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Digital Autopsy v Invasive Autopsy

بِسۡمِ اللهِ الرَّحۡمٰنِ الرَّحِيۡمِ

1. Post-mortem examinations, also known as autopsies, entail a meticulous analysis of deceased bodies aimed at determining the medical cause of death. These examinations are initiated either at the request of the coroner or a hospital doctor. If requested by the coroner, the next of kin are not required to provide consent for the examination. Coroners, serving as judicial officers, investigate deaths under specific circumstances, including those that are unexpected, violent, unnatural, suspicious, or related to accidents, injuries, or medical procedures.

2. Post-mortem examinations are typically conducted promptly, often within two to three working days following death, and sometimes sooner. Specially trained doctors known as pathologists perform these examinations, which involve the extraction of major organs such as the heart and lungs from the deceased body. In certain cases, the brain may also be removed for examination to ascertain the cause of death.

3. Approximately 20% of adult post-mortem examinations and a majority of pediatric examinations do not immediately reveal the cause of death. Diagnosis in such cases relies on retaining small tissue samples from relevant organs for further analysis. These samples may need to be sent to specialized units for additional testing. Following completion of the examination, individuals are informed whether tissue samples and organs have been retained.

4. In instances where the cause of death remains elusive, post-mortem examinations may take several weeks to conclude. Following the examination, organs are returned to the body, and a pathologist drafts a report detailing the findings. If requested by the coroner, the cause of death, as determined by the pathologist, is conveyed to the relevant parties by the coroner or coroner's officer.

5. Digital autopsies, also known as digital post-mortems, offer a non-invasive alternative to traditional post-mortem examinations for determining the cause of death. This method involves medical scanning of the body using techniques such as CT or MRI scans. CT scans, which are brief in duration, generate digital data used to create a 3D image of the entire body. Specially trained radiologists analyze these digital reconstructions to identify the cause of death, achieving a success rate of over 70% in adult cases. However, the cause of death identified through digital autopsy must be validated by the coroner's pathologist before a medical certificate of cause of death (MCCD) can be issued.

6. In England and Wales, the implementation of digital autopsies requires approval from the involved coroner. Despite the advantages of digital autopsies, some coroners prefer the traditional invasive approach due to personal beliefs or training backgrounds. However, a 2015 High Court ruling emphasized avoiding invasive autopsies when a non-invasive autopsy could realistically establish the cause of death.

7. Requests for digital autopsies can be made to the local coroner by relatives wishing to opt for this method over traditional autopsies. The decision to conduct a digital autopsy is made based on its appropriateness for the case.

8. Currently, families are responsible for covering the costs of digital autopsies, while local councils typically fund traditional post-mortems. Sandwell Council is an exception, covering the costs of digital autopsies for its residents.

9. In cases where a digital autopsy fails to identify the cause of death, a traditional invasive post-mortem may be necessary. However, digital autopsies can still provide valuable information to minimize the invasiveness of subsequent post-mortem procedures.

Recent research has explored the use of post-mortem CT scanning to determine the cause of death. A 2017 study published in The Lancet demonstrated a high correlation between post-mortem CT scans and findings from invasive post-mortems. Ventilation of the lungs and injection of radio-opaque dye into coronary arteries resulted in a diagnostic rate of 92% among scanned cases. The study concluded that both traditional and post-mortem CT examinations are generally sufficient to establish the cause of death, albeit with certain limitations. Additionally, various scanning protocols for post-mortem CT scans exist, each differing in scan duration and diagnostic success rates.



Dr. A. Hussain