Test Overview
An autopsy is a medical procedure that
consists of a thorough examination performed on a body after death, to evaluate
disease or injury that may be present and to determine the cause and manner of
a person's death.
The decision about an autopsy occurs at a
difficult time for most families since they have just lost a loved one.
Counselors or spiritual advisors who specialize in bereavement services may be
available to help families through the process. Family members may consider an
autopsy:
- When a medical condition has not been
previously diagnosed.
- If there are questions about an unexpected
death that appears due to natural causes.
- If there are genetic
diseases or conditions that they also may be at risk for
developing.
- When the death occurs unexpectedly during medical,
dental, surgical, or obstetric procedures.
- When the cause of death
could affect legal matters.
- When the death occurs during experimental treatment.
For more information, see:
An autopsy may be required in deaths that have medical and
legal issues and that must be investigated by the
medical examiner's or
coroner's office, the governmental office that is
responsible for investigating deaths that are important to the public's health
and welfare. Deaths that must be reported to and investigated by the medical
examiner's or coroner's office can vary by state and may include those that
have occurred:
- Suddenly or unexpectedly, including the sudden
death of a child or adult, or the death of a person who was not under the care
of a doctor at the time of death.
- As a result of any type of injury, including a fall, motor
vehicle accident (MVA), drug overdose, or poisoning.
- Under suspicious circumstances, such as a
suicide or murder.
- Under other circumstances defined by law.
In some of these deaths an autopsy may be required, and the
coroner or medical examiner has the legal authority to order an autopsy without
the consent of the deceased person's family (next of kin). If an autopsy is not
required by law, it cannot be performed unless the deceased person's family
gives permission.
An autopsy is generally performed by a doctor
(pathologist) who has training and expertise in the
examination of body tissues and fluids.
Why It Is Done
An
autopsy is done to:
- Determine as precisely as possible what caused
the death. This can sometimes give family members information about
diseases or conditions that they also may be at risk for developing.
- Confirm or exclude a disease diagnosis made before death (such as
Alzheimer's disease). An autopsy also may be done to
help understand how a given disease progresses or to determine the
effectiveness of the treatment for that disease.
- Document the
presence of a disease that was undiagnosed before death.
- Collect
samples of body fluids or tissues for possible genetic testing. This is
generally done only after discussion with the deceased person's
family.
- Collect evidence and information in criminal
cases.
- Help health departments or other government agencies
identify and track a disease or potential public health hazard (such as a
suspected contagious disease or contaminated drinking water).
How To Prepare
When an autopsy is not required by law,
permission from the deceased person's family is required before the autopsy is
done. The laws governing who can give permission for an autopsy vary from state
to state. Generally, a consent form must be signed in the presence of a
designated witness. Some areas may allow witnessed phone consent
instead.
How It Is Done
Before the actual autopsy, as much
information as possible is gathered about the person who died and the events
that led to the death. This includes reviewing medical records and consulting
with the person's doctors about previous medical problems. Other information
may be gathered by interviewing family members, investigating the area where
the person died, and studying the circumstances surrounding the death.
Depending on the circumstances of the death, law enforcement and the medical
examiner's or coroner's office may be involved in the investigation.
Procedures done during the autopsy may vary depending on the
circumstances surrounding the death, whether the medical examiner or coroner is
involved, and what specific issues are being evaluated during the autopsy. In
some cases, family members agreeing to the autopsy may limit what can be done
during the autopsy.
The autopsy begins with a careful examination
of the external part of the body. Photographs may be taken of the entire body
and of specific body parts. X-rays may be taken to evaluate skeletal or other
abnormalities, confirm injuries, locate bullets or other objects, or to help
establish identity. The body is weighed and measured. Clothing and valuables
are identified and recorded. The location and description of identifying marks,
such as scars, tattoos, birthmarks, and other significant findings (injuries,
wounds, bruises, cuts), are recorded on a body diagram.
A complete
internal examination includes removal of and dissection of the chest,
abdominal, and pelvic organs and the brain. The examination of the trunk
requires an incision from the chest to the abdomen. The removal of the brain
requires an incision over the top of the head. The body organs are examined
before removal, then removed and examined in detail.
In some
cases, organs may be placed in a preservative called formalin for days to weeks
prior to dissection. This is particularly important in the examination of the
brain for certain types of diseases or injuries. Tissue samples are taken from
some or all of the organs for examination under a microscope. Samples of blood,
organs, and body fluids may be removed and preserved to test for drugs or
infection or to evaluate chemical composition or genetics. Samples may include
blood from the heart or blood vessels,
vitreous gel from the eyes,
bile from the gallbladder, contents of the stomach,
urine, and tissues from organs, such as the liver.
Completion of
the autopsy may require examination of tissues under a microscope, further
investigation of the circumstances of death, or specialized tests (such as
genetic or toxicology tests). The tests performed may vary based on the
findings at the autopsy dissection, the circumstances of death, the questions
asked about the death, and the condition of the tissues and body fluids
obtained at autopsy. Toxicology testing is not generally performed in every
autopsy, particularly those not required by law. Genetic testing is not usually
done unless the family has been consulted. A written report describes the
autopsy findings. This report may address the cause of death and may help
answer any questions from the deceased person's doctor and family.
If the autopsy was required by law, after the autopsy is completed, the
pathologist, coroner, or medical examiner completes and signs the cause and
manner of death on the death certificate. If the autopsy was not required by
law, the doctor caring for the person prior to death often signs the death
certificate and may complete it before the results of a family-requested
autopsy are known.
