5 Things You Didn't Know About Autopsies

When conducting an autopsy, the weight of the unopened corpse is taken before anyone peeks inside. Then the organs are removed and weighed individually. This latter step is important because some disorders affect organ sizes, so if the heart or stomach is unusually heavy, it could help the examiner pinpoint the cause of death.

The first step toward opening the chest is placing a rubber block beneath the torso area, which props up the ribcage. Next, a Y-shaped incision is made; at the bottom of the sternum, a long cut extending down to the pelvis connects with two diagonal cuts that terminate at the shoulders. Rib cutters, bone saws or good old-fashioned pruning shears are then used to remove the rib cage, giving the examiner a clear view of most of the body's major organs. (The brain is extracted in a separate process.)

The coroner can remove those vital organs one by one, but in some scenarios it makes more sense to take groups of them out together in blocks, thus keeping their points of connection intact.

Regardless, each organ must to be carefully weighed and measured. Though the process might sound tedious, it's sometimes the best way to identify certain maladies. For example, an abnormally heavy heart might indicate that the victim had myocardial hypertrophy. Likewise, kidney sizes fluctuate in cases of chronic progressive nephropathy.

But a medical examiner can't call something abnormal unless he knows what the standards of normalcy are. Tables or charts that document the average weights and dimensions of various organs are consulted during autopsies. As this data is reviewed, the victim's age has to be kept in mind: Babies and adults have differently sized organs, after all.

Who pays for an autopsy? Generally, the operation is financed by the party that's demanding or requesting it. If somebody dies under suspicious circumstances, a state or county may call for a forensic autopsy. Taxpayers foot the bill in those situations. In cases where the government sees no need to mandate an autopsy, the family of the deceased can request one — but they may have to pay for it out of pocket.

As "Frontline" reports, most insurance plans don't cover autopsy expenses, so many families wanting an autopsy of a deceased loved one must hire a private autopsy service. Others use their own money to pay the local medical examiner or coroner's office for a thorough inspection of the corpse. But be warned: Privately financing an autopsy can set you back to the tune of $3,000 to $6,000.

Turning to your local hospital could be a (much) cheaper option. While some of these institutions command hefty price tags for autopsies, others will conduct them on former patients at no cost. Yet hospitals that offer this kind of free service may not have the facilities to perform autopsies themselves and hence outsource the work.

Prior to the 1970s, accredited hospitals in the United States were required to conduct autopsies on at least 20 percent of their deceased ex-patients, but that requirement was lifted in 1971.

This policy change is one reason why hospital autopsies have become rarer over the past half-century. (Another contributing factor was the rise of body-scanning technologies.) In the late 1940s, around 50 percent of all the deaths in American hospitals were followed by an autopsy. By 2017, that rate had dropped to 5 percent nationally. Today many U.S. hospitals no longer perform any in-house autopsies whatsoever.

Under New York State law, "if a surviving friend or relative of the deceased" argues that an autopsy is against the decedent's religious beliefs, no such examination can be performed unless there's a "compelling public necessity."

What does that mean, exactly? In a nutshell, coroners and medical examiners throughout the Empire State do have the right to override religious objections to an autopsy — but only if a) the procedure is part of a criminal investigation, b) the victim's death is linked to a major public health crisis, or c) a court reviews a formal petition and decides that there's another "demonstrable need for an autopsy or dissection."

Louisiana, California, Maryland, Ohio, New Jersey and Rhode Island all have comparable regulations in place. Minnesota joined their ranks in 2015, after a medical examiner tried to operate on the bodies of an Ojibwe man and a Chippewa woman who'd died in separate car accidents. This deeply offended both Native American communities because corpse desecration violates the Midewiwin religion's traditional burial practices. (Orthodox Jews often express similar reservations about tampering with a person's body posthumously.)

In some states like Florida and New Hampshire, religious protests against specific autopsies are reviewed on a case-by-case basis. One rule that's consistently enforced across all 50 states is that families and friends of the deceased cannot block an autopsy on religious grounds if the authorities suspect foul play or have a strong reason to believe that a threat to the general populace — such as a dangerous disease — led to the person's death.

Consider yourself fortunate if you've never been told to "run the bowels." That's the nickname given to one of the autopsy room's dirtiest jobs: opening the intestines. Upon removal, these organs are slit horizontally. The small and large intestines of an adult human have a combined length of around 25 feet (7.6 meters), so cutting them open is no easy task.

Extracted poop is normally washed down a medical sink, but sometimes it plays a diagnostic role. Hard stool clumps may indicate fecal impaction, a potentially fatal condition that leaves the colon plugged by dung. In addition to feces, running the bowels can reveal polyps, tumors and other things of great value to pathologists.

That brings us to undigested food. The stuff we eat generally spends about four to six hours inside our stomachs before moving onward to the intestines. So if any recognizable food turns up inside the stomach of the person being autopsied, chances are the deceased party died shortly after he or she consumed it.

Such evidence can be a godsend for forensic teams. In 2010, two masked men tried to rob an Oregon coffee kiosk at gunpoint. Things got violent when the barista pulled out a firearm of his own. One of the attackers was killed, but the other escaped.

While probing the dead gunman's stomach, an examiner removed half of a french fry. Now potatoes are easy to digest and usually break down within an hour. Clearly, the deceased had gobbled up his last meal shortly before expiring. And that's not all: An analyst recognized the (mostly intact) spud as a Wendy's french fry. Sure enough, when investigators checked out the security footage at a nearby Wendy's restaurant, they were able to identify both criminals and apprehend the survivor.

Getting an autopsy isn't like taking your car to the garage. If a mechanic takes the steering wheel apart, he can put it back together exactly as he found it. Obviously, when a dead person's ribs have been cut, they can never be uncut.

Right off the bat, conducting a second — or third — autopsy on a body that's already been dissected presents significant challenges. Fluids extracted from the cadaver during the first examination are not always preserved for later study. Likewise, the opening and reshuffling of organs can leave the second pathologist with something of a jigsaw puzzle. Photographs of the body taken before or during the original autopsy are extremely helpful in these situations. So are the accompanying notes.

Despite all the hurdles, skilled pathologists may be able to oblige families or investigators who want repeat autopsies. New evidence sometimes emerges during follow-up postmortems. Maybe the second autopsy will involve molecular-level dissections that weren't performed during the first. Or perhaps it will take a closer look at an underexplored portion of the body. By comparing new findings with information from the previous autopsy, investigators might get a clearer picture of the circumstances surrounding a person's death.

Yet experts say that even when sequel autopsies turn up fresh clues, they rarely undermine the overall conclusions drawn from the first postmortem — unless that initial procedure was botched. Nonetheless, a second go-around can be a means of quality control. It may also provide reassurances to the decedent's loved ones.