Autopsy

• An autopsy is a medical procedure involving the examination of a dead body. An autopsy is sometimes termed an obduction or a post-mortem examination. The word autopsy is derived from the Greek word autopsia, which means "to see with one's own eyes."
• Autopsies are performed by pathologists, medical doctors who have received specialty training in the diagnosis of diseases by the examination of body fluids and tissues.
• Autopsies are performed for a variety of reasons, including:
  • to determine the cause of death
  • to ascertain whether clinical diagnoses are correct
  • to evaluate the effectiveness of medical or surgical treatment
  • to gain information for the family about possible inherited or genetic conditions
  • for teaching and/or research purposes in academic hospitals
  • to aid in criminal investigations of wrongful death
  • to provide closure and reassurance for family members who may have questions about diagnoses or treatment
• Forensic autopsies are a specialized form of autopsy with legal implications that are performed to determine if a given death was an accident, homicide, suicide, or a natural event.

In the U.S., an autopsy can be ordered by a coroner or medical examiner if there are suspicious circumstances surrounding the death. Autopsies may also be ordered, depending upon the jurisdiction, in special circumstances, for example, if a death occurs in a person not under medical treatment for a known condition, if a death occurs within 24 hours of admission to the hospital, or if death occurs during a surgical procedure.

If an autopsy is not ordered by the coroner or medical examiner, the relatives of the deceased must give consent for an autopsy to be performed. The relatives providing consent also have the right to limit the scope of the autopsy, which means that they specify the organs or areas of the body that may or may not be examined.

The procedure for performing an autopsy varies according to the extent and purpose of the examination. If there are no restrictions imposed by the family, most standard autopsies consist of an examination of the chest cavity, abdominal cavity, and the brain. To examine the organs in the chest and abdomen, the pathologist usually performs a Y- or U-shaped incision beginning at the shoulders that meets at the sternum (breast bone) and continues vertically down to the pubic bone. Examination of the brain is carried out through an incision made in the back of the skull from one ear to the other.

Before any incisions are made, the autopsy begins with a thorough physical examination of the outside of the body that includes determination of height and weight. Any scars, surgical incisions, wounds, or evidence of lesions on the skin are also described.

For examination purposes, the organs are usually removed from the body. The pathologist may weigh the organs individually and further dissect (cut) the tissue to look for abnormalities inside the organs. After the organs are viewed with the naked eye, small pieces of tissue are taken from the organs for microscopic examination. The physical and microscopic characteristics of each tissue are carefully described in detail.

At the end of an autopsy, the incisions made in the body are closed. The organs may be returned to the body or may be retained for teaching, research, or diagnostic purposes. Performance of an autopsy does not interfere with an open casket funeral service, as none of the incisions made are apparent after the body is prepared for burial.

Pictures of findings at the autopsy may be taken for future reference. Photographic documentation is performed for many autopsies, particularly forensic autopsies for which the autopsy record may be important for a court case. In teaching hospitals, photographs of organs or tissues may be taken for research or instructional purposes. Organs may be preserved and stored in formalin for further examination, sampling for microscopy, presentation at conferences, or archiving for medical student training, depending on the particular situation and family consent.

Sometimes, the pathologist will order special laboratory studies to be carried out on tissue samples taken during an autopsy. These may include:

• cultures or tests to identify infectious agents (bacteria, viruses, parasites, or fungi)
• chemical analysis for metabolic abnormalities
• genetic studies to identify disease-associated mutations or heritable diseases
• toxicology studies to identify drugs, poisons, or exposures

Additionally, tissue may be frozen and stored for future diagnostic or research purposes.

When the autopsy and all special studies including microbial cultures and toxicity tests are completed, the pathologist prepares a detailed report. This report describes the observations made during the autopsy procedure and explains the microscopic findings and the results of any special studies that were performed. The report gives a list of medical diagnoses and a summary of the case, emphasizing the correlation between clinical diagnoses and the autopsy findings.

Beginning in the 1950s, hospital autopsy rates started falling from an average of around 50% of all deaths to 10% in the late 1990s. Currently, the rates are even lower at non-teaching hospitals. Many factors are likely responsible for the reduction in autopsy rates, including the belief that modern diagnostic technology renders a postmortem examination obsolete. However, multiple studies have shown that autopsies still reveal a number of significant conditions and findings that were previously unknown and can provide valuable information to physicians and relatives of the deceased.