Contacting next-of-kin for research consent following medico-legal autopsy: a practice-based study from Denmark

Obtaining informed consent from next-of-kin (NOK) for research use of medico-legal autopsy tissue is ethically sensitive and operationally complex. Although families may be receptive when approached appropriately, consent processes within medico-legal systems remain poorly described. This study aimed to describe response patterns, practical barriers, and experiences associated with contacting NOK for research consent following medico-legal autopsy. We conducted a retrospective evaluation of NOK contact attempts at the Department of Forensic Medicine, University of Copenhagen, in relation to a health science research project. Quantitative data were extracted from a consent database and call-log exports. Themes were identified from documented free-text notes of phone interactions. Among 173 eligible cases with at least one living NOK, consent was obtained in 120 cases (69.4%). Phone contact was attempted in most cases (94.2%). When contact was established, median call duration was 4.8 min (IQR 5.4), with a median of 2 attempts per case. No response occurred in 25.4% despite repeated contact attempts. NOK expressed altruistic motivations for consenting, but also raised questions about autopsy findings, hereditary risk, and tissue retention. Declines most often reflected reluctance to revisit the circumstances of the death or disrupt their own or other family members' grieving. In a Danish medico-legal setting, obtaining research consent from NOK was feasible, and consent was provided in most cases but required substantial effort. Consent conversations also revealed unmet informational needs from NOK, particularly regarding autopsy findings, cause of death, and tissue retention. Clear communication, appropriate timing, and structured follow-up may improve NOK experience and strengthen the ethical foundation of medico-legal research.