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CHHS18/096

Canberra Hospital and Health ServicesClinical ProcedurePost Mortem Examinations and Retention of Body Tissue Contents

Contents....................................................................................................................................1

Purpose.....................................................................................................................................2

Alerts.........................................................................................................................................2

Scope........................................................................................................................................ 2

Section 1 – Procedure...............................................................................................................2

Section 2 – Tissue samples and organ retention.......................................................................5

Section 3 – Timing of post-mortem...........................................................................................6

Section 4 – Post Mortem Results and Reports..........................................................................7

Section 5 – Options for the return and/or disposal of organs collected at post-mortem.........7

Related Policies, Procedures, Guidelines and Legislation.........................................................7

References................................................................................................................................ 8

Search Terms............................................................................................................................ 8

Doc Number Version Issued Review Date Area Responsible PageCHHS18/096 1 15/03/2018 01/04/2021 Pathology 1 of 9

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

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Purpose

The purpose of this document is to: Ensure the appropriate request and performance of post mortems Assist clinical staff discussing post-mortem procedures with the next of kin of a deceased

patient Provide information to assist doctors and other health care professionals answer

questions about post-mortem examination.

Back to Table of Contents

Alerts

This procedure document specifically excludes: The conduct of Coronial autopsies The post mortem removal of organs or tissues for transplantation to another recipient


Scope

This document applies to all clinical staff and other health care professionals in the Canberra Hospital and Health Services (CHHS).


Section 1 – Procedure

Prior to a decision to conduct a post mortem, the treating doctor must ensure the death will not be referred to the Coroner. The Deceased Person’s Checklist must be completed to determine if the death should be referred to the Coroner. Please refer to the When Death Occurs Procedure for further information.

When it has been established that the Coroner does not have jurisdiction, and that the treating team or next of kin (NoK) would like a post mortem to be performed and therefore it is appropriate for CHHS to conduct a post mortem.

The following must occur: The clinician must speak to the Anatomical Pathologist or Anatomical Pathology Registrar

and discuss:o When the examination will be performedo What incisions will be madeo If there is a need for retention of organso Indicate to the Anatomical Pathologist or Anatomical Pathology Registrar if there are

any infectious diseases presento The possible outcomes and when results may be available.



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Once this information is available, a member of the treating team should discuss these details with the patient’s family/next of kin. An information leaflet is available for the family/next of kin to read about post mortem examinations and this should be given to the family/next of kin at the time post mortem is being considered. This leaflet is available on the Policy Register.

Note:Please note there are two information leaflets for the family/next of kin: 1. Adult – Post Mortem Information2. Child/Babies – Post Mortem Information

Designated OfficersIn the ACT, post mortems cannot be conducted unless they have been authorised by a Designated Officer. A Designated Officer is appointed by the Minister for Health and Wellbeing under the Transplantation and Anatomy Act 1978. After making reasonable inquiries, a designated officer may authorise a post mortem if:(a) The deceased had, during their life, expressed a wish for, or consented to, a post mortem

and they had not withdrawn such a wish or revoked their consent prior to their death; or(b) The deceased had not, during their life, expressed an objection to a post mortem and the

deceased’s senior available next of kin (SANoK) has not objected to a post mortem. If there is no SANOK, the Designated Officer may authorise a post mortem if they have satisfied themselves of the requirements in points (a) and (b) above.

Who is senior available next of kin?In relation to deceased adults, the order of senior available next of kin is as follows: Spouse Child (over 18 years of age) where above is not available Parent where none of above is available or the death involves a baby/child Sibling (over 18 years of age) where none of the above is available.

Information that the next of kin may needThe following points may assist in covering all issues that need to be discussed with the family/next of kin in order to obtain fully informed consent.

Reason for post mortemThe information to be gained can be surmised as follows: Confirm cause of death Provide confirmation of the clinical diagnosis Provide additional information about the cause or causes of death or other diseases

present Identify abnormalities that may be important for genetic counselling Where the death is a perinatal death provide information that may assist in managing

future pregnancies Give information on complications of treatment



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Be a form of medical audit.

The main incisions made at autopsy are in the midline from the neck to the pubis. A second incision is made over the back of the head to examine the brain. After the body is restored, and the body is suitably dressed, these incisions should not be visible.

In some circumstances, it is best practice to retain a whole organ to allow for subsequent detailed examination and this must be discussed with the SANoK during the consent process - refer to section 2.

