Department of Anatomical Pathology

Information for next-of-kin regarding consent for a non-coronial postmortem

What is a postmortem?

A postmortem, also known as an autopsy, is an examination by a trained doctor,
usually a pathologist or doctor training in pathology, of a body after death.
Pathologists are doctors who specialise in the study of disease.

When is consent needed for a postmortem?

Sometimes a postmortem is ordered by the Coroner and will be legally required. This can
occur in a number of different circumstances including; when someone dies suddenly of an
unknown cause; dies within twenty-four hours of an anaesthetic, or there are suspicious or
unusual circumstances surrounding the death. In these circumstances, the postmortem may be
carried out without your consent. These postmortems are called coronial postmortems.
However, this information covers non-coronial postmortems only. Information brochures
about coronial postmortems are available from the Coroner’s Office and are usually provided
by the police.
In some cases a postmortem is not legally required and the postmortem examination is
recommended to you by a doctor to provide information about the cause of death. These are
non-coronial postmortems and they require written consent from the deceased (given when
they were alive) or from the senior available next-of-kin.
As the senior available next-of-kin, you may be approached by a health care worker and asked
for your consent to the postmortem examination. You are free to choose whether or not to
give your consent for the postmortem examination. Your consent must be given in writing.

It is recognised that in Aboriginal and Torres Strait Islander culture dealing with these
arrangements is usually performed by an appropriate person within the family, or extended
family, through the kinship structure, or a particular person within the clan or tribe to have
responsibility in all matters relating to the funeral arrangements of a deceased person. Too
frequently there is an absence of a senior next-of-kin, as understood under Australian law. The
Human Tissue Act allows a senior available next-of-kin to authorise another person, in
writing, to exercise their functions. This ‘authorised person’ can then give written consent for
a non-coronial postmortem and for the use of tissue removed for the purposes of the
postmortem. There is a form you will be asked to complete if you wish to delegate these
decisions to another person.

What issues should be considered?

It is important that you make the decision that is right for you and your family. It can be
helpful to consider what the deceased person would have wished in the circumstances.
Consider how you and your family will feel in the future. In particular, think about whether a
postmortem would help you and your family understand and come to terms with your loved
one’s death later on.

What information can a postmortem provide?

A full postmortem may:
-    Find out more information about medical conditions which may have caused or
contributed to the death of the person.
-    Provide information that may confirm or rule out a suspected or unsuspected medical
condition. This could be important for you or other members of the family, for example, if
the condition might be inherited; and
-    Provide information that may help improve the care of other people in the future.
A postmortem examination does not always provide all the answers about a person’s death.
But it can be reassuring to know that a treatable illness was not overlooked.

Limiting the postmortem

A limited postmortem may involve either an external examination only; an external
examination and some testing on small samples of tissue or blood; or an external examination
with an internal examination limited to the site of an operation. Limited postmortems will not
provide the same information as a full postmortem examination and there is always the
possibility that something unexpected will be missed. However consenting to a limited
postmortem can also provide information that may be helpful in some circumstances.

What happens at a postmortem?

A doctor, who is usually a specialist pathologist, performs the postmortem. The
doctor will carefully review the medical record and then undertake a thorough
examination of the deceased person. There are three main stages to this
examination:
(1)    The external examination involves an inspection of the outside of the person’s
body looking for marks or other abnormalities that might indicate injury or
disease.
(2)    The internal examination is a surgical procedure, somewhat like a large operation.
The pathologist will usually make two incisions, one across the back of the scalp
to provide access to the skull and brain, and another on the front of the body to
gain access to the internal organs. The major organs are removed from the body,
and examined. Small samples of tissue or body fluids are taken from each of the
organs and kept for later microscopic examination. Sometimes it is necessary to
keep an entire organ (see below). Everything else is returned to the body.
(3)    The laboratory examination may involve:
*    Microscopic examination of the tissue samples taken during the internal
examination looking for evidence of disease processes (known as histology).
*    Blood testing for evidence of chemical changes caused by disease or drugs
(biochemistry and toxicology).
*    Laboratory testing of various other samples to find evidence of infection or, in
special cases, genetic abnormalities.

Teaching

Medical students and specialists in training need to attend and sometimes assist in performing
autopsies as part of their training. Qualified medical practitioners may also need to participate
as part of their ongoing medical education. In these circumstances the autopsy is conducted in
the usual manner and is always supervised by a fully qualified pathologist. Organs and tissue
specimens retained for diagnosis during the autopsy may also be studied as part of the
teaching process. As with any other clinical teaching activity, all personal information is
treated confidentially.

What happens after the postmortem?

Once the examination is complete, the body is cleaned and the incisions closed like a surgical
operation. There are occasional circumstances where the incisions may not be closed after the
postmortem; for example if the risk of infection to pathology staff is high. In most cases, once
the body has been clothed, the effects of the postmortem are not very noticeable. However,
the appearance and colour of the skin of the deceased person will change after death and the
body will feel different to the touch. These changes occur naturally and are not related to the
postmortem.
Normally, you will be able to see the body after the postmortem unless there are particular
reasons that your doctor will explain.

