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Aims: After the so called "organ retention scandal" in the UK this study set out to assess the impact on death certification and hospital (consent) necropsies, including the postmortem retention of tissues and organs.
Methods: Data were prospectively gathered over a one year period for all deaths occurring at the Royal Hallamshire Hospital, Sheffield, UK to determine the frequencies with which death certificates were completed and necropsies were requested. The seniority of the clinician undertaking these duties was recorded. Pathologists were asked to record the extent of every necropsy during the study period. The type and planned uses of tissues retained were recorded.
Results: Death certificates were issued for 88.5% of the 966 deaths for which clinicians completed proformas. Of these, 88.9% were issued by preregistration and senior house officers. Consent was sought for a necropsy in 6.2% of cases (usually by non-consultant staff) and was granted in 43.4% of these. The overall, medicolegal, and hospital necropsy rates were 13.4%, 9.9%, and 3.5%, respectively. Tissues were retained from 55.4% of necropsies for diagnostic purposes, although sampling does not appear to be systematic.
Conclusions: Death certification and seeking consent for a necropsy are frequently delegated to junior clinical staff. This may explain the low standard of death certification reported by others and the low necropsy rate. The decline in the necropsy rate and the low rate of sampling for histological examination highlight the decline of the hospital necropsy and the lack of a systematic approach to tissue sampling.
That the necropsy is a valuable procedure in modern clinical practice (1-7) and medical education (8-16) has been repeatedly and well established. Nonetheless, previous studies have indicated the gradual but persistent decline in the necropsy rate both in the UK (17,18) and in the USA. (19)
Necropsies have never been under as much scrutiny from the public, the media, the government, and the medical profession. In 1991, guidelines were published to assist those involved in seeking consent for non-medicolegal necropsies. (20) In addition, the Royal College of Pathologists (UK) set out recommendations for the extent of postmortem examinations, including an indication of the nature and minimum number of tissue samples to be retained for histopathological evaluation. (21) (More detailed guidelines on necropsy practice were published by the Royal College of Pathologists after our study was completed (22).) The inquiry into paediatric necropsy practices at the Royal Liverpool Children's Hospital (Redfern report (23)) and the associated media coverage of these events have damaged the public confidence in, and the reputation of, postmortem pathologists. (24)
"Necropsies have never been under as much scrutiny from the public, the media, the government, and the medical profession"
In May 2001, we set out to determine prospectively the nature of necropsy practice in our hospital. In particular, we wished to determine who was issuing death certificates, the frequency of requests for hospital (consent) necropsies, the frequency with which such requests were granted, and who was asking (and being asked) for consent. In addition, we wished to know the frequency with which complete, limited, and needle necropsies were performed, the reasons for limiting necropsies, the frequency with which tissues and organs were retained at necropsy, and the reasons for such retention.
Our study took place between May 2001 and April 2002 at the Royal Hallamshire Hospital, Sheffield, UK. This is a major 850 bed teaching hospital with busy surgical and medical units. In addition, the mortuary undertakes necropsies on patients dying at the local oncology hospital and the local women's hospital as required.
Determining the death rate and necropsy rates
The mortuary records for the Royal Hallamshire Hospital from 1979 to 2001 were examined to determine the number of bodies received by the mortuary each year, the number of …