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Forensic pathology research

May 22nd, 2014
Forensic pathology research
Forensic pathology at the NIPH. Credit: Jimmy Linus

There is currently considerable media attention around the forensic pathology activities at the Norwegian Institute of Public Health (NIPH). The NIPH took over responsibility for these activities in June 2011 when the Institute of Forensic Medicine was transferred from the University of Oslo.

The police requests all the forensic autopsies that are performed at the Norwegian Institute of Public Health - around 950 per year. Approximately 20-25 of these post-mortem investigations concern infants and children aged from 0 to 3 years, approximately 40 forensic autopsies of children are performed totally in Norway.

When the police requests a forensic autopsy, the bereaved are informed but consent is not acquired. The information responsibility does not lie with the pathologist but with other health professionals, according to the SIDS Guidelines (Krybbedødspermen) at the Norwegian Electronic Health Library.

Recommended procedures

There are internationally recommended procedures (protocols) for forensic autopsies. These procedures are followed by the NIPH. A forensic autopsy requires a careful examination of the exterior of the body as well as the internal organs, including the brain and heart. In addition, radiological, toxicological, histological, microbiological and genetic analysis are mandatory in order to be able to determine the cause of death.

The brain must be "fixed" in a formaldehyde solution for several weeks and the heart for several days before they can be examined correctly. This routine is not for research purposes but is a procedure advised by the international protocols, and is the only manner that enables a thorough examination.

Organs removed during autopsy are handled with respect. Where possible, these are returned before the deceased is released for burial. Organs that must be fixed are cremated and buried after examination, either anonymously in an urn grave, or placed in the child's own grave if requested by the parents.

During the 1980s, Norway faced an epidemic of cot death (SIDS), with a peak incidence of 2.7 per 1000 in 1988. In 1984, a research biobank was established. Small tissue and fluid samples (not whole organs) were collected during the forensic autopsy and stored for research purposes. The goal of the biobank was to perform research which could generate new knowledge regarding the death mechanisms in order to prevent future infant death. Tissue samples from more than 700 cases of sudden infant and child deaths are stored in the biobank as of 2014. Substantial research activity has been based on this biobank within the past three decades resulting in a better understanding of hazardous risk factors for sudden infant death and increased knowledge of mechanisms and causes of death. The legal regulations for this research activity have changed significantly from 1984 to today. However, necessary authorisations have been collected with changes in regulations during the past years.

Research stopped

The NIPH management has been responsible for the research activity in forensic pathology since 2011.

"We are currently uncertain of the legal basis for the collection of these tissue samples for research. Therefore, as of 16 May 2014, we have stopped all further collection of material for research from autopsy activities and all research on already collected material. Research will not be allowed to continue until we have determined whether any of the activities are in violation of the law and which corrective measures need to be implemented," says Bjørn Magne Eggen, Director of the Division of Forensic Sciences at the NIPH.

The NIPH management has informed the Ministry of Health and Care Services, the Office of the Attorney General, the Norwegian Health Supervision Authority and the Regional Ethics Committee.

Continued routine forensic autopsy activities

Assignments related to forensic autopsy activities will continue as before and we emphasise that there is no doubt about the legal basis for these activities. Forensic autopsies are requested by the police with a basis in Norwegian criminal law.

Causes of death

Causes of sudden, unexpected death among children aged 0-3 years:

  • approx. 50% SIDS (cot death)
  • approx. 35% acute disease
  • approx. 5% accident
  • approx. 3% child neglect
  • approx. 4% child abuse
  • approx. 3% murder

Provided by Norwegian Institute of Public Health

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