Cohen M C, Blakey S, Donn T, McGovern S, Parry L
Histopathology Department, Sheffield Children's NHS Foundation Trust, Sheffield, UK.
Med Sci Law. 2009 Jul;49(3):179-84. doi: 10.1258/rsmmsl.49.3.179.
In the U.K., cases of sudden unexpected death in infancy are under the jurisdiction of the Coroner and consent for a post-mortem is not required. Prior to the Human Tissue Act 2006 (HTA) there was also no requirement to request retention of tissue (blocks and slides). The HTA stipulates that parental/ guardian consent is mandatory to retain or dispose of all tissues after the Coroners' purposes have been fulfilled. In 2007, in order to avoid confusion with the consent needed for hospital post-mortems, a new form was introduced by Sheffield Children's Hospital NHS Foundation Trust (SCH) called Record of parents'/guardians'wishes regarding samples taken at a Coroner's post mortem. This version specifically asks if blocks and slides may be retained as part of the medical record, or are to be disposed of, and for parental agreement (or not) for the frozen tissue, blocks and slides to be used for education, audit, quality control and medical research. One hundred and nineteen Coroners' postmortems covering the years 2006-2007 were reviewed. All parents/guardians (P/G) were contacted and the outcomes of P/G wishes recorded by SCH staff, Coroners' Officers (CO) and Police Family Liaison Officers (PFLO) were analysed and compared (44% from CO were outstanding at the time of audit). Any delay in recording P/G wishes by these three groups was also compared. In 2006, parental agreement to the use of blocks and slides for education, audit, quality control and medical research was 94%, 77% and 75% for SCH, CO and PFLO, respectively. In 2007 it was 84%, 37% and 100% for the same groups. Permission for the retention of frozen tissue given to SCH, CO and PFLO was 90%, 62% and 100% in 2006 and 90%, 44% and 100% in 2007, respectively. Cases where parents did not wish for the retention or use of tissue (including blocks and slides) were 3%, 15% and 0% in 2006 for SCH, CO and PFLO respectively, and 0% for all groups in 2007. Training of staff in all aspects of post-mortem and bereavement care is essential for ascertaining parental wishes. Families should be provided with the knowledge that allows them to make informed choices. The analysis of the results of the audit supports this view.
在英国，婴儿猝死综合征病例由验尸官管辖，无需进行尸检同意。在2006年《人体组织法》（HTA）颁布之前，也没有要求保留组织（组织块和玻片）。HTA规定，在验尸官的目的达成后，保留或处置所有组织必须获得父母/监护人的同意。2007年，为避免与医院尸检所需的同意产生混淆，谢菲尔德儿童医院国民保健服务基金会信托基金（SCH）引入了一种新表格，名为“父母/监护人对验尸官尸检所取样本的意愿记录”。该版本特别询问组织块和玻片是否可作为病历的一部分保留或处置，以及父母是否同意（或不同意）将冷冻组织、组织块和玻片用于教育、审计、质量控制和医学研究。回顾了2006年至2007年期间的119例验尸官尸检。联系了所有父母/监护人（P/G），并对SCH工作人员、验尸官官员（CO）和警方家庭联络官（PFLO）记录的P/G意愿结果进行了分析和比较（审计时CO记录的结果中有44%未完成）。还比较了这三个群体记录P/G意愿的任何延迟情况。2006年，SCH、CO和PFLO对将组织块和玻片用于教育、审计、质量控制和医学研究的父母同意率分别为94%、77%和75%。2007年，同一群体的同意率分别为84%、37%和100%。2006年给予SCH、CO和PFLO保留冷冻组织的许可率分别为90%、62%和100%，2007年分别为90%、44%和100%。2006年，SCH、CO和PFLO中父母不希望保留或使用组织（包括组织块和玻片）的病例分别为3%、15%和0%，2007年所有群体均为0%。对工作人员进行尸检和丧亲护理各方面的培训对于确定父母的意愿至关重要。应该向家庭提供知识，使他们能够做出明智的选择。审计结果分析支持这一观点。
