More families may be seeking private autopsies in 2025. Coroners and medical examiners, at least in Pennsylvania, only do autopsies on cases that fall within their legal purview. Hospitals may not grant family requests for a medical autopsy when someone dies of apparent natural causes (see below).
Sometimes a family is concerned about neglect or abuse when a loved one dies in a nursing home or prison. The coroner/medical examiner may review such cases but may ultimately decide a forensic autopsy is not warranted. Again, it would be up to the family to arrange for a private autopsy.
Hospital autopsies on the decline
This graph from the National Center for Vital Statistics shows the sharp decline in the total number of autopsies performed in the U.S. from 1972 to 2020. The graph includes autopsies done by coroners or medical examiners. Only 3.1% of hospital inpatient deaths and 0.4% of nursing home deaths had an autopsy in 2020.
Until 2019, Medicare required hospitals “to attempt to secure autopsies in all cases of unusual deaths and of medical-legal and educational interest.” But in September 2019, the federal government eliminated that requirement. An editorial in the New England Journal of Medicine deplored the move away from autopsies. Both the College of American Pathologists and the American Medical Association unsuccessfully opposed the change.
As noted in an article from the Yale School of Medicine, the decline in U.S. autopsies matters to patients, doctors, scientists, and families.
Can private autopsies provide answers?
If the hospital won’t do an autopsy, families with concerns about the medical diagnosis or treatment of a deceased person may want to arrange a private autopsy. However, the estimated cost of $3000 to $6000 on top of funeral costs will prevent many from doing so.
Natural causes: What can a private autopsy find?
In a study of malpractice claims, thirty-one percent of autopsied cases had findings that differed significantly from the diagnoses made before death. However, not all of the findings would have changed the course of treatment or the fatal outcome.
Even when there is no concern for malpractice, families sometimes desire greater certainty about a medical cause of death. What are the most likely conditions private autopsies in 2025 will confirm or discover?
According to the Centers for Disease Control and Prevention (CDC), heart disease and cancer were the two leading causes of death in 2023. Coroners may autopsy some cases of sudden death and find heart disease, but the majority of cardiac disorders will be diagnosed during life. Coroners occasionally find a previously undiagnosed cancer, usually in people who have not received medical care for one reason or another.
Accidental or suspicious deaths
Third on CDC’s list of leading causes of death in 2023 was “unintentional injury.” That term includes drug intoxication (overdose) deaths and other accidental deaths of all kinds. By law, coroners will always review accidental deaths, although they may not always do a complete autopsy.
Families sometimes want an independent or second autopsy in cases of police-related deaths. Colin Kaepernick’s organization Know Your Rights can “provide a second autopsy free-of-charge for victims’ families who have lost their loved ones due to a police-related death.”
Autopsies and genetic testing of Infant and child deaths are a complex subject beyond the scope of this post.
Who does private autopsies?
Only a pathologist with training in anatomic pathology should do medical autopsies. If there is concern for abuse, neglect, or foul play (and the coroner isn’t doing an autopsy), families should seek out a forensic pathologist. My 2022 post on autopsies provides information on how to find qualified pathologists.
Funeral directors can sometimes refer a family to a professional laboratory or pathologist for a private autopsy. Such requests remain rare however: one funeral director (personal communication) noted that only one percent of the families he served in 2024 had requested a private autopsy.
Brain Autopsies
Brain-only autopsies are an alternative to full autopsies and are the only way to diagnose certain conditions.
Technology has drastically improved diagnosis of heart disease and cancer before death. The same is not true for common brain diseases like the various dementias or uncommon diseases like Creutzfeldt-Jakob disease (CJD). Chronic traumatic encephalopathy (CTE) is brain damage due to repetitive trauma like concussions. It is another condition that can only be diagnosed by examining the brain after death.
Brain Donation for Research
Any adult (18 and over) can register for brain donation for research purposes prior to death. The Brain Donor Project, a 501c3 nonprofit organization, exists to facilitate registration and referral to the most appropriate brain bank.
Five brain and tissue banks in the U.S. are part of the National Institutes of Health (NIH) NeuroBioBank network. Donors should discuss their decision with family because the brain donation organization will ask next of kin to sign a consent form at the time of death.
According to the Brain Donor Project website, family can request a summary of the neuropathological findings. The University of Maryland Brain and Tissue Bank website, for example, offers such a report. It is available “upon request at no additional cost.” The reports can take a little as 90 days or as long as a year after the death.
Other Resources for Brain Autopsies
What if a brain does not meet criteria for donation programs and the case does not require a medicolegal autopsy by a coroner or medical examiner?
Working with the hospital, coroner, or a funeral director, family can often arrange for timely brain retrieval. Families living in western Pennsylvania, for example, can work with the University of Pittsburgh’s Neuropathology Brain Only Autopsy Program. Their website states that “if the patient was ever admitted to a UPMC hospital there is no charge to the family for the autopsy. If this is a non-UPMC patient there will be a charge of $1000.”
Private autopsies in 2025: A difficult decision
Hospitals and even medicolegal death investigation offices will continue to limit the number of autopsies they do. However, the expense and logistical challenges of a private autopsy mean families will find it difficult to arrange private autopsies in 2025. Hospitals, nursing homes, physicians, funeral directors, and coroners should be prepared to advise families on their options. Current opportunities for no-cost brain autopsies may be a valuable resource for families.
Feature image credit: Crime Lab Design