Information for Relatives About Post Mortem Examinations on Adults v7

Patient Information

Bereavement Services

Author ID: KR

Leaflet ref: BS 004

Leaflet title: Information for relatives about post mortem examinations on adults

Version: 7

Last review: November 2022

Expiry date: November 2024

Talking it over 

We understand that this is a difficult time to consider such an issue, but we hope this leaflet will help you understand the reasons for undertaking a post mortem examination, what is involved and its potential value.

You will probably have lots of questions - in the first instance, talk to the Doctor or Nurse who was caring for your loved one, talk to other people about the decisions you have to make, but remember, the decision is ultimately yours. Try to talk to your family and friends or, perhaps, contact one of the organisations in the Hospital Booklet ‘Guidance and Support for Bereaved Relatives’.

If you don’t need a detailed explanation at present, please tell the Doctor who will inform the Consent Team of this when you are discussing the post mortem. 

What is a post mortem?

A post mortem is a detailed examination of your relatives’ body after their death. The examination is done as a means of looking into your relative’s illness or to provide an explanation as to why they have died.

Some post mortem examinations are legally required, others are not. 

Types of post mortem

The Post Mortem and Bereavement Services undertake two types of post mortems – Coroners and Hospital (when your consent is given voluntarily). 

Coroner’s post mortem

This examination is a legal requirement; so you will not be asked to give your permission. You should, however, be given an explanation of the process and the reasons for it. 

There is a dedicated team of officers working for the Coroner, who are available to provide information to bereaved families on sensitive issues surrounding a post mortem, such as:

• Why a post mortem is required.
• Why tissues / organs are required / retained for further investigations to establish the cause of death
• The results of the post mortem examination (cause of death)
• What disposal options are available for any tissues / organs retained once the Coroner’s investigation is complete 
• Inquests should this be necessary following the post mortem examination (this is an inquiry into who has died, how they died and when and where the death occurred).

Hospital post mortem

This examination is not a legal requirement; a post mortem of this kind cannot be undertaken without consent, so you will be asked to give your permission for it to go ahead. 

Where the wishes of the deceased are not known and there is no personal representative then there is an order of ranking for giving consent, i.e. Wife or Husband; Son or Daughter etc.  It is advisable to seek the opinions of other members of the family before giving consent, as this can often lead to family disputes when there are strong objections.  It should be noted that families do not have the legal right to veto or overrule the deceased’s wishes.

Where will the post mortem take place?

Coroners’ post mortems will be carried out in the Royal Albert Edward Infirmary mortuary by trained Pathologists who work on behalf of the Coroner.

A hospital post mortem may be carried out in the mortuary at Royal Albert Edward Infirmary, dependent on the availability and agreement of the Honorary contracted pathologist, or the deceased will be transferred to Salford Royal Infirmary for one of their pathologists to undertake this on behalf of our Trust.

Coroner’s post mortem examinations 

This is an examination carried out by law under the instruction of H.M. Coroner.  Consent is not required for this type of post mortem examination, but the next of kin can be represented by a medical representative of their choice; i.e.  patient’s G.P.

The Coroner will decide from the information provided by the hospital doctors if it is necessary to have a post mortem examination.  Should the Coroner authorise a post mortem he/she will also request the services of a specialised Doctor; a Pathologist who works under the Coroner’s direction in the Mortuary, to carry out a full and thorough examination of the body. 

Hospital post mortem (where consent is given voluntarily)

This type of post mortem examination requires no involvement from the Coroner.  It could mean that the Doctors may have spoken with the Coroner who has instructed them to issue a Medical Certificate of Cause of Death, or the doctors are in a position to issue this certificate due to natural causes.

You may be asked permission for a Hospital post mortem by your relatives Consultant or their Registrar; this is not to establish the cause of death but to help you and the clinical staff to understand your relative’s illness in greater detail or to contribute to teaching by helping to increase medical knowledge. 

It is entirely your decision to give permission for a Hospital post mortem and you must give this permission freely.

If you accept the request, you will be provided with the relevant information to read thoroughly prior to making the decision to continue (See leaflet on giving consent for a post mortem).

The Post Mortem and Bereavement Services Team will arrange to meet with you or you and your family to complete the necessary paperwork and discuss any concerns you may have.

A Hospital post mortem examination may be ′full′ or ′limited′, but a limited examination may not provide a full explanation as to the cause of death, the Consent Team will discuss this issue if this type of examination is requested.

Further information about your loved one’s post mortem examination 

Whether the post mortem has been ordered by the Coroner or requested by your Hospital Doctor, the way it is carried out is the same and it will normally be within 2 to 3 working days of the death.  Post mortems are performed in the Post Mortem Suite by a team of trained staff (Pathologist and Technologists).  The Pathologist is a fully qualified Doctor who has had specialised training in Pathology, the study of disease process.

Pathologists and Technologists, like all Doctors, are bound by a strict code of conduct and will always treat your loved one with dignity and respect.  The Pathologist works to strict guidelines that are set out by the Royal College of Pathologists and acts under the direction of the Coroner.

The post mortem procedure involves the thorough examination of the outside of your loved one’s body, sometimes involving taking photographs and possibly X-rays.  The next step is to remove and examine all the major internal organs.  This is carried out in a similar way to an operation, with incisions made to the chest and abdomen and under the hairline.  Each organ in the chest and abdomen is removed and examined by the pathologist and then put back inside his or her body. 

