College supports amendment to health and care bill on retention of tissue samples following post-mortem
Most post-mortem examinations that take place are carried out at the request of a Coroner and are performed without the consent of the next of kin. According to the Coroner’s statistics for England and Wales in 2020 there were 79,400 post-mortem examinations ordered by Coroners in 2020.
Of these,17,002 (21%) included histology, and 19,802 (25%) included toxicology. Once the Coroner’s work is complete, these tissue samples (in the form of small blocks and slides) must be destroyed unless specific consent is provided by someone in a qualifying relationship. Given the way the system works, this consent is logistically very difficult to obtain in practice and therefore very little tissue taken during Coroner’s post-mortem examinations is kept. The RCPath has been concerned for some time about the lack of tissue available from post-mortem examinations in England, Wales and Northern Ireland for teaching, audit, and research purposes.
This issue was the raised by a number of organisations, including RCPath and the British Medical Association, as part of the McCracken Review of the Human Tissue Act which recommended in 2013 that:
‘Consideration should be given (inter alia) to: reducing the scope so that microscope slide and tissue block samples and bodily products such as saliva, urine, and faeces are excluded’
The Government accepted this recommendation but this issue has not subsequently been progressed.
The Importance of Retention
The interpretation of the findings from a post-mortem is often subjective, rather than definitive. Causes of death are often a result of the exclusion of other causes, and the examination should be regarded as a snap-shot of the deceased at the exact point of death, rather than necessarily a documentation of the events that led up to the death.
This means that pathologists are highly reliant on the supply of accurate and comprehensive clinical information relating to the circumstances leading up to and around the time of death to be able to provide a reasonable clinico-pathological correlation and cause of death.
Proposal to Amend the Legislation
RCPath supports the position regarding blocks and slides in the Human Tissue Act 2004 to be reviewed and to be brought in line with the position in Scotland where tissue samples, in the form of blocks and slides, automatically become part of the person’s medical record following a post-mortem examination. The Human Tissue (Scotland) Act 2006 distinguishes between these samples and whole organs (which, by contrast, do not automatically become part of the medical record), reflecting the emotional significance these body parts have. In Scotland, authorisation is required for the retention of any organs following a post-mortem examination but not blocks and slides.