We read with interest "When Families Ask About an Autopsy" (Viewpoint, August). The author describes a common dilemma: nursing staff being asked by a dead patient's family members whether an autopsy is recommended. The author correctly notes the sharp decline in the rate of autopsies performed in the United States.

Even with improved laboratory testing, imaging, and technology, there remains an important role for the autopsy in clinical medicine. Autopsies can enhance our understanding of disease and how we die. They may also provide legal evidence, as well as relieve the stress of the unknown. However, consented autopsy is on the verge of extinction.1 The rate of autopsies has plummeted over the decades. It is estimated that an increasing number of the 2.5 million Americans who die each year do so without being examined at all.2

We believe the problem is multifactorial. The heavy burden of procedures, teaching responsibilities, and laborious administrative tasks pathologists have to face in academia discourage the most experienced of them to effectively engage in the practice of autopsies.1 In private practice, autopsies are typically limited. At the state level, some state medical examiner's offices have been forced to cut the number of autopsies because of underfunding and understaffing, resulting in compromising the accuracy of death rulings.3

As the author points out, cost is a major factor, as autopsies are not covered under Medicare, Medicaid, or most insurance plans. A private autopsy can cost between $3,000 and $5,000.2

All stakeholders, including physicians, patients, the general public, pathologists, health care policymakers, insurance payers, and politicians must work together to develop a feasible plan to help solve the decline of consented autopsies in this country.

Xiulu Ruan, MD

Alan D. Kaye, MD, PhD

New Orleans

Kim S. Kaye, MD

Covington, LA

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