On rare occasions the brain may require an examination by a Neuropathologist.  This could be a longer process and may take up to 4 to 6 weeks before the brain can be examined due to procedures it has to go through and therefore cannot be returned to the body immediately, on completion of the post mortem examination. During the examination it may be necessary to remove small blocks of tissues usually 1cm² to 2cm² which are transferred to the Laboratory for processing for a more detailed microscopic investigation.  Consent is not required for tissue to be taken in the event of a Coroners’ post mortem as it may be required to establish the cause of death. 

Occasionally the deceased or samples may have to be transferred to another Hospital for specialist examination e.g.  Specialist post mortem, diagnostic or histological tests.  You will be informed of which Hospital is involved when the deceased is transferred and if they will be returned to this Hospital.

X-rays or other images may be taken during a post mortem examination and will be retained as part of the deceased’s medical records.  If these are used for teaching or ethically approved research, then the patient’s identity must be removed.  Once the examination is complete a team of trained Technicians will be on hand to close all incisions made by the Pathologist.

Consent must be given by you or personal representative or the Coroner for Medical Students / Nursing Students to attend the examination for educational purposes.

If you would like a more detailed discussion about the post mortem report when it is available, you can ask for an appointment with the Hospital Doctor to discuss it, or this may be suggested to you. 

The Hospital Mortuary staff or the Coroner’s Office should be able to give you an approximate time when your loved one will be ready for release to your Funeral Director.

Retaining samples, tissues and organs

Sometimes it is difficult to get enough information from the outward examination of whole organs.  In this case, the Pathologist will remove small samples of tissue as indicated above; these are sent to the Laboratory for processing.  These samples will usually be treated with chemicals and have wax added so that they can be made into a block.  This can then be sliced very thinly so that sections can be examined under a powerful microscope.  These samples - blocks and slides - form part of your loved one’s medical records and so will be retained indefinitely unless you decide otherwise. 

When your permission for a Hospital post mortem is sought, you will also be asked for permission to keep samples of tissue, or sometimes, whole organs like the heart or brain.  If you do not want to postpone the funeral in the case of a detailed and lengthier examination of the brain, you will be asked what to do with the samples or organs once the examinations are finished. You may want a separate service to reunite them with your loved one, or you can request disposal of them in a respectful way at the Hospital. 

Occasionally a Doctor may ask your permission to retain samples or organs indefinitely so that they can be used to research your loved one’s illness in more detail, or to teach other Doctors.  Whether or not you agree is entirely your choice - nothing will be kept without your express permission.  If you change your mind at any time, and wish to have the samples or organs returned to you, contact either H.M. Coroner or the Mortuary where the post mortem was undertaken.

Consent for the retention of tissue during a Coroner’s post mortem is not required, as this may be needed to establish the cause of death.  Once the Coroner has completed their investigations you will need to decide upon the disposal option you require, a member of the Coroner’s Office will discuss these options with you. 

If a Hospital post mortem has been undertaken, the disposal options are slightly different than those of the Coroner. The next of kin or representative will have been informed of the disposal methods available and will discuss the options with the Consent Team.  The option chosen will be specified on the consent form. 

Viewing the deceased after post mortem examination 

It is quite usual to want to see your loved one again; if you wish this can be done in the mortuary viewing room after the post mortem examination or at your Funeral Director’s Chapel of Rest. You may have questions about how your loved one will look.  Each deceased is different, but you should expect the following: the post mortem examination will have been done in a sensitive way, with all the incisions hidden by your loved one’s clothes, shroud or hair, and will not be obvious to you by just looking.  You may also notice the normal changes that happen after death, which are unconnected with the post mortem examination.  Your loved one’s skin may look dry or flaky, lips and nails may look redder than previously. You may also notice marks on your loved one’s skin that look like bruises.  These are not bruises, but marks from where the blood settles when the heart stops beating.  Your loved one will also feel very cold.  If you have any questions about their appearance when you see him or her, please talk them over straight away with either the Mortuary Staff or Funeral Director. They will almost certainly be able to reassure you. 

There may be rare occasions where viewings cannot be undertaken due to circumstances that determine otherwise but the Technical Staff or your chosen Funeral Director will advise you of this.

If you would like to talk to the Bereavement Specialist Liaison Nurse about the death of your loved one, you may like to contact the bereavement services on 01942 773548 / 773598 or via the hospital switchboard on 01942 244000; the Bereavement Nurse will help and support in dealing with your loss.

Arranging the funeral

You will be able to arrange the details (but not the date) of the funeral, you will require the Medical Certificate of Cause of Death before the Registration of death is undertaken, unless the Coroner is involved.  Once the Coroner’s post mortem examination has been completed, the Coroner will issue the paperwork required to register the death.  More details of how to do this are contained in the booklet ‘Guidance and Support for the Bereaved’ which your nurse will have given you.  After this you will be able to confirm and finalise the arrangements for your loved one’s funeral. 

If the Coroner opens an inquest, a death certificate will not be issued; instead an interim death certificate will be provided, to allow you to proceed with funeral arrangements.  The Coroner will also provide your funeral director with a cremation form “E” or “burial order”.  Only after the conclusion of the inquest will you be provided with a certified death certificate

If after reading this leaflet you have any concerns, please do not hesitate to contact the Technical Staff on 01942 822000 (Monday to Friday 8am to 4pm).