How It Feels
Family members may have concerns and
strong emotions about an autopsy being done on a loved one. It is important
that the family understand that the autopsy is a medical procedure performed
respectfully and carefully, to objectively evaluate disease or injury that may
be present and to determine the cause and manner of the loved one's
death.
Risks
There are no risks from the actual autopsy. But
an autopsy may uncover the effects of habits or diseases that people close to
the deceased person did not know about. For example, the pathologist may find
cancer during the autopsy, or examination of the liver may show
cirrhosis, which can occur from the overuse of
alcohol.
Results
An autopsy is a medical procedure that
consists of a thorough examination performed on a body after death, to evaluate
disease or injury that may be present and to determine the cause and manner of
a person's death. Following the autopsy, it may take several weeks for the
results of specialized tests to be completed. For this reason, a final written
autopsy report may take weeks to months. The
pathologist or deceased person's doctor may speak
directly to the family after the dissection portion of the autopsy and again
after the final autopsy report is complete.
After performing the
autopsy, the pathologist will generally make a statement about the cause and
manner of death. Manner of death is defined as natural or unnatural. A natural
death means the death occurred as a result of a disease or from the natural
effects of old age. Some examples of natural causes include:
- Damage to the heart caused by heart disease, a
heart attack, or
heart failure.
- Damage to the brain caused by conditions such as tumors,
bleeding,
stroke, poorly controlled
epilepsy,
diabetes, or
Alzheimer's disease.
- Damage to the lungs
caused by a blood clot, bleeding, or
pneumonia.
- Damage to organs in the
abdomen, such as the stomach, spleen, liver, or kidneys.
An unnatural death means the death resulted from an
unexpected, unusual, or suspicious cause. If an injury caused or
contributed to the death, the manner of death is called unnatural. Unnatural
manners of death are homicide, suicide, accident, and undetermined. Unnatural
deaths generally are investigated under authority of the medical examiner or
coroner, and the determination of the manner of death requires a detailed
investigation of the circumstances surrounding the death. Some unnatural causes
of death include:
- Bullet wounds.
- An automobile
accident or plane crash.
- Fire, drowning, or
electrocution.
- Death resulting from extreme heat or
cold.
- Poisoning or drug overdose.
What Affects the Test
Several things can interfere
with the autopsy and the results.
- Ideally, an autopsy should be done in a timely
fashion, generally within several days of death. In some cases, such as
evaluation for metabolic disease in an unborn baby (fetus) or
infant, prompt tissue sampling is important to improve the likelihood of
establishing a diagnosis. But even after a number of days, an autopsy may still
provide useful information.
- The training and experience of the
pathologist may influence the quality of the autopsy. Access to consultant
pathologists with training in specialized areas and to other experts, such as
toxicologists and geneticists, may be helpful in complicated cases. For
example, neuropathologists have special expertise in the diagnosis of
neurological (brain) diseases; pediatric pathologists may have special
expertise in diseases of infants or unborn babies. Families may wish to talk with
their doctor for assistance in finding a competent, experienced
pathologist.
- Autopsy procedures may differ for each deceased person
depending on the medical history of the person, the circumstances surrounding
the death, questions the person's doctors and family members would like
answered, and the findings at the initial dissection. It is important that the
family members and doctors discuss their questions and concerns with the
pathologist before the autopsy is performed, so that the autopsy can be
individualized and samples can be obtained that may allow performance of
specialized tests. Samples may not be retained for specialized tests (such as
genetic, toxicology, or paternity testing) unless specific requests are made at
the time of the autopsy.
- Autopsy is not an accepted procedure for
some cultures, ethnic groups, and religions. If an autopsy is not required by
law because of the circumstances of death, it will not be performed unless the
family gives specific permission.
What To Think About
- Organ or tissue removal for donation purposes
requires separate permission from an autopsy.
- If a family requests an autopsy, the consent form generally
describes the details of the autopsy, especially with respect to retention of
organs and tissues for teaching. The requesting family member should make sure
that the details of the autopsy are fully understood.
- A family can
request that a hospital do an autopsy on a person who died there. In some
hospitals there is no charge for this service. In some teaching hospitals, a
person who died outside of the hospital (for example, at a nursing home or at
home) may be autopsied at the hospital at no charge. If an autopsy is required
by law, there is no charge to the family. But charges should be clarified
before the procedure is performed since many hospitals charge for autopsies and
insurance generally does not pay for autopsies.
- An autopsy does not
prevent the body from being viewed in an open casket. Generally, none of the
incisions made during the autopsy will show after the body is prepared for
viewing. The rare exception to this is with autopsies in which injuries on the
face, scalp, or hands are evaluated. These autopsies may leave some marks that
are visible during viewing of the body.
- If an autopsy is being
performed at the request of the family, the family may request that the
examination be restricted or limited to certain parts of the body. It is
important to discuss these restrictions with the pathologist to ensure that the
requested examination allows the pathologist to answer the family's questions
about the death.
- Autopsies to determine natural causes of death are
not done as often now as they were in the past. But when death has most likely
occurred from natural disease, an autopsy can uncover information that is very
valuable to the deceased person's doctor and family.
References
Other Works Consulted
- Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis:
Saunders.
- Fischbach FT, Dunning MB III, eds. (2009).
Manual of Laboratory and Diagnostic Tests, 8th ed.
Philadelphia: Lippincott Williams and Wilkins.
Credits
| By | Healthwise Staff |
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| Primary Medical Reviewer | Kathleen Romito, MD - Family Medicine |
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| Specialist Medical Reviewer | Corinne L. Fligner, MD - Anatomic Pathology |
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| Last Revised | May 12, 2011 |
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