Free for all: Exploring next of kin consent for autopsy

Autopsy provides critical benefits for patients, families, healthcare systems, and communities by confirming diagnoses, identifying unexpected findings, and improving medical knowledge. Less is known, however, about how autopsy consent is distributed across demographic groups when access barriers are minimized. This study evaluates the socioeconomic trends of autopsy utilization among various race, sex, income, and primary language groups at a large academic institution. A retrospective review of all in-hospital deaths and autopsies was completed for cases from 2018 to 2022. Frequencies of autopsies for race, economic status, sex, and English as a first language were compared to frequencies of in-hospital deaths for these same variables. Of 4626 deaths, 821 autopsies were performed that met the inclusion criteria (a 17.7% autopsy consent rate). Most autopsies were performed on men (n = 489, 59.6%), White (n = 568, 69.2%), non-Hispanic patients (n = 644, 78.4%), and living in-state residents (n = 703, 85.6%). Women, Asians, and nonnative English speakers were less likely to be autopsied; only 5% of autopsies were done for decedents with English as a second language (P<0.00001). At an institution with a universal consent policy wherein families are always offered an autopsy at no charge, there was evidence of different utilization rates by sex and first language but not by most racial or ethnic groups. These findings highlight patterns of autopsy utilization in a setting where families are universally offered the procedure at no cost, underscoring differences in consent decisions rather than access.