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Draft Form (Organ Retention) Coroners Act 1962

The coroner has directed a postmortem examination of the body of_______________ in order to establish the cause of death. Small blocks of tissue may be retained for microscopic examination and will form part of the record of the postmortem examination. In order to establish the cause of death it may occasionally be necessary to retain a whole organ or organs for further examination. In the majority of cases no organs are retained. In order to carry out the examination with minimum distress to the family we require the following information:

I have been given an explanatory leaflet on postmortem examinations. []

I do not wish to be informed that an organ has been retained. []

I wish to be informed that an organ has been retained before the body is released for burial or cremation. []

I wish to be informed that an organ has been retained after the examination is completed []

Where an organ is retained we need to ascertain your wishes for disposal.

I request the hospital to dispose of the retained organ(s) in accordance with an agreed practice. []

I wish to make my own arrangements for disposal. []

Signed______________________ Spouse or next-of-kin

N.B. This is not a consent form for a coroner’s autopsy. (See note 9)