Chapter 11: Special Case – Autopsy
Alcor 1997 Stabilization and Transport Manual
Table of Contents
For cryonicists, an unavoidable autopsy can be the most frustrating and emotionally difficult of all transport and cryonic suspension situations. The patient may experience significant structural injury during negotiations to obtain release of the patient from a coroner or medical examiner, both on the macro level — through the dissection of the organs and body — and on the micro level — through cellular degradation. While transport team members should be aware of the time-critical nature of a cryonic suspension, they should nonetheless protect themselves against allowing this to unduly hasten decision-making during transport preparations where an autopsy must be conducted. Coroners do not take kindly to being pressured by cryonicists. In an autopsy situation, the demands of the State may be fulfilled, and indeed must be fulfilled, before the release of any cryonics patient will occur. Team members who remain calm and display a professional demeanor while attempting to accommodate the demands of the bureaucracy will generally receive superior cooperation from regulatory bureaucrats.
Conditions demanding an autopsy vary from state-to-state and county-to-county. Even the title of the regulatory agency delegated to carry out autopsies may vary: You may encounter either a ‘Coroner’ or a ‘Medical Examiner’ with this authority. For the purposes of further discussion, ‘coroner’ is used to indicate the local regulatory agency, whether it is the Coroner or the Medical Examiner whose office performs autopsies. Some of the more common classes of deaths reportable for autopsy are listed in the table below.
Classes of Death Subject to Autopsy
|Unattended death||Death following accident or injury|
|Physician unable to state cause of death||Associated with rape|
|Suspected or known homicide||Associated with “crime against nature”|
|Suspected or known suicide||Drowning|
|Death involved criminal action||Fire|
|Involved suspicion of criminal action||Gunshot|
|Occupational disease or hazard||Starvation, exposure, aspiration|
|Operating room death (within 24 hours)||Accidental poisonings|
|In prison or while under sentence||Drug addiction|
|All deaths of unidentified persons||Sudden infant death syndrome (SIDS)|
|Contagious disease / public health hazard||Stabbing, cutting, asanguination|
|Involved self-induced / criminal abortion||Hanging, strangulation|
Of the types of death listed above, there are two classes of death which result in autopsy which deserve greater explanation than the table allows. Each of these is an ambiguous classification and is subject to interpretation by the coroner, who has some discretion in choosing whether or not to or how thoroughly to autopsy individuals. These types are unattended death and death following an accident or injury.
Unattended death includes all deaths which occur without the attendance of a physician. Usually, the coroner’s office will conduct an investigation into these deaths. If the result of a cursory investigation is that the individual died of natural causes, and if a qualified physician is willing to sign the death certificate attesting to ‘death by natural causes’, the coroner may waive the requirements for a full autopsy and release custody of the patient to Alcor.
For patients who die in a hospital, (for the purposes of autopsy regulations) the patient is considered to have a physician in attendance at the time of death. In cases where the patient’s primary physician in unavailable, for any reason, the death will often be reported to the coroner’s office for investigation. This may result in the coroner deciding an autopsy should be performed.
Death following an accident or injury encompasses innumerable circumstances. An accident could occur on the way to or from work. It could be an auto accident, a bicycle accident, an accidental fall, all injuries resulting from an accident, etc. This list could go on for several pages.
A situation where the autopsy requirements may be waived is that of an elderly person falling at home and fracturing, or even breaking, a bone. One outcome of this accidental fall could be that the patient is taken to a hospital for treatment, where treatment is hampered by the shock, which results in a suppressed immune system, which develops into bronchopneumonia, which ultimately leads to death. In many such instances the coroner may waive the autopsy, relying on physician affidavits and medical records to substantiate the cause of death.
All transport personnel should be aware that the conditions for autopsy discussed above (including those listed in the table) are based on local policies and procedures of a standard coroner’s office, and these policies and procedures vary from state to state and county to county.
Regardless of regional differences, it is imperative that you thoroughly understand the requirements local to the patient. Any ambiguities in the information or material provided by the local coroner must be resolved! In particular, it’s essential that you understand the requirements surrounding the presence of a physician or qualified nurse for pronouncement of legal death. Assertions which may be subject to interpretation must be clarified. “Physician in attendance” may mean that the physician must be present at the moment of death, or it may mean that the individual must have been seen by a physician within 24 hours of pronouncement of death.
