SOME 10 years after it was first revealed that organs were retained without consent following postmortem examination in Irish hospitals, an independent audit of such practices was published last week. The audit, carried out by Michaela Willis, a former member of the Retained Organs Commission in the UK, was a key recommendation of the 2006 Madden report into the scandal. While the Willis report found that all hospitals are now seeking informed consent before organs are retained, the importance of completing an audit cycle is emphasised by its finding that there is room for improvement in certain hospitals and in postmortem practices.
Mortuary facilities of varying standards and a dearth of training for mortuary staff emerge as a countrywide problem. The mortuary facilities of many hospitals are unsuitable for high-risk postmortems, Ms Willis found. The continued incineration of organs by some hospitals, well after the publication of the Madden report, is unacceptable. And problems continue in relation to the treatment of the bereaved in cases of sudden death or when a postmortem examination is ordered by a coroner.
However, it is the revelation of widespread problems at the Rotunda Hospital, necessitating a separate inquiry carried out in parallel with the retained organs audit, that will cause most concern. Given that some of the most repugnant postmortem practices unearthed in 1999 related to children’s and maternity hospitals, the ongoing problems identified at the flagship Dublin maternity hospital will distress families and patient representative groups.
The report by a review group, chaired by Ian Carter, found some 129 cases of organ retention were “noncompliant” with the consent given by parents. The most damning revelation is that in 92 instances, organs were retained for more than one year, even though this time period was explicitly agreed to by the hospital at the time of consent. These findings are completely unacceptable; the current Master of the Rotunda has issued an unreserved apology and rightly acknowledged “the very difficult and stressful situation in which these families have been placed”. He must now examine professional performance at the hospital and correct all deficits identified by the review group. Demonstrable progress must be apparent by the time a further planned audit is carried out in six months’ time.
Previous reports into postmortem practices both here and in the UK have concluded that poor professional practice was not wilful; in most cases it represented the continued use of outdated practices no longer “fit for purpose”. And some of the blame can be laid at the door of medical paternalism, a process that may exclude patients and their families from full participation in medical decision-making. The Willis and Carter reports underline the importance of following up on original health scandal reports. But they do not excuse the tardiness of the Minister for Health in failing to publish legislation covering postmortem practices a full decade after unacceptable standards were laid bare.