Importance of autopsies
Clinical and forensic autopsies are comprehensive medical examinations of deceased individuals aimed at clarifying the cause of death, verifying diagnoses and treatments, and expanding medical knowledge. For relatives, they provide clarity regarding the cause and circumstances of death, support the grieving process, and can offer important insights in cases of hereditary or infectious diseases. The goal is to detect familial or contagious illnesses in relatives at an early stage—or ideally even before onset—and to protect them as effectively as possible through preventive measures. Autopsies offer valuable insights for physicians by confirming known diagnoses and, in many cases, adding previously unknown findings. Scientifically, autopsies contribute to the understanding of disease onset and progression, improve therapeutic approaches and diagnostic accuracy, and support the education of medical professionals through well-founded evidence.
The clinical autopsy involves a thorough external and internal medical examination of the deceased. The clinical autopsy is carried out by doctors who specialize in the examination of organs and tissues, the pathologists.
In addition to the clinical autopsy, there is also the forensic autopsy, which is carried out in forensic medicine by forensic pathologists who are specially trained to investigate deaths in legal and criminal contexts.
Respect for the deceased and respect for human dignity characterize the conduct of the examination in all autopsies. As part of the examination, all organs are first assessed with the naked eye, weighed and measured. Tissue samples are then taken for microscopic (i.e. histological) or molecular examination.
Clinical autopsies aim to answer unresolved questions from the family and the treating physicians. This particularly concerns the primary cause of death, but also includes other diseases or disease processes that may have gone undetected until then. Even in the modern era of medicine with numerous diagnostic tools, clinical autopsies continue to yield medically significant observations and regularly provide new insights. For the family, accurately determining the cause of death is often especially important for the grieving process and saying goodbye. It helps answer the pressing question of “why”.
Forensic autopsies, by contrast, are mainly performed in cases of unclear or non-natural causes of death, for example when there is suspicion of a criminal act, accident, or suicide. They are ordered by the public prosecutor’s office and serve to precisely determine the cause of death and reconstruct the events leading up to it. Family members have no way to refuse a court-ordered autopsy.
Autopsies are also extremely relevant for clinical research. The causes of many diseases remain unclear and insufficiently studied, largely because the examination of affected tissue during a patient’s lifetime is not possible. Therefore, medical research on human tissue and bodily fluids obtained postmortem plays a crucial role in improving our understanding of disease mechanisms and in the development of targeted new therapies. A biobank containing human tissue from patients with various underlying conditions is thus a vital prerequisite for future medical advancements.
In addition to clinical and forensic autopsies, there are official, insurance-related, and private autopsies. These also serve to clarify causes of death in the context of administrative, insurance-related, or personal concerns, and thereby support the investigation of a death.
A written report is prepared once the examinations have been completed. A preliminary report with all the key findings is available within a few days. This usually already contains all the important information. A final assessment report usually takes a few weeks, as a variety of additional examinations have to be completed first. These reports are sent to the treating physicians and attached to the medical records and, if requested, also sent to the deceased’s GP practice. Relatives can therefore receive information about the results months and years after a clinical autopsy. The results of the autopsy can also be discussed in person with the next of kin by prior arrangement.
If the autopsy is carried out on behalf of the public prosecutor’s office, the results of the investigation will be forwarded to them. As a rule, the expert opinion can be requested from the responsible public prosecutor’s office as a family member after the investigation proceedings have been concluded.
As the gold standard for determining the cause of death, autopsies provide certainty about the cause of death and primary illness. This certainty often helps to cope with the grief of losing a loved one. In addition, findings can be made that are of immediate importance to the next of kin. The detection of an infectious disease, such as tuberculosis, enables a clear diagnosis and early treatment for the bereaved. The autopsy can reveal work-related illnesses, which can result in compensation payments for the next of kin, e.g. death benefits or survivors’ pensions.
If a potentially hereditary disease or burden of disease is found, relatives can consult doctors at an early stage and obtain advice on the risk of illness and further action. In the case of hereditary diseases, information obtained during the autopsy can also be important for family planning and for avoiding further deaths in the event of an increased risk.
The autopsy – both clinical and forensic – offers considerable benefits for the treating physicians. In a clinical autopsy, the precise examination of organs and tissue enables a review of the diagnoses and the therapies applied and can thus provide further evidence of a possible metabolic disease, an infection or a malignant tumor of the deceased in retrospect. This allows the course of the disease to be traced in detail. Diagnoses that were confirmed before death can be confirmed and often supplemented by additional findings and sometimes put into a new context. The effects of therapeutic strategies can be assessed and discussed. In many cases, the course of the disease of the autopsied patient, which has been extensively reviewed by the autopsy, is then jointly reviewed at interdisciplinary conferences by the various specialist disciplines involved in the treatment and discussed in the manner of a “final ward round”. This not only contributes to quality assurance in clinical medicine, but also to the continuous improvement of medical treatments and the understanding of rare or complex clinical pictures.
Forensic autopsies, which are carried out in cases of unclear or non-natural deaths, can also provide valuable information. It helps to better understand medical complications or unexpected courses of events and promotes the clarification of potential treatment errors. In both cases, the findings of the autopsy help to expand medical knowledge, strengthen legal certainty, objectify patients’ rights and improve clinical practice.
The National Autopsy Network is continuously committed to improving postmortem examinations, imparting knowledge to clinicians and specialists and increasing public awareness. This includes the optimization and standardization of autopsy findings, their integration into the registry and the development of new areas of application in close cooperation with scientists. Thanks to the scalability of the registry, it can be expanded to include additional modules if there is a corresponding research interest. This work is regularly presented at conferences and congresses to give interested parties an insight into autopsy research. In addition, there is an increased focus on public relations work in order to give the public a comprehensive insight into the topic. This is done, for example, through the targeted publication of comprehensible reports (e.g. on social media), the provision of press releases and information material and close cooperation with the press and various media.
Autopsies continue to be of great importance for understanding the pathogenesis of diseases, i.e. the development and progression of the disease in the body. This applies, for example, when the disease is caused by a previously unknown pathogen, as has been impressively demonstrated for the diseases caused by SARS-CoV (2002, worldwide), MERS-CoV (2012, Arabia), SARS-CoV-2 (2020, worldwide). Even when mutations of known viruses occur, as with the H1N1 influenza virus (2009, worldwide) and the H5N1 influenza virus (2004, worldwide), autopsies have provided important insights into the pathogenesis. In addition to infectious causes, autopsies provide valuable insights into a variety of other clinical pictures, such as cardiovascular diseases, cancers, neurological diseases, rare diseases and also, for example, the consequences of adverse drug reactions.
In the case of novel or difficult-to-explain diseases, the autopsy provides important answers. It shows how the disease has spread in the body, which organs are affected and whether there may have been pre-existing, unrecognized diseases that contributed to a particularly severe course. This helps doctors to better understand why some people fall more seriously ill than others. At best, such findings can be used to improve the treatment of future patients.
But even in the case of known diseases such as heart attacks or cancer, the autopsy can shed light on the exact course of the disease, whether the treatment worked as expected or whether there were complications. The autopsy thus provides treating physicians with important information for their diagnostic and therapeutic strategy. Even the effects and side effects of medication or medical devices, such as pacemakers or implants, can be better assessed through autopsies. In the case of advanced cancers, autopsies can be used to research the mechanisms by which cancer cells can escape the effects of therapy.
The findings from autopsies therefore help to constantly improve medicine: they enable more accurate diagnoses, better therapies and more targeted preventive measures. They also help to improve the training of doctors by deepening their understanding of disease progression and providing new knowledge that is important for the treatment of future patients.
