Consent
The first step of a post-mortem is to obtain consent. This is not the case when a post-mortem is requested by a coroner because then the post-mortem must take place by law.
Direct consent
It is possible for the hospital to obtain consent for a post-mortem directly from the person before they die. If the person gave their consent, that decision cannot be overruled by the next of kin.
However, the person does not have to give their consent, or they may wish to limit the scope of the post-mortem. For example, they can request that no tissue samples or organs are removed. In these circumstances, the pathologist may decide not to carry out the post-mortem at all, if it is felt that restrictions would prevent any useful information from being obtained.
Nominated representative
Sometimes, a person may nominate a representative to act on their behalf after their death. In this case, the hospital requesting a post-mortem must obtain written consent from the deceased's nominated person.
Next of kin
If no direct consent is obtained and there is no nominated representative, consent will then be sought from the next of kin.
The Human Tissue Act, which is the law that governs post-mortems, ranks relationships to the deceased in order of importance (see box, top left). Consent is obtained from the highest ranked existing relative on the list.
The Secretary of State for Health can override the wishes of the next of kin and order a post-mortem to go ahead. However, this power is reserved for only the most exceptional circumstances, such as a public health emergency.
The examination
The body will be moved in a respectful manner to the place where the examination will be carried out. This is normally the hospital mortuary.
The pathologist is usually assisted by a mortuary technician. Medical staff may also be present to observe the examination as part of their training. The pathologist does not need your consent for this, but if you are unhappy at the prospect, you should let them know. The pathologist will respect your wishes.
Pathologists perform their examination to standards set by the Royal College of Pathologists. One of the most important standards is that the examination must be carried out in a respectful manner and with full regard for the feelings of the bereaved relatives.
Pathologists are particularly aware of sensitivities surrounding post-mortems on children. All of the staff involved will take the utmost care of the child's body until it is returned to the parents.
Images
The pathologist will make a careful examination of the body and possibly take photographs, digital images and X-rays for more detailed study. These images are kept as part of the post-mortem record.
Internal examination
The internal part of the post-mortem then begins. Sometimes, an existing surgical incision can be used for the examination. If not, an incision is made down the front of the body.
However, these openings are made discreetly, in places which are as least noticeable as possible. For example, if the brain needs to be removed, an incision is made behind the hair at the base of the head. The pathologist will make every effort to avoid leaving any physical signs of examination, although this is not always possible.
Removing the organs or tissues
The pathologist will remove the internal organs, or pieces of organs and other tissues, that are needed for detailed examination. If the pathologist feels it is necessary, samples of tissue and sometimes whole organs will be placed in special chemicals to preserve them. They will then be used to determine the cause of death.
Following the examination, the remaining organs are returned to the body and the incision is closed.
However, it may not be possible to return the organs to the body for several weeks. Your hospital or coroner's office will be able to advise you about how long the tests will take.
You have the following options:
- You can delay the funeral so that organs and tissues may be returned to the body for burial or cremation.
- You can ask for any organs and tissues to be returned to the funeral director, who can arrange a separate burial or cremation service for them.
- You can donate tissue samples and organs for use in medical training and research (see Why it is done).
- You can ask the hospital to dispose of the organs and tissues, which is normally done by cremation.
