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Wednesday, 31 January, 2001, 11:45 GMT
Alder Hey: Leading pathologist James Underwood quizzed

Professor James Underwood, Vice-President of the Royal College of Pathologists answered your questions in a live Forum on Wednesday.

To listen to coverage of the forum, select the link below:



Susan Wren, Washington Tyne-and-Wear:

What damage do you think has been done to genuine research in this country by the Alder Hay scandal?

Professor Underwood:

I think it has already done damage. We have noticed in our hospitals over the last year or so a substantial reduction in the number of post mortems that are being done with the consent of relatives. Many people engaged in research into disorders of the brain and heart for example are finding it increasingly difficult to obtain tissues for study.


Do you believe that relatives will still be willing to agree to organs being taken after these reports have come out?

Professor Underwood:

Yes I do. I think it is very interesting that in comments that have been made in the news items about Alder Hay and Bristol, where parents have had very distressing experiences, many of them have said that they would have been perfectly willing to allow the child's heart or other organs to be used for research. What they really object to and they find deeply upsetting and insulting is that no one had the courtesy to ask them.

Steve Woolf, UK:

Who at present decides which organs are needed and which ones aren't?

Professor Underwood:

It is important to remember that 90 per cent of post mortem examinations done in this country are required by law and the pathologist is required by the coroner's rules to keep any tissue or other material which in his opinion has a bearing on the cause of death. This rule was set up in about 1984 as an attempt to help families to enable them to proceed with the funeral without waiting for the coroner's verdict. But unfortunately it is this rule which seems to have caused a lot distress. It is very much up to the individual pathologist based on his medical judgement to decide which tissues are important for determining the cause of death.


Is there anything at present which could stop a pathologist who wants to take more organs than perhaps are strictly needed?

Professor Underwood:

Yes indeed. The Human Tissue Act 1961, which I think needs rewording and modernising in view of recent events, states very clearly that if a pathologist or indeed any other medical practitioner wishes to obtain tissues or organs from a post mortem examination for research or teaching, that can be done only having first determined that the relatives do not object.

Dr. Moran:

Are the parents' claims morally tenable given that the alternative to organ extraction and use is that the organs would be either burned or buried to no beneficial purpose whatsoever?

Professor Underwood:

I believe the parents' interests are morally tenable because they have a duty in law to ensure the body of the deceased is disposed of according to current legislation such as enables cremation or burial. The problem in the past has been that during the process of a post mortem examination or the process of a coroner's investigation, that right has been temporarily removed from them.

Chris Thompson, Bournemouth:

What assurances can you give that there are no more skeletons in the NHS closet - relating that particularly to pathology? Have we seen it all now do you think?

Professor Underwood:

The Chief Medical Officer's census was extremely searching and I don't believe that there is anything that is now left uncovered. I would emphasise also that since March of last year when our college published its guidelines on tissue and organ retention, which were endorsed by the Chief Medical Officer, there has been no repetition of these events.

Dr Salmas, London, UK:

How much information do you think is too much for patients these days?

Professor Underwood:

That is a very good question. The decision can really be made only by the bereaved family. There must be no limit on the amount of information that they need to seek and be provided with before they feel comfortable with their decision regarding consent to an autopsy or the retention of tissues and organs for educational research. It is very much up to the individual family to assess how much information they need before they make this difficult decision.

Jeff, UK:

Shouldn't we have a centralised database where everyone could record their wishes in these cases?

Professor Underwood:

This would be similar to the donor cards which many people carry that allow their organs to be used for transplantation. I think it is something that is worth exploring. After all, many people carry donor cards but for various reasons when they die the organs are unsuitable for transplantation; nevertheless, the organs could be useful to advance medical knowledge and for medical education.

Marian Phillips, Coventry, UK:

What must the medical profession do now to win back the trust of their patients?

Professor Underwood:

I think we need to do much in the whole medical profession, not just pathology, but all branches of medicine, to demonstrate to the public that we have already done a great deal to learn from the mistakes of the past and to restore public confidence in the integrity of doctors. It may be that in respect of post mortem examinations, the Government needs to produce a code of practice against which the performance of individual doctors and coroners and others involved in this can be assessed.

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