Autopsies

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.

The causes of many diseases are still unclear and cannot be adequately researched using animal models. This is mainly due to the fact that it is not possible to examine the diseased tissue while the patient is still alive. Medical research on human tissue and body fluids obtained after death therefore plays an extremely important role in gaining a better understanding of the causes and thus finding targeted new therapies. A biobank with human tissue from patients with various serious underlying diseases is therefore an important prerequisite for future medical progress.
The clinical autopsy is intended to answer unresolved questions from the family and the attending physicians. This applies in particular to questions regarding the main illness that led to death, as well as other illnesses and disease processes that did not directly cause death. Even in the modern age of medicine with its many examination methods, the clinical autopsy makes medically important observations and regularly provides new findings. The exact determination of the cause of death is often of particular importance for the family in coping with grief and saying goodbye.
The forensic autopsy is carried out in particular in cases where the cause of death is unclear or not natural, for example if a criminal offense, accident or suicide is suspected. It serves to clarify the exact cause of death and to reconstruct what happened before death.
In addition to clinical and forensic autopsies, there are also official, insurance-related and private autopsies. They also serve to clarify the cause of death in official, insurance-related or personal matters and thus 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.