Autopsy

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An autopsy is a medical procedure that consists of a thorough examination performed on a body after death, to evaluate disease or injury that may be present and to determine the cause and manner of a person's death.

The decision about an autopsy occurs at a difficult time for most families since they have just lost a loved one. Counselors or spiritual advisors who specialize in bereavement services may be available to help families through the process. Family members may consider an autopsy:

• When the reason for the death may be a medical condition that was not previously diagnosed.
• If there are questions about an unexpected death that appears due to natural causes.
• If there are concerns about genetic diseases or conditions that they also may be at risk for developing.
• When the death occurs unexpectedly during medical, dental, surgical, or obstetric procedures.
• When the cause of death could affect legal matters.
• When the death occurs during experimental treatment.

For more information, see:

Autopsy: Should I Have an Autopsy Done on My Loved One?

An autopsy may be required in deaths that have medical and legal issues and that must be investigated by the medical examiner's or coroner's office, the governmental office that is responsible for investigating deaths that are important to the public's health and welfare. Deaths that must be reported to and investigated by the medical examiner's or coroner's office can vary by state and may include those that have occurred:

• Suddenly or unexpectedly, including the sudden death of a child or adult, or the death of a person who was not under the care of a doctor at the time of death.
• As a result of any type of injury, including a fall, motor vehicle accident (MVA), drug overdose, or poisoning.
• Under suspicious circumstances, such as a suicide or murder.
• Under other circumstances defined by law.

In some of these deaths, an autopsy may be required, and the coroner or medical examiner has the legal authority to order an autopsy without the consent of the deceased person's family (next of kin). If an autopsy is not required by law, it cannot be performed unless the deceased person's family gives permission.

An autopsy is performed by a doctor (pathologist) who has training and expertise in the examination of body tissues and fluids.

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	Autopsy: Should I Have an Autopsy Done on My Loved One?

Why It Is Done

An autopsy is done to:

• Determine as precisely as possible what caused the death. This can sometimes give family members information about diseases or conditions that they also may be at risk for developing.
• Confirm or exclude a disease diagnosis made before death (such as Alzheimer's disease). An autopsy also may be done to help understand how a given disease progresses or to determine the effectiveness of the treatment for that disease.
• Document the presence of a disease that was undiagnosed before death.
• Collect samples of body fluids or tissues for possible genetic testing. This is generally done only after discussion with the deceased person's family.
• Collect evidence and information in criminal cases.
• Help health departments or other government agencies identify and track a disease or potential public health hazard (such as a suspected contagious disease or contaminated drinking water).

How To Prepare

When an autopsy is not required by law, the deceased person's family must give permission before the autopsy is done. The laws governing who can give permission for an autopsy vary from state to state. Generally, a consent form must be signed in the presence of a designated witness. Some areas may allow witnessed phone consent instead.

How It Is Done

Before the autopsy is done, as much information as possible is gathered about the person who died and the events that led to the death. This includes reviewing medical records and consulting with the person's doctors about previous medical problems. Other information may be gathered by interviewing family members, investigating the area where the person died, and studying the circumstances surrounding the death. Depending on the circumstances of the death, law enforcement and the medical examiner's or coroner's office may be involved in the investigation.

Procedures done during the autopsy may vary depending on the circumstances surrounding the death, whether the medical examiner or coroner is involved, and what specific issues are being evaluated during the autopsy. In some cases, family members agreeing to the autopsy may limit what can be done during the autopsy.

The autopsy begins with a careful examination of the external part of the body. Photographs may be taken of the entire body and of specific body parts. X-rays may be taken to evaluate skeletal or other abnormalities, confirm injuries, locate bullets or other objects, or to help establish identity. The body is weighed and measured. Clothing and valuables are identified and recorded. The location and description of identifying marks, such as scars, tattoos, birthmarks, and other significant findings (injuries, wounds, bruises, cuts), are recorded on a body diagram.

A complete internal examination includes removal of and dissection of the chest, abdominal, and pelvic organs and the brain. The examination of the trunk requires an incision from the chest to the abdomen. The removal of the brain requires an incision over the top of the head. The body organs are examined before removal, then removed and examined in detail. Sometimes only a partial autopsy in one specific area of the body is needed. In this case, only the organs and tissues of interest are removed and examined.

In some cases, organs may be placed in a preservative called formalin for days to weeks prior to dissection. This is particularly important in the examination of the brain for certain types of diseases or injuries. Tissue samples are taken from some or all of the organs for examination under a microscope. Samples of blood, organs, and body fluids may be removed and preserved to test for drugs or infection or to evaluate chemical composition or genetics. Samples may include blood from the heart or blood vessels, vitreous gel from the eyes, bile from the gallbladder, contents of the stomach, urine, and tissues from organs, such as the liver.

Completion of the autopsy may require examination of tissues under a microscope, further investigation of the circumstances of death, or specialized tests (such as genetic or toxicology tests). The tests performed may vary based on the findings at the autopsy dissection, the circumstances of death, the questions asked about the death, and the condition of the tissues and body fluids obtained at autopsy. Toxicology testing is not generally performed in every autopsy, particularly those not required by law. Genetic testing is not often done unless the family has been consulted. A written report describes the autopsy findings. This report may address the cause of death and may help answer any questions from the deceased person's doctor and family.

