Introducing virtopsy into a country religiously opposed to autopsy

Abstract

Purpose To evaluate accomplishments and challenges in introducing virtopsy to the pediatric forensic post-mortem examination. This in a country (Israel) requiring family consent, with religious opposition from most of the population (Jewish, Muslim, Christian and Druze) to autopsies and even to shipping the body from one location to another before final interment. What lessons can be learnt applicable to similar communities. Materials and methods Data was collected from the National Center of Forensic Medicine in Israel during the 18 month period introducing post-mortem imaging (Group A) carried out in a medical center located miles away from the Forensic Center. There was limited daytime access to imaging devices, resulting in interment delay. The data was compared to the previous 18 months (Group B). The examined parameters were cases submitted, those examined, autopsied or imaged depending on family consent. Results Out of all cases consent to autopsy was similar (A=56% vs. B=54%). Of all cases in Group A, consent for imaging was 24%. Of those imaged, 77% underwent autopsy. Of those examined externally only, 16% consented to imaging. For 7% of total cases in Group A, estimation of cause of death was based on virtopsy alone. Conclusion In a country with high religious opposition to post-mortem forensic procedure, there are challenges to making virtopsy an integral part of the pediatric forensic post-mortem protocol. At this point those consenting to post-mortem imaging are more likely to agree to the performance of autopsies. Even with the difficulties, some we have identified, there was an immediate increase of 7% of cases where a possible cause of death would not otherwise be given. Virtopsy does not breach religious doctrine in Israel, and might partially substitute autopsy.