Many people believe that autopsies should only be performed when there is uncertainty as to the cause of death. Although this is a valid reason for an autopsy, it is not the only reason. The purpose of an autopsy is two-fold: 1) to thoroughly evaluate the presence and extent of human disease in patients and 2) to evaluate the effectiveness of therapeutic procedures for the benefit of patient families, our staff, and the future practice of medicine. The personnel involved in the autopsy are able to see the physical manifestations of human disease during the post-mortem examination. The results of the autopsy are also used to develop quality assurance data and health care quality outcome measures for the Yale New Haven Hospital.
An autopsy can be reassuring for the family. As part of the autopsy consent process, the family has the option to place limitations on the both the retention of organs and the extent of the autopsy. Please note that any limitations may compromise the diagnostic value of the autopsy, or may limit the usefulness of the autopsy for education, quality improvement, or research purposes. These items are discussed below.
Autopsies are diagnostic by nature, and can help a family learn more information about the disease processes that caused a patient’s demise. For example, an autopsy could identify an unknown primary cancer, or it can allow doctors to perform examinations that were not feasible when the patient was alive. An autopsy offers clinicians the best opportunity to obtain a more complete understanding of why the patient passed.
Autopsies provide an opportunity for clinicians, residents, medical students, pathologists’ assistant students, forensic science interns, and our staff to learn more about various disease processes and how they manifest in the body. Tissue may be used in certain programs at the Yale School of Medicine to further the education of students. In addition, some cases are used in various presentations to help others understand rare and complicated cases. All educational tissue procured from autopsies is utilized in accordance with the Health Insurance Portability and Accountability Act (HIPAA) privacy laws.
The Joint Commission for the Accreditation of Health Care Organizations (JCAHO) requires that the results of autopsies be incorporated into the quality assurance program of the hospital. Autopsy clarification/discrepancy information is recorded to document instances in which the autopsy examination added to, clarified, or altered the clinical understanding of the case.
Each clarification/discrepancy is graded by assigning it to one of the following levels:
0. Indicates that the case had no clarifications or discrepancies.
I. Major unexpected finding or clarification contributing to the patient’s death.
II. Major unexpected finding or clarification that did not contribute to the patient’s death.
III. Minor unexpected finding or clarification contributing to the death of the patient.
IV. Other minor unexpected finding or clarification that might have eventually required treatment.
Yale New Haven Hospital supports a variety of ongoing research projects. The Tissue Procurement team ensures that all protocols are vetted, and are responsible for acquiring the necessary tissues for these projects. Occasionally, the autopsy is limited to recovery of tissue for a particular program. If the clinician’s contact information is included on the consent, the autopsy staff can coordinate with the clinical team to ensure proper recovery and preservation of the tissue.
The restrictions on the autopsy consent dictate whether the autopsy is considered to be a technical only. A technical only autopsy is done at the exclusion of diagnostic, education, quality improvement, and research purposes. There are a variety of reasons that the autopsy would be considered a technical only autopsy. Examples include 1) the removal of hardware to be sent back to the manufacturer for testing, and 2) the removal of brain or other tissue to be sent out to another facility.
Autopsies have been performed on individuals of all religious backgrounds, and many major religions leave this decision to the next-of-kin. However, you may wish to consult with your priest, minister, rabbi, or other religious leader before providing consent for an autopsy. When necessary, the autopsy staff can coordinate with a specified religious leader to ensure the family’s religious needs are met.