Regional neuropathology referral practice before and after new organ retention legislation

Previous organ retention controversies in the United Kingdom have resulted in public concern in relation to the retention of organs following post mortem examination. Therefore, protocols were devised and implemented to facilitate adequate sampling for diagnostic purposes for neuropathology autopsy referrals, without the need for organ retention. We have examined various aspects of referral practice before and after the introduction of these new sampling protocols.

All neuropathology autopsy referral cases were reviewed between 1993 and 1995, and 2003 and 2005 and data such as: referral source, nature of samples (whether whole organ or limited sampling) and final diagnosis were recorded.

Overall, the number of autopsy cases referred for neuropathology opinion reduced, particularly those originating from hospital consented autopsies. Forensic referrals also reduced, with a shift in practice from referrals of whole fixed brains, to both whole brains and sampled brain slices. Within the referrals from forensic practice, whilst cases of 'natural deaths' and head injury cases secondary to road traffic accidents or falls reduced, cases involving inflicted, traumatic head injury and sudden unexpected death in epilepsy and infancy remained static.

The introduction of protocols to facilitate sampling of brains at autopsy, so minimising organ retention, proved successful and, whilst there has been a reduction in neuropathology referrals, cases in which neuropathology input is deemed best practice remained static.