Stanford Medicine brings autopsy suite, morgue and decedent care into a single hospital space

Stanford Health Care, Stanford Medicine Children’s Health and Stanford Health Care Tri-Valley care for some of the sickest patients in the nation. Inevitably, some of them die in the hospital.

Last week, Stanford Health Care opened a 4,400-square-foot state-of-the-art autopsy facility that will greatly enhance learning, teaching and research opportunities for scientists and clinicians. The space also houses the Office of Decedent Affairs, which supports family members of deceased patients, guiding them through grief as well as the many tasks that follow a death.

“When a patient passes away at Stanford Health Care, they are still our patient,” said the Rev. Charles Tigard, manager of the Office of Decedent Affairs, who added that consolidating all postmortem services in one area is a relatively unusual approach among academic medical centers. “They are still under our care. But our focus shifts to supporting their family and staff navigating the administrative duties that accompany a death.”

Bringing the two services together in one space, along with a new morgue, will help pathologists conducting research autopsies, which — with the permission of the patient or the patient’s next of kin — provide critical tissue, organ and cell samples to researchers and clinicians studying the molecular causes of disease so they can design new drugs and therapies for use in the clinic.

Aiding science

Only about 14 centers in the country are equipped to conduct research autopsies; with the new space, Stanford Medicine plans to launch a research autopsy fellowship program to train the next generation of specialized pathologists.

“Most people have no idea how incredibly much we can learn from any autopsy,” associate professor of pathology Jody Hooper, MD, said. “The cause of death is only one factor. We can learn why the patient died on the day that they did, instead of after a longer time, for example. This information is relevant to treatment and can help us make another person’s life better now, even if they have a terminal diagnosis.” Hooper is the director of Stanford Medicine’s Research Autopsy Center and of autopsy services.

Formerly, the three hospitals shared one autopsy room and a distantly located morgue that required staff to spend time retrieving and returning deceased patients for autopsy. The room also lacked space for research activities.

The new suite has two autopsy rooms with an up-to-date computer system and 80-inch wall screens to display images or real-time dictation notes. The adjoining morgue streamlines the autopsy process and enables the Office of Decedent Affairs to work closely with the pathologists to release a patient’s body for collection by funeral homes or other services as quickly as possible.

A place to say goodbye

The space also contains a bereavement area, with beverages and restrooms, for family to gather; there is also a peaceful viewing room for family members to spend time with their loved one after death, away from the busy hospital setting. Team members from the Office of Decedent Affairs are available to support family and even Stanford Health Care health care providers when necessary.

“The goal of my team is to provide comfort and clarity,” Tigard said. “We are all in health care because we put our patients first. We help with the necessary logistics — documenting the death in the patient’s medical record, filling out an autopsy consent form, ensuring that the front-line care team has the information they need, for example — and provide spiritual and emotional care to a patient’s family as well as staff members. Sometimes, when a death happens, staff members who cared for them are distressed.”

His six-member team, which was formed about three years ago, includes people with backgrounds in spiritual care and the funeral industry as well as hospital administrative staff.  After a death, members of the team sit with the family and answer questions about the next steps, such as how to contact a funeral home and coordinate transportation. They provide written resources in multiple languages and remain available by phone to answer any additional questions that may arise after the family has left the hospital.

“Often we are meeting people on what might be the worst day of their lives,” Tigard said. “They may be experiencing shock, anger or disbelief as well as grief. These spaces give them the dignity and privacy they need.”

Helping the living

When a research autopsy is conducted, Hooper and her colleagues can collect many types of tissues — including the brain and other organs of the body — that are difficult or impossible to procure from living patients. The volume that can be collected after death allows them to provide materials to a wide variety of researchers who need samples of tissue and cells that are healthy as well as diseased.

“The resources available in this new space will greatly expand the type of research we can support. We are in a whole different universe of possibility,” Hooper said.

For example, some researchers at Stanford Medicine use tissues from research autopsies to grow small, three-dimensional versions of organs, called organoids, that recapitulate the many cell types and shapes of organs in the human body. Doing so allows them to compare healthy and diseased mini-organs in a laboratory environment and study how disease affects their function. Other researchers examine whether and how the genetic sequences from a patient’s tumor differ from the time of their diagnosis, after treatment and at the time of the patient’s death to learn how the disease evolved in the body.

Pathologists can also use a portable brain magnetic resonance imaging machine to study patients’ brain structure as part of the Knight Initiative for Brain Resilience, whose goal is to extend the lifespan of the healthy human brain by uncovering the causes of and treatments for dementia due to aging and disease.

“We have over 40 research groups interested in postmortem tissue for study,” Hooper said. “Anyone healthy or ill can sign up to donate their body after death at no cost to them or their family. This is an incredible contribution to science.”

The meticulous attention given to deceased patients, and the efforts by Hooper’s team to optimize the amount of information obtained from each autopsy, are hallmarks of the respect Stanford Health Care holds for those who entrust their medical care to the many health care providers at the three hospitals, Tigard emphasized.

“Stanford University was founded as the result of the death of Leland Stanford, Jr.,” Tigard said. “That death became what we are today, and it’s a legacy we’re still living when we honor a patient after death, care for their family members and promote the education of future generations. I like to think it’s in the DNA of this place.”