The routine post mortem examination of baby/child usually involves taking clinical photographs (digital images) and X-rays prior to the autopsy.

Limited post-mortem examinationSome NoK may be reluctant to consent to a full post mortem. In these circumstances a limited post-mortem may be valuable, especially if it is directed to answering specific questions. Incisions are then usually more limited and the pathologist may even use recent surgical incisions, if appropriate. Whenever limited examination is being contemplated, discussion with the Anatomical Pathology Registrar or Anatomical Pathologist is advisable. If a limited post-mortem is desired the extent should be clearly stated on the consent.

The post mortem procedureAt the Canberra Hospital the post mortem examination will be performed by either an Anatomical Pathologist or Anatomical Pathology Registrar under supervision of the Anatomical Pathologist.

An Anatomical Pathologist is on-call and available for consultation at all times.

Contact the department of Anatomical Pathology: During working hours on extension 42867 and ask for Anatomical Pathology Registrar on

roster for post mortem. After hours, switchboard will contact the Anatomical Pathologist on call.

Autopsy Request FormsThe clinician requesting the post mortem must complete the Request and Permission for Post Mortem Examination form, available on the Clinical Forms Register.1. The clinician must complete the form with the SANoK as this is what the Designated

Officer will use to satisfy the appropriateness of the post mortem

Note: It is possible for this form to be completed by the patient in the days prior to their death. This overrides the need for a SANoK to complete the form.

2. The clinician must provide a detailed clinical history on the request form



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3. The names and contact details of anyone the post mortem results should be distributed to (i.e. SANOK, clinician, General Practitioner) should be included on the request form

4. The death certificate should be signed prior to the post mortem

Note:A death certificate is not required for fetuses less than 20 weeks gestation.

5. The case notes will also need to be reviewed by the Anatomical Pathologist or Anatomical Pathology Registrar and should be returned to Clinical Records with the completed autopsy request/consent form

6. The SANoK is required to sign the consent form, once the procedure has been explained, and all questions they have raised are answered

7. Designated officers will review the post mortem request and notes then counter sign the autopsy request/consent form once they have satisfied themselves that neither the deceased, nor their SANoK has expressed any objection to the post mortem. If the Designated officer is not satisfied with the information provided on the request form, they should contact the SANoK to clarify any points.


Section 2 – Tissue samples and organ retention

Post-mortem examination requires a wide range of tissue samples to be taken for histological examination, as well as some tissue and fluid taken for other tests. These samples are not returned to the deceased. These tests may include histological examination, microbiological examination, genetic examination, or in some cases, test for metabolic disease. In some circumstances, it is best practice to retain a whole organ to allow for subsequent detailed examination. The heart and brain are the most likely organs requiring retention.

It is important to discuss all samples that may be required with the Anatomical Pathology Registrar or Anatomical Pathologist prior to the Request for Post Mortem form being completed by the SANoK so that they are fully informed and can provide appropriate consent. While discussions about organ retention may be difficult to have with the SANoK, any hesitation to provide consent may be reduced if the clinician provides a full and thorough explanation regarding the process and why organ retention may be necessary. It should be explained that the implications of not retaining organs in some cases may mean that some important question about factors contributing to death may remain unanswered.



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Note:The placenta is an essential part of the perinatal autopsy examination and therefore, this should accompany the baby. It should NOT be placed in formalin to allow microbiology, cytogenetics and freezing of samples to be performed.

Occasionally during the post mortem examination the Anatomical Pathology Registrar or Anatomical Pathologist may feel there is a need to retain a whole organ for further examination of for teaching purposes which were not previously discussed with or consented to by the SANoK. In these cases the Anatomical Pathology Registrar or Anatomical Pathologist must contact the SANoK to obtain consent for retention of the organs.

Extreme distress can be caused to the NoK if they later discover that organs have been retained without their knowledge or consent.

Retaining tissue for teaching or research projectsResearch projects must be authorised by the ACT Health Human Research Ethics Committee and additional consent procedures will apply. Specific informed consent will need to be obtained from the SANoK or the patient in their lifetime if an organ is to be retained for teaching. In the latter case an additional consent procedure will apply. For all information regarding tissue donation, please contact the Anatomical Pathology department on 62442867.