Retaining organs for diagnostic purposes

It is often important for the pathologist to retain a complete organ (usually the brain or heart)
for further examination in order to test for signs of disease or injury that are not immediately
apparent. The importance of retaining a particular organ may not be known until the
postmortem is under way.

In some cases, a short delay in the funeral arrangements may be enough to have the organs
returned to the body before it is released for burial or cremation. If this is not possible, you
can decide whether you would like the organs:
*    returned to you or a person nominated by you for separate burial or cremation; OR
*    disposed of in a lawful manner by the public health organisation (usually cremation).

Retaining organs and tissue for use for therapeutic, medical and scientific purposes

When you are approached to give consent for a postmortem, you may also be asked to
consider allowing the use of your deceased relative’s organs or tissue for other purposes (such
as research, medical or therapeutic purposes) that are not an essential part of the postmortem
examination (see information at the end of this document).

If you consent to organs and/or tissue being retained for research, medical or therapeutic
purposes, the organ or tissue will usually be retained for the period for which it is considered
useful. The period of retention of retained organs or tissue for research may be outlined in the
specific information on the research project or you can ask for more information. If the period
of retention is known, you may be able to elect to have the organ or tissue returned to you or a
person nominated by you for separate burial or cremation or disposed of in a lawful manner
by the public health organisation (usually cremation).

You do not have to consent to the use of organs or tissue for therapeutic, medical or scientific
purposes. A postmortem can still be carried out, even of you do not consent to the use of
tissue for these purposes. If you do give such consent, it applies only to the tissue that was
removed for the purposes of the postmortem examination. It does not mean that any extra
organs or tissue will be removed. Donation of organs and tissue for transplantation is a
separate issue, and a separate consent must be obtained for that to occur. You should ask to
speak to someone about organ and tissue donation if you think your relatives wished in this
regard require consideration.

Will I have to pay for a postmortem examination?

There may be costs associated with the postmortem examination. It is important you discuss
these costs with your doctor or hospital representative before you give consent.
Financial assistance with the funeral costs associated with burial of retained organs may be
available through the hospital or Area Health Service.

Your options

You may choose to:
*    Consent to a full postmortem with retention of organs and tissue as determined by the
pathologist. If you do not want a full postmortem to be done, but are prepared to
consider a limited examination, your doctor or the pathologist can advise you whether
this is likely to be useful. You will then be able to advise as to how you would like the
postmortem to be limited.
*    Specify particular organs and tissue that you do not wish to be retained, or you may
require that no organs or tissue be retained. However, small samples of tissue for
microscopic examination will be retained.
*    Agree to the use of your deceased relative’s organs or tissue for other purposes such as
research, medical or therapeutic purposes. In this case you may request more detailed
information and restrict which organs or tissue you do not wish to have retained.
*    Have a copy of the postmortem report sent to you or your doctor.
*    Have the body ready for the funeral by a certain date.

If organs or tissue are retained for diagnostic purposes, you may elect to have the organs or
tissue returned to the body for burial at the completion of the postmortem, returned for
separate burial or disposed of in a lawful manner by the hospital.
If organs or tissue are retained for other purposes and the period of retention is known, you
may be able to elect to have the organ or tissue returned to you or a person nominated by you
for separate burial or cremation or disposed of in a lawful manner by the public health
organisation (usually cremation).

What happens after consent is given for a postmortem?

The postmortem will be carried out as soon as possible after consent has been given.
Occasionally, when certain conditions are suspected, samples need to be taken soon after
death to enable the appropriate tests to be done. If this is the case your doctor will discuss it
with you. If you wish to see the body prior to the postmortem, let the doctor know and
arrangements will be made to delay the postmortem.

A preliminary postmortem report will be available within a few days of the examination but
the results of some tests may take up to twelve weeks, after which the final report will be
prepared.

The report may be sent to the family doctor and the other doctor(s) who cared for your loved
one if you so wish. We suggest you make a time with one of these doctors to discuss the
report, and any implications it may have for you or your family. You may request that a copy
of the report is sent directly to you. However, you may still need assistance in understanding
the report as it will contain technical language. You should consider whether it may be best
for you to receive the postmortem report directly, or to receive a copy through your family
doctor, or another doctor, who can discuss the report with you.

Use of organs or tissue for research, medical and therapeutic purposes following non-
coronial postmortem examinations

Sometimes, organs or tissue collected at postmortem can contribute in an important
way to research. Such research may include:

(1)    Research into causes or mechanisms of human disease

(2)    Testing of the feasibility of new surgical or diagnostic procedures (when there is
no suitable means of studying these in animals or in the laboratory).

(3)    Practising new surgical or diagnostic procedures (when there is no suitable
alternate means of doing this).

(4)    Forensic research (learning more about causes of death particularly those that are
not due to natural causes)

All research projects involving human tissues or organs must be approved in advance by a
Human Research Ethics Committee, operating in accordance with Australian guidelines laid
down by the National Health and Medical Research Council.