(ARME) Properties and Requirements of Autopsy Lesson

Properties and Requirements of Autopsy

Autopsies are usually performed by a pathologist who is specifically trained in post-mortem examinations. They are usually performed to determine the cause of death, though this is not always possible. They are also performed for various reasons such as:

  • To verify or exclude a disease diagnosis made prior to death. This can help families to decide if further testing or treatment is indicated for them in the case of genetic diseases.
  • To help practitioners understand the progression of a particular disease or the effectiveness of a treatment.
  • To document the presence of an undiagnosed disease.
  • To collect evidence for criminal cases or to help government agencies, such as the CDC, track public health hazards and epidemics.

Family consent is required before an autopsy is performed in cases where autopsy is not required legally. Medicolegal deaths, or deaths that require an official examination by a coroner or medical examiner, legally require autopsy. Medicolegal autopsy requirements vary by state, but generally an autopsy is legally required in the following circumstances:

  • Death by homicide, suicide or accidents
  • Death amidst unusual circumstances when foul play is suspected
  • Deaths in the workplace
  • Death by a disease or agent that is a threat to public safety
  • Death of a person in custody or incarceration
  • Death of a person who is institutionalized (such as in a mental health facility)
  • Hospital deaths where the person was unconscious when admitted or who died within 24 hours of admission
  • Deaths of adults after medical procedures or anesthesia
  • Deaths resulting from injuries sustained a significant time before death such as post-operative complications with blood clots
  • All obstetric deaths
  • Deaths in which the cause is not known with any degree of certainty
  • All newborn and child deaths (This includes typical causes of child death and less common, such as SIDS deaths, deaths from anesthesia or medical procedures and parental drug abuse)
  • Deaths of people who received an organ transplant within 60 days prior to death

Families sometimes choose not to have an autopsy on their loved one due to ethical and religious objections. Families often state that they fear their loved one being disfigured by the autopsy, that their loved one has "suffered enough" or that it will delay or interfere with funeral arrangements. In the case of religious objections, most major religions allow at least limited autopsy when needed. Autopsy is accepted in most circumstances in the majority of the branches of Christianity, Buddhism, Church of Jesus Christ of Latter Day Saints, Jehovah's Witness, Shinto, Taoism and Confucianism. Autopsy is accepted in limited circumstances in Judaism, Islam, Hinduism and Sikhism.

In clinical or medical autopsies, or those not required by law, the family's permission must be acquired or no autopsy can be performed. In medicolegal, or required autopsies, the family's consent is not needed. These types of autopsies may also be called "Forensic Autopsies". In the case of significant protest to the autopsy by the family due to religious or ethical objections, decisions are made by a judge on a case by case basis.

Autopsy Procedure

evidencebag.jpgBodies arrive at the medical examiner's office or hospital in a body bag or evidence sheet. Body bags are always new and are not reused so that only evidence pertaining to that body is in contact with the body bag. They are always closed and sealed during transport so that no evidence is contaminated or lost. Evidence sheets are sterile sheets used to drape over a body during transport. Just as with body bags, evidence sheets are never reused. After transport, the body is brought into the examination area by a diener. A diener is an assistant in the morgue who is responsible for moving and cleaning the body and exam room throughout the autopsy process. They also sometimes assist with the autopsy. If the body is not autopsied immediately, the diener will transport the body to be stored in the morgue in refrigerated storage. When the body is ready to be examined externally, the seals on the body bag are broken or the sheet is removed and the body is photographed before being moved onto the examination table. The medical examiner carefully observes the deceased person's clothing and notes the state and position of the clothing. Evidence is collected from the surface of the body such as hair samples, fingernail clippings, gunshot residue, fibers, glass fragments, paint chips, and other foreign objects.

Next, the body is examined with a UV light to search for other evidence such as body secretions. Before the body is cleaned, it is examined for obvious wounds. After the initial examination, the body is cleaned, weighed and measured. The body is then placed on a slanted aluminum examination table with raised edges, faucets and drains. The faucets and drains are used to wash away blood that collects during examination. The body lies face up with a "body block" placed under the back. The body block is a piece of plastic or rubber in the shape of a brick that raises the chest up for easier incision.

Before making any incisions, the body is thoroughly described in the autopsy notes with the following information: race; sex; hair color/length; eye color; estimation of age; identifying marks such as tattoos, birthmarks or scars; evidence of medical treatment; and x-rays made of the body.

Lastly, a blood and Vitreous Humor sample is taken to submit for toxicology testing. Vitreous Humor is the liquid part of the eye and is used in Toxicology testing. Drugs remain in the Vitreous Humor longer than in the bloodstream, so it is often tested to look for traces of drugs in the body.

Interactivity: Autopsy Procedure

Autopsy Tools

Autopsy tools have changed very little in the past 100 years. Below are some of the most commonly used tools of autopsy:

Bone Saw - Used to cut through bone or the skull.

Bread Knife - Used to slice small, thin sections of organs for microscopic examination.

Enterotome - Scissors used to cut open the intestines.

Hagedorn Needle - A thick, heavy needle used to stitch up the tissue flaps after examination.

Hammer With Hook- Used to remove the skull cap.

Rib Cutter - Shears used specifically to cut through ribs.

Scalpel - Tool for making incisions; the one used in autopsy has a large blade for making long, deep cuts.

Scissors - Standard surgical scissors are used for cutting open organs and vessels.

Skull Chisel- Assists in skull cap removal.

Stryker saw - Electric saw used to cut through the skull.

Toothed Forceps - Similar to large tweezers, these are used to lift large organs.

While the tools for standard autopsies have changed very little in the past 100 years, new technology has allowed for a new type of autopsy methodology known as "Virtual Autopsy". Virtual Autopsy uses imaging techniques such as CT Scans or MRI Scans to process the body's external appearance and inner structures. It allows for non-invasive, detailed images from inside the body without the need to cut the body open. While it is currently used in some situations to supplement standard autopsies, the technology is not yet developed enough or accessible enough for the majority of death investigations. The equipment is quite costly and many limited county and state budgets can't afford it. As the technology continues to improve and becomes more affordable, other uses for this technology are also coming to light. Doctors may some day use this technology to help diagnose issues without the need for exploratory surgeries as they sometimes must do currently. 

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