If the autopsy was required by law, after the autopsy is completed, the pathologist, coroner, or medical examiner completes and signs the cause and manner of death on the death certificate. If the autopsy was not required by law, the doctor caring for the person prior to death often signs the death certificate and may complete it before the results of a family-requested autopsy are known.

How It Feels

Family members may have concerns and strong emotions about an autopsy being done on a loved one. It is important that the family understand that the autopsy is a medical procedure performed respectfully and carefully, to objectively evaluate disease or injury that may be present and to determine the cause and manner of the loved one's death.

Risks

There are no risks from the actual autopsy. But an autopsy may uncover the effects of habits or diseases that people close to the deceased person did not know about. For example, the pathologist may find cancer during the autopsy, or results of a liver test may show cirrhosis, which can occur from the overuse of alcohol.

Results

An autopsy is a medical procedure that consists of a thorough examination performed on a body after death, to evaluate disease or injury that may be present and to determine the cause and manner of a person's death. Following the autopsy, it may take several weeks for the results of specialized tests to be completed. For this reason, a final written autopsy report may take weeks or even months. The pathologist or deceased person's doctor may speak directly to the family after the dissection portion of the autopsy and again after the final autopsy report is complete.

After performing the autopsy, the pathologist will often make a statement about the cause and manner of death. Manner of death is defined as natural or unnatural. A natural death means the death occurred as a result of a disease or from the natural effects of old age. Some examples of natural causes include:

• Damage to the heart caused by heart disease, a heart attack, or heart failure.
• Damage to the brain caused by conditions such as tumors, bleeding, stroke, poorly controlled epilepsy, diabetes, or Alzheimer's disease.
• Damage to the lungs caused by a blood clot, bleeding, or pneumonia.
• Damage to organs in the abdomen, such as the stomach, spleen, liver, or kidneys.

An unnatural death means the death resulted from an unexpected, unusual, or suspicious cause. If an injury caused or contributed to the death, the manner of death is called unnatural. Unnatural manners of death are homicide, suicide, accident, and undetermined. Unnatural deaths generally are investigated under authority of the medical examiner or coroner, and the determination of the manner of death requires a detailed investigation of the circumstances surrounding the death. Some unnatural causes of death include:

• Bullet wounds.
• An automobile accident or plane crash.
• Fire, drowning, or electrocution.
• Death resulting from extreme heat or cold.
• Poisoning or drug overdose.

What Affects the Test

Several things can interfere with the autopsy and the results.

• Ideally, an autopsy should be done in a timely fashion, generally within several days of death. In some cases, such as evaluation for metabolic disease in an unborn baby (fetus) or infant, prompt tissue sampling is important to improve the likelihood of establishing a diagnosis. But even after a number of days, an autopsy may still provide useful information.
• The training and experience of the pathologist may influence the quality of the autopsy. Access to consultant pathologists with training in specialized areas and to other experts, such as toxicologists and geneticists, may be helpful in complicated cases. For example, neuropathologists have special expertise in the diagnosis of neurological (brain) diseases; pediatric pathologists may have special expertise in diseases of infants or unborn babies. Families may wish to talk with their doctor for assistance in finding a competent, experienced pathologist.
• Autopsy procedures may differ for each deceased person depending on the medical history of the person, the circumstances surrounding the death, questions the person's doctors and family members would like answered, and the findings at the initial dissection. It is important that the family members and doctors discuss their questions and concerns with the pathologist before the autopsy is performed, so that the autopsy can be individualized and samples can be obtained that may allow performance of specialized tests. Samples may not be retained for specialized tests (such as genetic, toxicology, or paternity testing) unless specific requests are made at the time of the autopsy.
• Autopsy is not an accepted procedure for some cultures, ethnic groups, and religions. If an autopsy is not required by law because of the circumstances of death, it will not be performed unless the family gives specific permission.

What To Think About

• In some situations, CT scans and MRI imaging tests may provide an alternative ("virtual autopsy") to a traditional autopsy. This may be useful in cases where religious beliefs prevent cutting into the body after death.
• Organ or tissue removal for donation purposes requires separate permission from an autopsy.
• If a family requests an autopsy, the consent form generally describes the details of the autopsy, especially with respect to retention of organs and tissues for teaching. The requesting family member should make sure that the details of the autopsy are fully understood.
• A family can request that a hospital do an autopsy on a person who died there. In some hospitals, there is no charge for this service. In some teaching hospitals, a person who died outside of the hospital (for example, at a nursing home or at home) may be autopsied at the hospital at no charge. If an autopsy is required by law, there is no charge to the family. But charges should be clarified before the procedure is performed since many hospitals charge for autopsies and insurance generally does not pay for autopsies.
• An autopsy does not prevent the body from being viewed in an open casket. Generally, none of the incisions made during the autopsy will show after the body is prepared for viewing. The rare exception to this is with autopsies in which injuries on the face, scalp, or hands are evaluated. These autopsies may leave some marks that are visible during viewing of the body.
• If an autopsy is being performed at the request of the family, the family may request that the examination be restricted or limited to certain parts of the body. It is important to discuss these restrictions with the pathologist to ensure that the requested examination allows the pathologist to answer the family's questions about the death.
• Autopsies to determine natural causes of death are not done as often now as they were in the past. But when death has most likely occurred from natural disease, an autopsy can uncover information that is very valuable to the deceased person's doctor and family.

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