Building a rapid autopsy program – a step-by-step logistics guide

Abstract

Background Rapid Autopsy Programs offer an opportunity to collect tissue from patients immediately after death, providing critical biological material necessary to develop more effective therapies and improve patient outcomes. Here, we present a step-by-step guide to build a cancer-focused Rapid Autopsy Program, based on our own experiences building “The Legacy Project” at the City of Hope Comprehensive Cancer Center. Methods The linear timeline of events is separated into four phases: 1) Building the Infrastructure, 2) Recruiting and Consenting, 3) Preparing for Death, and 4) Tissue Collection and Follow up. Important considerations and methods for adaptation are discussed throughout the protocol. Discussion Using these methods, we successfully collected a total of 533 specimens from 9 subjects. The average time from death to last specimen acquisition was 6.1 h (range: 4.03–7.66 h; median: 5.71 h). A diverse team with various areas of expertise is critical for successful program implementation. Our goal herein this protocol is to provide a comprehensive framework and foundation for other institutions to use as a model.

Proteome alterations in human autopsy tissues in relation to time after death

“…All autopsies were performed at the Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary. Tissue specimens from the lung, kidney and liver have been derived from patients with predefined post-mortem time interval (6,12,18,24,48,72, 96 h) and a lack of specific diseases significantly affecting the preservation of the investigated organs. Corpses were stored at 4 °C between death and autopsy procedure.…”

“…for genomics [ 2 ], transciptomics [ 3 , 4 ] or proteomics [ 5 ]. Nevertheless, RAPs remain confined to specialized institutions [ 6 , 7 ] and it still poses a challenge to harness the possibilities of non-RAP autopsy specimens for translational research. Some authors have sought to keep the post-mortem interval as short as possible by performing core biopsies after death [ 8 ].…”

Research autopsy programmes in oncology: shared experience from 14 centres across the world

“…More recently, research autopsies have also been used to help to understand organ damage from COVID-19 [19,[28][29][30]. In oncology, multiple excellent autopsy programmes have been developed and have described their structure and logistics of approach [11,[16][17][18][31][32][33][34][35][36][37][38]. Most publications are, however, single programme reports and do not compare methodologies across locations in a structured way [16,32,38].…”

“…In oncology, multiple excellent autopsy programmes have been developed and have described their structure and logistics of approach [11,[16][17][18][31][32][33][34][35][36][37][38]. Most publications are, however, single programme reports and do not compare methodologies across locations in a structured way [16,32,38]. The research autopsy as a method of enhancing access to tissue samples is also still under-utilised.…”

Kidney Disease and Viral Infection in COVID-19: Why Are Kidney Organoid and Biopsy Studies Not in Agreement?

“…In addition, reports of coronavirus-like particles identified in postmortem kidneys by other groups have been questioned due to the lack of rigorous criteria of virus identification, the resemblance of these particles to cytoplasmic organelles, and the presence of postmortem artifacts [8, 9]. Ultrastructural evaluation of postmortem kidneys could be significantly improved in the future by the adoption of rapid autopsy protocols [38]. The mitigation of postmortem artifacts with this approach combined with the use of rigorous EM criteria of virus identification would facilitate the distinction between putative coronavirus particles and their cellular mimics in autopsy material.…”