What happens during a post mortem? Pathologists perform post-mortem examinations to standards set by the Royal College of Pathologists. These standards include carrying out the post mortem in a respectful manner and with regard for the feelings of the bereaved relatives.
Most post mortems are carried out by pathologists who specialise in histopathology, which is the laboratory study of disease and of diseased tissue. Pathologists are helped by anatomic pathology technologists, who have had specialist training to assist pathologists. Post mortems are usually carried out in the hospital mortuary in a special post-mortem examination room, which is a similar to an operating theatre. In certain circumstances, they may be carried out in the local public mortuary, or in a regional centre for specialist post mortems. The body will be moved respectfully from the place where the person died to the place where the examination is to be carried out.
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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.
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.
Deaths in suspicious circumstances If the death is thought to have occurred as a result of criminal activity, then the post mortem will be undertaken by a forensic pathologist. Forensic pathologists investigate deaths where there are medico-legal implications, for example, suspected murder, death in custody and other complex medico-legal cases.
In such circumstances, a legal defence team (e.g. the barrister or solicitor of the accused person) can request a second post mortem by an independent forensic pathologist. This is allowed, because otherwise, the accused person could allege that the post-mortem was not carried out properly, resulting in the court case being dismissed without a clear outcome.
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Retention of organs and tissue If the pathologist thinks it is necessary, the coroner will retain tissue blocks and slides. Similarly if there is a possibility of criminal involvement in the death, the tissue may be needed by the police as evidence, separate to the need of the coroner. In both cases, the tissue samples, blocks and slides or organs may need to be kept for several months or, in some cases, years.
If tissue samples and organs have been retained, you should expect to be given a choice about what happens to them when they are no longer needed by the coroner. Your consent will be needed for any tissue samples or organs to be kept for future use such as research or education and training of medical staff.
Viewing the body You can view the body of the person who has died at any reasonable time before or after the post mortem.
After a post-mortem, mortuary staff will prepare your relative’s body for you to see, should you wish to. The internal examination involves an incision down the front of the body which cannot be seen when your relative is dressed. There may also be an incision concealed at the back of the head.