Instructions for having an autopsy performed at the NIH Clinical Center by the Postmortem Section of the Laboratory of Pathology

In general, any patient who has been seen at the NIH for any reason is eligible for an autopsy done by the Laboratory of Pathology. In addition, non NIH patients with diseases of significant clinical or basic research interest may have an autopsy done at the NIH if permission is obtained from the Chief of the Postmortem Section and the sponsorship of a principal investigator at the NIH. For an in-patient death or the death of an NIH or non-NIH patient outside the NIH:

1. Upon the death of an in-patient or notification of the death of an NIH patient outside the NIH, obtain a Death Packet from Admissions.

2. If the death falls within the jurisdiction of the Maryland State Medical Examiner, the Medical Examiner must be consulted prior to obtaining permission for autopsy. In general, patients who die from accidental causes, who arrive at the Clinical Center and are pronounced Dead On Arrival, or who die in association with a therapeutic procedure may fall under the jurisdiction of the Medical Examiner.

3. The Death Packet contains all of the necessary forms and instructions for having an autopsy performed on an NIH patient.

4. The NIH follows the State of Maryland's guidelines for consent to post-mortem examination. Permission from next-of-kin must be obtained even if the patient had a stated desire for an autopsy. The following is exerpted from the Annotated Code of Maryland, Section 5-501.

Consent for postmortem examination

(a) In general - Consent for a postmortem examination of a body by a physician is sufficient if the consent is given as provided in this section.

(b) Persons authorized to consent --

(1) The consent may be given by any one of the following persons if that person, whether alone or with another, has assumed control of the body for its final disposition:

(i) A parent;
(ii) A spouse;
(iii) A child;
(iv) A guardian;
(v) A next of kin; or
(vi) In the absence of these persons, any other person.

(2) If a person does not assume control of a body under paragraph (1) of the subsection, the consent may be given by the State Anatomy Board.

(c) Form of consent--The consent may be in the form of:

(1) A written document;
(2) A telegram; or
(3) A recorded telephonic or other recorded message

5. The patient may be transferred to the morgue from the nursing unit to await either autopsy or transfer to the responsible funeral home. The body must have proper identification (toe tag, wrist band) or the autopsy will not be performed.

6. Once permission for autopsy has been obtained, a member of the clinical care team should contact the pathology resident who will be assigned to the case, so that the clinical history and the questions to be answered may be reviewed with the pathology resident. The name and contact information of the pathology resident responsible for a new case may be obtained from the Surgical/Autopsy Pathology office (6-2441) during normal working hours. During weekday evenings and on weekends or holidays the resident on-call is responsible for performing autopsies. The name and contact information may be obtained through the NIH Page Operator.

7. The autopsy will be performed when the body, chart and permission have all arrived in the Laboratory of Pathology. Autopsies are begun routinely from 8:30 AM to 4:00 PM, Monday to Saturday and from 8:30 AM to 2:00 PM on Sundays and Holidays. Permission to perform an autopsy outside these times should be obtained from Dr. David Kleiner, Chief, Postmortem Section, Laboratory of Pathology. He can be reached by page (102-10333), by work phone (301-594-2942) or through the resident on-call.

Submission of Outside Materials for Review by the Postmortem Section

In general, the Postmortem section accepts materials for review or second opinion on patients who have died and have had an autopsy performed elsewhere.

1. The materials submitted may consist of tissue specimens, fixed or frozen, paraffin tissue blocks or stained slides. A cover letter or outside autopsy report identifying the materials should accompany the request for review. Copies of chart information, patient history summaries and laboratory data are helpful and should be made available to the Laboratory of Pathology.

2. The materials and any associated paperwork should be brought to the Surgical/Autopsy Pathology Office (Building 10, Room 2B50, 496-2441). A tissue examination request form should be filled out by the submitting physician. Frozen or Fixed tissue should be brought in sealed containers within an uncontaminated box.

3. The secretaries in the office will assist the submitting physician so that the case is appropriately handled and accessioned. The case is assigned to the resident pathologist on the postmortem service for that month.

4. If surgical or cytopathology materials are submitted with the autopsy materials, they will be separated and submitted to the appropriate section in the Laboratory of Pathology.