Section 3 – Timing of post-mortem

Post mortem will be performed within 24-72 hours after death – usually the same or next working day. In selected cases, such as genetic or metabolic diseases, specimens may need to be obtained within two hours of death therefore it may be necessary to hold preliminary discussions with the next of kin about post-mortem prior to death where death is inevitable but questions remain. Occasionally for perinatal autopsies a step wise autopsy may be performed . For example, the brain may need to be removed for examination soon after death and then the baby is returned to family for a time before being returned to pathology to complete the post mortem examination.

Note:Where the deceased is a baby/child these specimens can be obtained, and then the deceased can be returned to the family until the family is happy for the formal post mortem examination to proceed. If this is the case, it may be necessary to obtain consent for this, in suspected cases, prior to death. For this, expert advice from the pathologist who would be undertaking the autopsy should be sought before discussing with the NoK, to clarify what is required.




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Section 4 – Post Mortem Results and Reports

The full post mortem report with specialised tests is usually available within 4-6 weeks, butmay take up to 12 weeks. In order to provide timely information, an interim report, based on naked eye appearances, will be available within a few days and should be sent to the requesting clinician, the SANoK, and the deceased’s General Practitioner if requested by the SANoK.

It will be the responsibility of the requesting medical team to advise the family/next of kin of the results and provide appropriate advice and genetic counselling if required. Note: for many perinatal death, the fetal medicine unit will have a follow up meeting with the parent/s 6 weeks following the death.


Section 5 – Options for the return and/or disposal of organs collected at post-mortem

If organs are retained during a post mortem, the following options are available for the return and/or disposal of organs:1. Return of organs to the body prior to the funeral. Note this may require delay of the

funeral2. Return of organs to the family after examination about 6-8 weeks later3. Disposal of organs with surgical specimens once testing is completed. This would be

completed in accordance with the Waste Management Guidelines for Health Care Facilities

4. For a baby <20 weeks gestation organs may be disposed of by Canberra Hospital, through cremation at the regular quarterly service organised through the Pastoral Care team.

Incident managementAny incidents related to post mortems must be reported in RiskMan (e.g. post-mortem requested but not performed, post-mortem (or element thereof) performed without correct consent). Refer to ACT Health Incident Management Policy and Procedure for further information.


Related Policies, Procedures, Guidelines and Legislation

LegislationTransplantation and Anatomy Act 1978

PoliciesConsent and Treatment Policy



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Incident Management Policy

ProceduresWhen Death Occurs Operational Procedure:Perinatal Loss - Clinical and Bereavement Digital Images Operational ProcedureIncident Management Procedure

Standards NPAAC (2013) Requirements for the Retention of Laboratory Records and Diagnostic MaterialNPAAC (2013) Requirements for the Facilities and Operation of Mortuaries


References

1. Australian Health Ministers’ Advisory Council, Subcommittee on Autopsy Practice (2002).The National Code of Ethical Autopsy Practice.

2. El-Nageh, M.M., Linehan, B., Cordner S., et al. (1999). Ethical Practice in Laboratory Medicine and Forensic Pathology, World Health Organisation, Eastern Mediterranean Series 20.

3. New South Wales Health. Waste Management Guidelines for Health Care Facilities 4. http://www1.health.nsw.gov.au/pds/ArchivePDSDocuments/PD2005_132.pd 5. NPAAC (2013) Requirements for the Facilities and Operation of Mortuaries 3rd edition6. NPAAC (2013) Requirements for the Retention of Laboratory Records and Diagnostic

Material 6th edition


Search Terms

Post Mortem, autopsy, post-mortem, retention, tissue, examination




http://www1.health.nsw.gov.au/pds/ArchivePDSDocuments/PD2005_132.pd

CHHS18/096

Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Policy Team ONLY to complete the following:Date Amended Section Amended Divisional Approval Final Approval 14/03/2018 Complete Review Sanjiv Jain, A/g ED

PathologyCHHS Policy Committee

This document supersedes the following: Document Number Document NameCHHS12/179 Post Mortem Examinations and Retention of Body TissueCHHS12/180 Post Mortem Examinations and Retention of Body Tissue - Adult PatientsCHHS12/181 Post Mortem Examinations and Retention of Body Tissue - Perinatal Patients



Download - Post Mortem Examinations and Retention of Body … · Web viewThis document applies to all clinical staff and other health care professionals in the Canberra Hospital and Health Services

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