The non-forensic autopsy is on life support in most hospitals with only about 10% of patients undergoing the procedure nationally (see: The Vanishing Nonforensic Autopsy). However, the rapid autopsy has moved front-and-center for selected cancer patients with the need for rapid tumor tissue harvesting. This specialized type of autopsy was described in a recent article (see: Rapid autopsies could speed cancer research. They’re also fraught for families),. Below is an excerpt from it:
Medical teams have long rushed to save the living. Now, increasingly, they’re rushing to attend to the dead. A small but fast-growing number of hospitals are embracing procedures known as “rapid autopsies,” — conducted in the hours immediately after a patient’s death. The idea is to obtain tissues from tumors before they start significantly degrading. Using genetic analysis technology, doctors can then determine precisely how cancer cells survived every attempt to kill them. But the procedures are forcing doctors and patients to overcome their reluctance to discuss death, and family members to confront the idea of parting with loved ones’ bodies shortly after their death — within six hours, optimally....So far, roughly 10 hospitals conduct the procedures....
The logistics can be complicated. Doctors discuss the procedure with patients, but in most states, it’s the surviving family members who must consent to the procedure. Patients and family members can limit the scope of the autopsy however they wish, though...[a knowledgeable pathologist] said she “always makes some kind of incision.....[Johns] Hopkins doctors typically broach the subject with patients while they are introducing the prospect of hospice care. But it also helps to have doctors trained in having the conversation....Mass General created a formal rapid autopsy program this year. The hospital now performs roughly two to three procedures weekly, compared with one every three or four weeks in previous years, and is exploring ways to offer them to patients who die outside the hospital. The program will fuel one of the most significant trends in cancer research: the creation of what... [are called] patient avatars, the cell lines or mouse models derived from a patient’s tumor that can be used to test treatments for patients with similar histories.
The need to sample tumor tissue quickly from cancer patients post-mortem is driven by research on new therapy based on cancer genotyping. Immunotherapy is being tailored to exploit tumor genetic weaknesses. Asking for autopsy permission from family members has never been an easy task but there is now an added time urgency to harvest viable tumor tissue. In earlier times and particularly in teaching hospitals, relatives expected to be asked for autopsy permission. The rationale was often stated in the past as the need to learn from the case.
Requests for rapid autopsies are now being couched in terms of to the need to increase scientific knowledge by harvesting cancer tissue. As the article cited above states, the hard discussion with a patient about hospice care provides an opportunity to also address the subject of a rapid autopsy in cases where it is deemed appropriate. However, a transfer to hospice care also introduces the challenge of rapidly transporting a deceased patient back to the hospital for the autopsy. Also and as noted above, discussions with a terminal cancer patient provide the opportunity to discuss the creation of patient avatars with the harvested cancer cells used in medical research laboratories. This is analogous to the persistence in research labs of the immortalized cancer cell lines harvested from Henrietta Lacks (see: Henrietta Lacks).