Maintaining high autopsy rates in a Canadian blood and marrow transplant program:: preserving a diagnostic and research tool

Autopsy series have revealed patterns of injury in graft-versus-host disease and provided insight into infectious and toxic complications following hematopoietic stem cell transplantation ( HSCT). Overall autopsy rates have declined significantly in recent decades including specialized services such as neonatal medicine and cardiac care. However, rates of post- mortem exams at HSCT centers have not been specifically documented. We reviewed hospital records between 1992 and 2002 to determine overall autopsy rates at our hospital and within the HSCT program. Although the overall autopsy rate declined steadily from 24% in 1992 to 9% in 2002, rates of postmortem exams in the HSCT program remained relatively stable at 32% ( 24 - 46%). Autopsy rates were not significantly different for recipients of allogeneic vs autologous transplants and no clear difference was observed for the proportion of autopsies requested on weekdays compared with weekends. Autopsies confirmed major clinical diagnoses and/ or suspected causes of death in 45 of 61 autopsies ( 74%) and yielded major or minor disagreements in clinical diagnosis in 10 cases ( 16%) and seven cases ( 11%), respectively. The preservation of high rates of autopsy within our HSCT program demonstrates that specialized programs are able to maintain elevated rates of post- mortem examinations despite overall declining rates.