A post-mortem is the examination of a body after death. It is also known as an autopsy.
Post-mortems are carried out by pathologists (doctors specialising in medical diagnosis), who aim to identify the cause of death.
Why they are carried out
Post-mortems are carried out in either of the following situations:
- If the death has been referred to a coroner, who feels that a post-mortem is necessary to determine the cause of death (for example, because the death was sudden and unexpected). A coroner is a judicial officer (a lawyer or doctor) responsible for investigating deaths.
- At the request of a hospital, to provide information about an illness or cause of death, and to further medical research.
It is estimated that the cause of death can be wrong in up to a third of cases where a post-mortem is not carried out. However, a post-mortem cannot always provide a reason for death.
Post-mortems also play an instrumental role in medical research because they can provide information about illness and health that would not be uncovered in any other way. In fact, much of modern medical knowledge would not have been discovered without the use of post-mortems.
For more information, see Why it is done.
If a post-mortem is ordered by a coroner, it must take place by law, whether or not the next of kin gives agreement.
If a post-mortem is requested by a hospital, the hospital must obtain written consent from the deceased's next of kin or nominated representative. Relatives or partners of the deceased can also request that the hospital carry out a post-mortem to learn more about why their partner or relative died.
As part of a post-mortem carried out by a hospital, the pathologist may wish to take samples of human tissue or remove organs for further study and research. This can only be done if the next of kin gives consent.
For more information on obtaining consent and what happens during the examination, see How it is performed.
Why a post-mortem is necessary
Post-mortems are carried out if:
- The death has been referred to the coroner, who feels that a post-mortem is necessary to determine the cause of death.
- The hospital has requested it, to provide information about an illness or the cause of death, or to further medical research.
If the death has been referred to the coroner
If the post-mortem has been requested by a coroner and the pathologist decides that tissue samples are needed to establish the cause of death, consent from the next of kin is not required.
However, the coroner must handle organs and tissue samples according to the next of kin's wishes.
By law, the coroner can order a post-mortem examination to be carried out if the death is referred to them by the police or by a medical professional, such as a GP or hospital doctor. Deaths can be referred to the coroner for a number of reasons, but the main ones are:
- if the death was sudden and unexpected
- if the death was violent or unnatural, or if it occurred under suspicious circumstances
- if the death was a result of an accident
- if the death occurred during medical treatment or in hospital
- if the doctor treating the deceased person had not seen them within 14 days before their death
At the request of a hospital
Many families find post-mortems helpful because they can provide important information about how a loved one died. Understanding the reason for the death of a loved one can often help families come to terms with their loss.
This can be even more important in the case of the death of a child. Finding out why their child died can help parents to accept their loss and lessen any feelings of guilt or blame.
If parents experience the loss of their baby, they may be concerned about whether it is safe to try to conceive again. The information from a post-mortem may be able to provide an answer to that question, and could prevent complications in any future pregnancy.
Tissue samples and organs
Sometimes, a lot of information can be obtained just by looking at the organs in a post-mortem. However, often the only way to understand the cause of death is to examine part of the organ under a microscope. This requires the removal of small pieces of tissue. In some cases, the pathologist may wish to remove an entire organ from the body for further study.
After a post-mortem, any tissues or organs taken from the body are returned. However, some investigations can take several weeks, which may delay the funeral. As a result, you may wish to ask for the tissues or organs to be sensitively and respectfully disposed of to allow the body to be released for the funeral (see When it is done).
With consent, tissue samples can be kept for many years for a number of reasons:
- Further investigation. In cases of inherited (genetic) disorders, such as cystic fibrosis, looking back at the tissue of deceased family members may help in the diagnosis and treatment of living members of the family.
- Training. Examining tissue is one of the most important ways doctors learn about illnesses and how to treat them. Tissue samples are used to train medical students and new doctors. They can help experienced doctors learn more about certain conditions, and they can also be useful for providing healthcare professionals with specialist knowledge.
- Audit. Examining tissue samples is an important way of checking the standards and quality of care. For example, tissue samples may be used to check on standards in a hospital pathology service.
- General medical research. When a new disease or health problem emerges, tissue examination on a wide scale may provide useful clues about why the disease emerged and how to treat it. This was the case with variant CJD (Creutzfeldt-Jakob disease).
