blocks and slides are stored in special cabinets as part of the medical pathology records and in line with the Human Tissue Act 2004.

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The process of creating tissue blocks and slides may create very small amounts of unused or residual tissue. This is usually disposed of by incineration.

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Occasionally it is necessary to retain whole organs for further examination, as this can provide more detailed understanding of the cause of death.

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The next of kin will always be advised if any tissue samples or organs are retained for further tests.

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X-rays, photographs and other images

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It may be necessary to x-ray or photograph the body or an organ during the post-mortem examination. These images form part of the record of investigation of the death. They are usually retained indefinitely. Their use is strictly controlled and always confidential.

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Post-mortem results

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The pathologist will provide the preliminary results of the post-mortem examination to the Coroner very quickly. However, a final written report may not be available for some time as further tests may need to be carried out and these can take time to complete.

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The Coroner’s Liaison Officer will contact the family as soon as the preliminary results are available and will advise the family on the finding. They will also be able to say if any organs or tissue have been retained following the post-mortem examination.

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When the final post-mortem report is completed it will be sent to the Coroner who will forward a copy to the deceased’s doctor. The family will be informed when this happens and they may also request a copy of the final report from the Coroner. The report may contain complex medical terminology, and the family may wish to discuss the findings with their family doctor.

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Family members may feel that they would like to discuss the post-mortem examination with the pathologist who carried it out. The Coroner’s Liaison Officer can arrange this.

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Retained organs and tissue

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The pathologist, with the authority of the Coroner, may need to retain any organs and tissue samples removed at the post-mortem examination to assist in the investigation into the death. Once the Coroner’s investigation has finished, the Coroner will decide if these samples need to be retained or if they can be released.

The Coroner’s Liaison Officer will contact the family to discuss the Coroner’s decision and the options available to them. 

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Further use or disposal of organs

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The options are:

• for the organs to be returned through your funeral director - it will be the family’s responsibility to arrange a separate cremation or burial for these organs

• for the Coroner to allow disposal of the organs in a lawful and respectful way by the pathologist

• to allow the organ to be used for teaching and research if this is suitable

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Further use or disposal of tissue blocks and slides

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Tissue blocks and slides will be stored by the Pathologist on behalf of the Coroner until the Coroner’s investigation is completed and the Coroner decides that these no longer need to be retained.

The Royal College of Pathologists recommends that tissue blocks and slides form part of the medical pathology records and that they should be retained in case they need to be reviewed at a later time. If they are retained, access to them will be strictly controlled and they will not be used for any purpose without permission of the next of kin.

The family can request:

• the release of the tissue blocks and slides, and if the Coroner agrees, they can choose for the blocks, slides, and samples for genetic testing to be retained for future use – for example, the wellbeing of future people (including family members), education and training of health care professionals or research approved by an ethics committee if suitable

• for the Coroner to allow disposal of the tissue blocks and slides in a lawful and respectful way by the pathologist

• for the tissue blocks and slides to be returned through the funeral director

If the family's choice is to have the organs and tissues collected by a funeral director, it will be the family’s responsibility to make the suitable arrangements for a separate cremation or burial of the organs and tissues. This means it may not be possible to have the case more fully reviewed or to seek a second opinion at a later date. If collection does not take place within three months of contact, the hospital will tell the Coroner’s Liaison Officer who will clarify arrangements with the family.

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Returning the body

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The body will be prepared by the mortuary staff and then released to an undertaker who can make arrangements for family and relatives to view the body. Normally any incisions (cuts) that have been made during the post-mortem examination will not be visible. The funeral director will be able to tell you if there are any visible signs of the examination before you view the body.

The body is normally released immediately after the post-mortem examination. Very rarely, usually in criminal cases, it may be necessary for the pathologist to retain the body for further re-examination. If this is the case, the family will be given information about this and every effort will be made to release the body as quickly as possible.

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