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Contacts

Contact:

Ros Butterfield

Bereavement Coordinator/CNS

Organisation:

Bart’s and the London NHS Trust

London United Kingdom

Email:

rosamund.butterfield@bartsandthelondon.nhs.uk

Case study:

22 February 2012

Offering a non-invasive alternative to the traditional post-mortem

Key points

Bart’s and the London NHS Trust is running a pilot offering bereaved families facing a coronial post-mortem the option of an MRI scan
The service appeals particularly to families who for religious, cultural or other reasons find an invasive procedure upsetting
The coroner makes the final decision on whether an MRI scan is justified
In its first year 12 families used the service although three still had to have an invasive post-mortem.

Bart’s and the London NHS Trust has been running a pilot scheme offering bereaved families facing a coronial post-mortem the option of an MRI scan instead of the traditional approach.

Post-mortems normally involve invasive examination of the body’s internal organs. For cultural, religious and other reasons some families are keen to avoid this if possible.

An MRI scan (and/or other less invasive forms of examination) can in some cases avoid this by producing sufficiently detailed images to allow the coroner to be satisfied as to the cause of death on this basis alone.

The pilot began in July 2010 after the issue had been raised by the trust’s Jewish and Muslim chaplains. The trust cares for a high proportion of Muslim patients while the number of Jewish patients is less but still significant. Most of these families find coroners’ post-mortem a difficult and distressing process.

The service, which is open to everyone, currently covers Camden, Hackney, Islington and Tower Hamlets. Initially it was offered only for deaths in hospital but it was then decided to extend the service to the community.

Families who are considering this option may receive support from local faith leaders. A trust information leaflet provides the following information so the bereaved can make an informed choice:

The post-mortem by MRI scan is an optional procedure and families will need to pay a fee.
The MRI post-mortem will only be suitable if the coroner believes this procedure will give adequate information about the cause of death.
The coroner is legally bound to refuse the MRI scan report if the findings do not provide adequate information to establish the cause of death.
In these cases, a normal post-mortem will have to be conducted in addition to the MRI scan. However, the MRI scan fee will still have to be paid in full by the family.

The trust has created an MRI post-mortem pathway to establish clear, consistent procedures and ensure that families receive the support and information they need to make the appropriate decision.

The service, on The Royal London Hospital site, is not available on the NHS so all families choosing this option have to pay a fee ranging from £275 for a head scan to £900 for head, thorax and abdomen.

Between July 2010 and July 2011 the trust dealt with 12 cases where an MRI scan was preferred to the traditional post-mortem. Of these, three still had to proceed to invasive post-mortem.

So far there has been a relatively small uptake of the service. This is partly because it was not widely publicised initially and also because it is only available two days a week, although the team do provide a service outside these hours wherever possible. It is hoped that once The Royal London Hospital has transferred fully to its new premises in early 2012, the service will be extended to five days a week.