15283-B-Blokker

177 General discussion 9 Acceptance of the Minimally Invasive Autopsy Next-of-kin may always have been hesitant to any post-mortem investigation of their deceased beloved one, but nowadays they dare to speak up to “the then-well-known (and almighty) doctor,” 42 who currently seems less motivated to get them to consent to autopsy. MIA, however, may be more acceptable to next-of-kin, especially for those who have fear of mutilation of their beloved deceased 89 or to those that may have concerns about organ retention or feel a restriction to invasive autopsy due to religious convictions. 22,24,38,40,81 Among the 2197 in-hospital deceased patients in our study period, there were, apart from the 99 included cases, 98 more cases in which next-of- kin gave or, according to our survey, had been willing to give consent for MIA. Yet in 62 cases CA was not permitted on at least the whole torso. Next-of-kin might be able to choose for a MIA 24/7 with, if necessary, a “partial autopsy” of a specific organ (e.g. the heart for close examination of the sinoatrial and atrioventricular nodes). It seems plausible that introduction of MIA will increase the overall rate of clinical autopsies. However, acceptance of alternative autopsy techniques and its impact on autopsy rates should be formally investigated. MIA can support biomedical research programs by providing normal and pathologically changed tissues, whichwould otherwise be difficult to ascertain. For example, providing tissue from cancer metastases for comparison with primary tumor of the same patient, 276 as pursued in rapid (“warm”) autopsy programs, could make an important contribution to the development of personalized cancer treatment. 184,185 Next-of-kin of patients who died of cancer rarely allow a CA, because the cause of death is considered known, and the patient has suffered enough. They may more readily consent to a MIA with the primary goal to collect tissue frommetastases in different organs of the same patient. The RNA quality of these tissue samples obtained by MIA is of sufficient quality for molecular research. 26 The MIA procedure, once embedded in the daily workflow, could be carried out within hours after demise, so as to provide optimal tissue for high-end molecular studies. 26 MIA may also be more acceptable and thereby more useful in counselling families on hereditary diseases. Practical advantages MIA provides a permanent auditable record that can be repeatedly and objectively consulted by pathologists, radiologists, clinicians, scientists, and next-of-kin. The images can easily be stored and examined at any time or place, the biopsy targets may even be indicated by an off site radiologist. 130 As soon as the histological slides will be digitally available, 277 the complete MIA could be subjected to second reading.