Consent for autopsy.

Abstract

With their postal questionnaire, Dr Williams and colleagues found that just 4% of consultant histopathologists were actively involved in consenting for autopsy and only 20% expressed a willingness to be involved (November 2002, JRSM1). Most histopathologists (89%) felt that the clinician involved in the patient's care should be responsible for obtaining consent. Clinicians have the advantage of knowing the clinical history and indication for post mortem and may have developed a rapport with the relatives. However, clinicians often have a limited understanding of the process of post mortems and the issues surrounding the retention and disposal of organs and tissues. The pathologist performing the post mortem cannot be sure that consent obtained by a clinician is truly informed. We are conducting research into sudden unexplained death in young adults, aged 16 to 39. Our study involves obtaining informed consent from bereaved families to retain tissues and blood from post mortem for research purposes. To provide a recently bereaved relative with the information required for fully informed consent to a post mortem and the retention of organs or tissues is difficult and time-consuming, taking up to 3 hours. This is logistically impossible for both pathologist and clinicians. The public outcry after the Alder Hey and Bristol enquiries has placed informed consent for autopsy and retention of organs and tissue as a major priority. We feel that each trust should have a dedicated trained bereavement adviser, who would be responsible for obtaining informed consent for autopsy and retention of organs/tissues for diagnostic, research or donation purposes. The bereavement adviser would receive training in bereavement counselling, obtaining informed consent, the process of autopsy and issues surrounding retention and disposal of organs/tissues. They would be an important point of contact for bereaved relatives and would liaise closely with clinicians, pathologists, the coroner and primary care services (e.g. general practitioners and counsellors). A bereavement adviser seems the sensible way to provide a comprehensive service to bereaved relatives. This can only be achieved if the Department of Health supports trusts with extra funding which is ring-fenced for such a bereavement service.