Tissue donation in forensic cases: a retrospective study from Sweden

Loss of a loved one under traumatic circumstances is challenging and often requires families to make difficult decisions. Forensic autopsy cases frequently involve sudden or traumatic deaths but do not preclude tissue donation or contact with next-of-kin. Many deceased individuals in these contexts are young and medically suitable for donation, making it important to understand when such donations are feasible to ultimately expand the pool of available tissues. This study investigates how next-of-kin interpret the deceased's presumed donation wishes based on manner of death, age, and sex. Using registry data from the Swedish National Board of Forensic Medicine, we analyzed demographics and consent outcomes was used to assess factors associated with next-of-kin consent. Of 1159 donation assessments, 691 cases involved next-of-kin contact. In cases without prior official donor declaration (556 individuals), consent was about twice as likely after natural death compared with accidents (OR 2.42) or suicide (OR 1.73). Among children aged 0-17, next-of-kin were markedly more likely to interpret boys' wishes as positive compared with girls (OR 7.59), while no sex differences were seen in adults. These findings show that tissue donation remains feasible in forensic cases and that both manner of death and age shape family interpretations, underscoring the need for tailored communication.