When a post-mortem should be done
A post-mortem is usually carried out within two to three days after a death. This is because the earlier the examination is held, the more likely it is to provide useful information.
If you require the funeral of a partner or relative to take place within 24 hours due to religious reasons, you should inform the hospital or the coroner's office. The pathologist will try to do the post-mortem within the time limit.
How a post-mortem is performed
The first step of a post-mortem is to obtain consent. This is not the case when a post-mortem is requested by a coroner because then the post-mortem must take place by law.
It is possible for the hospital to obtain consent for a post-mortem directly from the person before they die. If the person gave their consent, that decision cannot be overruled by the next of kin.
However, the person does not have to give their consent, or they may wish to limit the scope of the post-mortem. For example, they can request that no tissue samples or organs are removed. In these circumstances, the pathologist may decide not to carry out the post-mortem at all, if it is felt that restrictions would prevent any useful information from being obtained.
Sometimes, a person may nominate a representative to act on their behalf after their death. In this case, the hospital requesting a post-mortem must obtain written consent from the deceased's nominated person.
Next of kin
If no direct consent is obtained and there is no nominated representative, consent will then be sought from the next of kin.
The Human Tissue Act, which is the law that governs post-mortems, ranks relationships to the deceased in order of importance (see box, top left). Consent is obtained from the highest ranked existing relative on the list.
The Secretary of State for Health can override the wishes of the next of kin and order a post-mortem to go ahead. However, this power is reserved for only the most exceptional circumstances, such as a public health emergency.
The body will be moved in a respectful manner to the place where the examination will be carried out. This is normally the hospital mortuary.
The pathologist is usually assisted by a mortuary technician. Medical staff may also be present to observe the examination as part of their training. The pathologist does not need your consent for this, but if you are unhappy at the prospect, you should let them know. The pathologist will respect your wishes.
Pathologists perform their examination to standards set by the Royal College of Pathologists. One of the most important standards is that the examination must be carried out in a respectful manner and with full regard for the feelings of the bereaved relatives.
Pathologists are particularly aware of sensitivities surrounding post-mortems on children. All of the staff involved will take the utmost care of the child's body until it is returned to the parents.
The pathologist will make a careful examination of the body and possibly take photographs, digital images and X-rays for more detailed study. These images are kept as part of the post-mortem record.
The internal part of the post-mortem then begins. Sometimes, an existing surgical incision can be used for the examination. If not, an incision is made down the front of the body.
However, these openings are made discreetly, in places which are as least noticeable as possible. For example, if the brain needs to be removed, an incision is made behind the hair at the base of the head. The pathologist will make every effort to avoid leaving any physical signs of examination, although this is not always possible.
Removing the organs or tissues
The pathologist will remove the internal organs, or pieces of organs and other tissues, that are needed for detailed examination. If the pathologist feels it is necessary, samples of tissue and sometimes whole organs will be placed in special chemicals to preserve them. They will then be used to determine the cause of death.
Following the examination, the remaining organs are returned to the body and the incision is closed.
However, it may not be possible to return the organs to the body for several weeks. Your hospital or coroner's office will be able to advise you about how long the tests will take.
You have the following options:
- You can delay the funeral so that organs and tissues may be returned to the body for burial or cremation.
- You can ask for any organs and tissues to be returned to the funeral director, who can arrange a separate burial or cremation service for them.
- You can donate tissue samples and organs for use in medical training and research (see Why it is done).
- You can ask the hospital to dispose of the organs and tissues, which is normally done by cremation.
Results of a post-mortem
A copy of the post-mortem report will be sent to the deceased's GP by the hospital or the coroner's office. A relative or partner of the deceased can arrange to discuss the findings of the post-mortem with the doctor who was in charge of the deceased person's care in hospital.
If a post-mortem has been ordered by the coroner, the report may be more limited. This is because the purpose of the post-mortem is to identify the cause of death, rather than to make a more detailed assessment.
Copies of the report can be obtained from the coroner's office, although there is usually a fee for this.
Death of a baby
In the case of the death of an unborn or newborn baby, the parents should be offered a follow-up appointment with their consultant obstetrician (expert in pregnancy) to understand the events leading up to their baby's death.
This appointment will be made six weeks after the parents have left the hospital. The results of the post-mortem should be available at that appointment.