The issue of organ retention by children's hospitals was first highlighted as part of the Bristol Heart Surgery inquiry. Subsequently, the Alder Hey Hospital in Liverpool disclosed that tissue from children's post-mortems was held back for teaching and research purposes.
Both of these cases focused attention on procedures for obtaining parental consent for autopsy.
Our Lady's Hospital for Sick Children in Dublin has had more than 300 inquiries to date from families wishing to establish whether their children's organs had been retained. According to hospital sources, the bulk of them relate to post-mortems carried out in the 1970s and 1980s.
Until 1999, post-mortem consent forms and practices in Our Lady's did not specifically distinguish tissue-retention from organ-retention. In July 1999, new procedures were instituted, in which parents are specifically asked for permission to retain the child's organs for further pathological examination.
There is a clear distinction between a statutory post-mortem ordered by the coroner and a post-mortem requested by the child's consultant in order to establish the cause of death in cases where this may not be clear. A coroner's post-mortem is performed under certain strictly laid down conditions - for example, a death taking place shortly after hospital admission. There is no optional element in such post-mortems - they must be performed by law.
In such cases, the families do not have a choice as to the extent of the autopsy process. They will be informed that the post-mortem will take place, but they cannot limit the process in any way.
Until recently, approximately 50 per cent of autopsies at Our Lady's Hospital were performed by direction of the coroner.
Discretionary post-mortems, on the other hand, are now the subject of a much tighter consent process. Parents will be asked specifically whether tissue or organs can be retained by the hospital. They will be able to limit the process to specific parts of the body.
The reason for the autopsy request is explained in detail and parents have the right to opt out and to refuse permission for a post-mortem examination.
Sources in the hospital have confirmed that the number of discretionary or optional post-mortems has fallen sharply since the new consent process was introduced last July. This is an understandable reaction by upset and grief-stricken parents, who do not wish to subject themselves or their families to the trauma of a discretionary autopsy.
While it may limit the research and teaching capabilities of hospital staff, it does reflect an improved process of obtaining con sent for post-mortem which now exists in Our Lady's and other hospitals throughout the State.