July 30, 1999

About a year ago, a man came to the MGH with unexplained pain in his abdomen and leg. Despite the efforts of his medical team, he died within a few hours. An autopsy, performed to find the cause of his unexplained death, showed that his aorta had torn and blood was traveling along an abnormal path to his legs. The condition, while sometimes treatable, is often difficult to diagnose.

The ability of an autopsy to give conclusive answers to a patient’s illness is why the MGH still continues the practice though many community hospitals have given up autopsies altogether.

Autopsies are performed to determine a cause of death and to study disease. In cases of homicide, suicide or accidental death, certified MGH pathologists perform autopsies for the state medical examiner, seeking a cause of death and any evidence of alcohol or drugs in the body. By state law, no permission is needed from a family for autopsies in medical examiner cases.

Over the years, the number of autopsies done at the MGH has declined. Of patients who died in the hospital last year, only 15 percent were autopsied, a total of about 300 patients.

There are a number of reasons for this decline, says Eugene Mark, MD (below, right), director of the Autopsy Service in the Department of Pathology and district medical examiner. Family members must give permission in order for an autopsy to be done, and some families are reluctant because they believe their loved one has "suffered enough" or they are worn out emotionally. Some decline autopsies for religious reasons or because of misconceptions about autopsies. An autopsy doesn’t delay burial, Mark says. Nor does it prevent an open-casket funeral – no signs of an autopsy are visible. There is no charge to the family for an autopsy of any MGH patient, even if that person died elsewhere.

What relatives sometimes fail to realize is that an autopsy may help them make sense of the death of a loved one, Mark says. The autopsy may find evidence of a hereditary disease or an infectious illness. Autopsies also aid physicians and researchers in understanding illness and finding better treatments.

Of the autopsies performed last year, about 20 percent revealed a clinically important finding. Another 30 percent resulted in findings that were unexpected, although of uncertain significance.

"I think an autopsy is beneficial because most families will say, "What good can come of this death?’" says Mark. "But the autopsy may answer some of their concerns, and the information gained almost certainly will help patients in the future. That’s a way that something good can come from a loved one’s death."