Whenever it is suspected that an Alcor patient has, or is likely to, become a “coroner’s case”, it is essential to move quickly. In six states (California, New Jersey, New York, Ohio, Rhode Island, and Maryland), an autopsy may actually be prevented if the patient has executed a “Religious Objection to Autopsy”. This document allows an individual to state that they do not wish to be autopsied, and the objection is based in religious beliefs, the exact nature of which do not need to be specified (i.e., a simple “I object” will suffice).
Contact Alcor Headquarters and inform them of the possible autopsy, and if the patient lives in one of the six states listed above, find out if a “Religious Objection to Autopsy” is available. Next, contact the coroner’s office and attempt to elicit cooperation. Offer Alcor’s assistance in delivering the patient to the coroner’s office, and request that Alcor personnel be allowed to pursue the transport protocol, which might include blood wash-out and replacement with an organ preservation solution before an autopsy is performed. (This request is dependent upon the patient’s condition at the time Alcor is notified of the actual or impending pronouncement of death.)
If the transport team members on hand are not allowed to implement the transport protocol before the autopsy, request that the autopsy be waived due to unusual circumstances (the patient’s desire to execute a whole-body anatomical donation, and Alcor’s contractual obligation to carry out this legal disposition). If they are unwilling to release the patient to the transport team without an autopsy (don’t be discouraged by this outcome, it is usually the case), request that the scope of the autopsy be limited: more specifically, suggest that an external examination might be sufficient for their purposes. If the coroner insists upon using invasive investigative techniques, request that the pathologist forgo direct examination of the brain: no removing it from the skull, no weighing, no sectioning. Always request that the patient be stored in a refrigerated room (ideally, 2-4°C — IT IS IMPERATIVE THAT THE TEMPERATURE BE ABOVE FREEZING TO PREVENT ICE FORMATION!) prior to and immediately following autopsy, until the patient is released to the transport team members.
Remember that although coroners may agree to accommodate these requests, they may nonetheless proceed at their convenience and perform whatever examinations they choose (i.e. they can and do lie). Take all possible steps to expedite and verify the proceedings, to include checking the temperature of the refrigerated room where the patient is being stored.
When an Alcor patient is at risk of autopsy, the transport technician must remain as close to the patient as possible, and not leave the facility where the patient is being maintained until after the autopsy issue has been resolved. The presence of a Transport Team member may encourage prompt release of the patient’s body and brain once the investigations have been completed.
Ensure that all of the necessary paperwork has been completed prior to transporting the patient from the coroner’s office. While the exact list of required documents may vary according to local regulations, the minimum requirements should be: a signed death certificate (and State-certified, if there is time), a ‘Disposition of Human Remains’ form, and a transport permit. If local morticians have been involved with the removal of a patient, they may be willing to assist with the completion of all necessary transport documents. Remember that funeral directors are experts at preparing the required documents for transporting human remains, and if a funeral director does not prepare the documents, make certain that the paperwork has been reviewed prior to the transport. This consultation, however, should not interfere with the timely transport of a patient.
Post-Autopsy Transport Preparations
When an invasive autopsy has been conducted, there will be no cryoprotective perfusion. In these cases, and once release has been secured, the focus of the transport team becomes cooling. It is important to remember that if an autopsy has occurred, sections of the patient’s organs may have been removed (like the brain) and placed in separate containers. Because the coroner’s authority includes keeping specimens, make certain that all organs (especially the brain) are released with the body.
If individual organs have been removed, like the brain, place these organs into individual containers (Ziploc bags will suffice, if large enough). Remove as much air as possible from the containers, seal them securely, and then completely surround the organ containers with ice.
Transport Team members should always coordinate shipping details, because in some circumstances, the patient may be packed in dry ice (solid CO2) for shipping.
On a final, cautionary note, a transport team member who is collecting an autopsied patient from the local coroner should be psychologically prepared for the realities of a morgue. Autopsies are the most invasive procedure, surgical or otherwise, which may be legally performed on a human being (granted, the individual must be pronounced dead first). No attempt is made to “be gentle”. The focus of an autopsy is information about the cause of death, and the result can be gruesome. Be prepared.
Of the three types of transport situations mentioned in Chapter 2, situations involving autopsy are the most technically-straightforward to handle. There is generally little which can be done for a patient who has been damaged in this manner, and the transport team member should concentrate on cooling and prompt delivery to Alcor Headquarters, ensuring that all parts are present when the body is released.
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