Related Terms: Necropsy, Postmortem Examination
Availability: Mon–Fri, 08:00–17:00. Anatomic Pathologist on call at all times for consultation and approval of the procedure.
Special Instructions: An autopsy cannot be performed until a properly signed and witnessed Autopsy Authorization Form is received. A valid permit must contain the signature of the next-of-kin or other responsible party. Customary practice within Hawaii Revised Statutes for responsibility priority are 1) spouse (unless divorced) 2) adult child (usually eldest), 3) parent or legal guardians 4) grandparents and other next-of-kin 5) in the absence of next-of-kin, a friend or person charged by law with the responsibility for the burial. The attending physician or physician pronouncing death is responsible for obtaining permission for an autopsy and for completion of the death certificate.
Analytic Time: Preliminary findings — 48 hours. Final report — 30 days (45 days for complex cases).
Interpretive Use: Ascertain the main disease and ancillary diseases, elucidate their pathogenesis and study their evolution; determine the cause(s) of death and if possible, the reasons for therapeutic failure; provide education at all levels: students, house staff, attending staff.
Limitations: Medical Examiner's cases: In possible medical-legal cases, the Department of the Medical Examiner must be contacted prior to any suggestion regarding autopsy permission or organ donation is made to the family of the deceased. Cases falling under the jurisdiction of the medical examiner include all violent deaths (homicide, suicide, accident), sudden unexpected death, death within 24 hours of admission to the hospital or when not under the care of a physician or in any suspicious or unusual circumstances. In general all violent deaths will be autopsied at the Department of the Medical Examiner and do not require an autopsy permit Other cases under their jurisdiction may be released by the Medical Examiner if the probable cause of death can be arrived at from clinical examination and if this cause of death is natural. Documentation of the Medical Examiner's release is required prior to an autopsy at the Queen's Medical Center for any of these other cases falling by law under their jurisdiction. Honolulu Medical Examiner's phone number (808) 527-6777.
The College of American Pathologists recommends that deaths in which autopsies should be especially encouraged are as follows:
- Deaths in which autopsy may help to explain unknown and unanticipated medical complications to the attending physician
- All deaths in which the cause of death is not known with certainty on clinical grounds
- Cases in which autopsy may help to allay concerns of the family and/or the public regarding the death, and to provide reassurance to them regarding the same
- Unexpected or unexplained deaths occurring during or following any dental, medical, or surgical diagnostic procedures and/or therapies
- Deaths of patients who have participated in clinical trials (protocols) approved by institutional review boards
- Unexpected or unexplained deaths which are apparently natural and not subject to the Medical Examiner's jurisdiction
- Natural deaths which are subject to, but waived by the Medical Examiner such as persons dead on arrival at the hospital, deaths occurring in the hospital within 24 hours of admission, and deaths in which the patients sustained or apparently sustained an injury while hospitalized or under institutional care
- Deaths resulting from high-risk infectious and contagious disease
- All obstetric deaths
- All neonatal and pediatric deaths
- Deaths at any age in which it is believed that autopsy would disclose a known or suspected illness which also may have a bearing on survivors or recipients of transplant organs
- Deaths known or suspected to have resulted from environmental or occupational hazards.