Follow-up report on organ retention

To ensure transparency COPFS should publish annually the number of organs retained after the deceased's body has been released. This information should be included in their publication scheme.

COPFS published the number of organs retained after the deceased's body has been released in their publication scheme which is available on their website. It is intended to publish this data annually.

Achieved

There should be an agreed written definition of what constitutes an 'organ' between pathology service providers and COPFS.

There has been discussion between COPFS and the pathology service providers on what constitutes an 'organ' but an agreed definition has not been reached. The subject is to be further discussed at a forthcoming meeting.

In Progress

Attendance on the 'Deaths 2' module and the 'Managing Communication with the Bereaved' course should be mandatory for all staff in the Scottish Fatalities Investigation Unit (SFIU) and in other specialist units that deal with fatalities, such as the Health and Safety Division. The training should be completed by legal staff within three months of joining SFIU or other specialist unit.

80% of the SFIU staff and 100% of the Health and Safety Division have attended the Managing Communication with the Bereaved course. The 'Deaths 2' module has been discontinued and is to be replaced by an e-learning module which is currently being finalised. The e‑learning module will be mandatory for all staff in the SFIU and in the other specialist units that deal with fatalities.

Substantial progress

In all cases involving suspected criminality, where an organ is retained following the release of the deceased's body, SFIU should assume responsibility for ensuring that the guidance and procedures relating to the retention of the organ are applied. In particular, SFIU should ensure that the nearest relatives are notified timeously of the retention, informed of likely timescales for the completion of the examination of the organ and their options for its disposal. The views of the nearest relatives on the disposal of the organ should also be obtained.

• A protocol should be drawn up specifying the procedure to be followed including reference to the specific form(s) to be used and the mechanism of recording the information.
• Following the release of the deceased's body and the completion of the examination of an organ, all records retained in the SFIU death file should be copied into any associated criminal file.

Guidance and a flow chart clarifying the process to be followed where an organ is retained have been issued to all staff in COPFS. The guidance specifies that SFIU is responsible for ensuring that the guidance and procedures relating to the retention of organs are applied.

Achieved

There should be a presumption that the death certificate should be issued when the deceased's body is released by the Procurator Fiscal.

Current practice is now to issue the death certificate when the deceased's body is released.

Achieved

COPFS should introduce one national organ retention form to be completed by the pathology service provider and COPFS in any case where an organ is retained after the body is released. The form should contain the following mandatory information:

• details of the deceased
• the type of organ retained
• where it is located
• how long it is likely to be retained
• when examination is complete
• date body is released
• the instruction on disposal

A single organ retention form has been introduced.

Achieved

For reconciliation purposes, a copy of the national organ retention database should be sent each month to a nominated post holder such as the mortuary manager or the administrative manager for each pathology department.

• The requirement to provide a monthly return, including timescales for returns should be incorporated into all pathology service providers' contracts.
• There should be an agreed stage when entries are removed from the national organ retention database. For example, when the wishes of the nearest relative have been provided to the pathologist.
• SFIU National should create and maintain operating instructions for duties relating to the operation of the Organ Retention Database.

The audit undertaken has confirmed that SFIU receives monthly returns from the pathology service providers. Entries are removed from the organ retention database when the organ is released to the family for burial/cremation or to the pathology service provider to arrange disposal.

Achieved

The existing contracts between COPFS and the pathology service providers should be amended:

• To provide a presumption that the death certificate should be issued when the body is released.

The contracts should be revised to include:

• A requirement to provide immediate and written notification to COPFS if an organ is retained beyond the deceased's body being released. (It is envisaged that this will be done by submitting the organ retention form.)
• To provide monthly returns within specified timescales to a nominated contact person/post holder in COPFS specifying details of any organs being held. A physical check should be undertaken each month and reconciled with the information provided by COPFS.
• To dispose of any organs in accordance with a written instruction provided by the Procurator Fiscal.

The pathology providers' contracts are under consideration. COPFS will seek to incorporate the provisions highlighted in our report within future contracts.

In progress

All communication on the wishes of the nearest relatives should be provided in writing to the pathologist who should acknowledge receipt. The written instruction and the receipt should be retained in the electronic death file.

This has been accepted as best practice and implemented.

Achieved

If nearest relatives fail to engage on the disposal of an organ, COPFS should arrange for a second communication, either in person if there is an established rapport, or by recorded delivery of correspondence seeking their instruction. This second communication should advise that COPFS will arrange for the pathologist to dispose of the organ if the nearest relatives fail to engage or provide an instruction on their wishes within a specified period of time.

If, after undertaking all reasonable inquiries, COPFS is unable to trace any nearest relatives, the Procurator Fiscal should instruct the pathologist to dispose of the organ.

SFIU guidance has been revised to reflect this approach.

Achieved