Facts

Over the past year, as a result of the "Alder Hey Scandal", there has been growing public awareness surrounding the retention of tissue that have been removed and stored for Histological examination.

Retention and Disposal of the Products of Conception - A Dilemma

The so called “Alder Hey Scandal” and the revelation that tissues were retained for further examination, when the parents had not given specific permission, has created a need for better communication between all concerned. The medical scientists in pathology laboratories will. because of this situation need to re-think their attitude, not only towards the retention of organs and tissue samples, but also towards their disposal. The concern of the general public appeared to centre only on the retention of the tissues that had been removed and that loved ones had been buried or cremated without these tissues. No thought appeared to be given to any scientific work that was carried out on these specimens, at the time of their removal, nor to any future comparative pathology that is an essential part of the country’s scientific research programme.

In the past. people adopted a somewhat head in the sand philosophy. They failed to face the reality of what a Post Mortem examination entailed. Although they would give permission for a Post Mortem. they did not realise that for over 100 years the practice of storing surgical and autopsy specimens was an inherent part of the process. They were unaware that fixed tissue was stored for possibly a decade and that wax blocks and slides were stored indefinitely. The realisation by the public of these practices is now affecting every pathology laboratory in the country. The medical scientist, on the other hand viewed the surgical and autopsy material as specimens, without any emotional association to a living human being. In the context of their every-day workload, the medical scientist processes hundreds of tissues and it becomes inevitable that these are treated dispassionately in a purely scientific manner.

Both these attitudes are understandable but common ground should be sought. The general public must be made aware that surgical tissue taken for Histology is taken so that a positive diagnosis can be made — for their benefit. They must also understand that these tissues may be required for future research and may be retained. As an example, retrospective studies made on stored tissue and wax blocks of lymphoid tissue has allowed researchers to study CJD on tissue samples taken prior to the first appearance of the disease in humans. The medical scientist is now very aware of the problem and the dialogue between Medical Staff:Biomedical Scientists. Patients and Relatives has greatly improved.

In the same context, a sensitive approach must be made towards the retention and disposal of the products of conception. These specimens may range from a few millimetres to identifiable foetal tissue. If these tissues are to be retained then it is essential that the parents really understand and agree to their storage. In the case of their disposal, a dignified and respectful method must be employed. This has to be irrespective of the size of the specimen and take into account the parents wishes. In today’s multi-cultural society, the customs and practices of all ethnic groups must be considered.

Caskets Ltd has produced a suitable casket that meets all these needs. Made of white cardboard with a base and lid, the caskets are coffin shaped. They are flat-packed in boxes of 50. At present these are designed for the larger products of conception. Smaller caskets are currently being developed. These caskets provide a dignified means of disposal of foetal tissues with minimum financial strain on the laboratory budget.