What happens when a child dies?

A typical scenario might be as follows:

The child is admitted to hospital suffering from a severe heart complaint. Assessment is carried out by a multidisciplinary cardiac team which meets regularly to review patient care. The team concludes that unless something is done the child will die within days, possibly sooner.

When faced with a child who is likely to otherwise die, doctors have no choice but to attempt high-risk procedures. The truth is that they sometimes fail.

The cardiac team and parents discuss the risks, and a decision is made to operate. At 8 a.m. the child, who is already well known to hospital staff, goes to the operating theatre.

At midday they return to the intensive care unit, and the critical 48-hour period begins. During the afternoon and evening the child begins to deteriorate and shortly after midnight, after multiple complications and cardiac arrest resuscitation, the child dies.

It is a devastating blow. Nobody wants to discuss an autopsy during the acute early stages of grief, but the family is often heading home to break the news to the extended family.

It is now the early hours of the morning, and the medical team may have to start again in a few hours with another patient.

In the past, paternalism on the part of the medical profession dictated that the worst of the details of autopsy were withheld. It was explained that no new incisions would be made and that the child would be treated with great respect.

It was not explicitly stated that the heart or other organs could be retained for up to 20 years or more and used for study and research which could contribute to saving other lives.

Since the current controversy arose, however, a new practice has been instituted. Parents must now know exactly what is to happen to the organs if their consent is to be had for an autopsy, even if this is so graphic that it leads to a refusal.