Guidance

Annex A: Information Sheet on Post Morterm, removal of human organs and tissue

Updated 25 July 2022

ANNEX A:

1. INFORMATION SHEET ON POST MORTEM, REMOVAL OF HUMAN ORGANS AND TISSUE

1.1 Circumstances under which Post Mortems are carried out:

Under Peruvian Law, post mortems are compulsory in the following circumstances:

• LEGAL: When the cause of death is unknown; when a judicial authority entitled to do so orders a post mortem; in order to identify a dead body; when a body is to be cremated (to prevent the disappearance of any criminal evidence); when it’s likey that the death is the result of a crime, a road accident, a natural disaster or poisoning.
• SANITARY: To establish the cause of death if it is suspected that there may be a threat to public health.
• CLINICAL: To evaluate how accurate a diagnosis was and the quality of the patient’s treatment. Only in this case family’s permission is needed by law.

1.2 Authorisation to Carry out a Post Mortem

Only the post mortem for CLINICAL reasons requires previous authorisation from the patient while he is alive or from his family after his death. Otherwise, no authorisation is required for a post mortem to be carried out, although a court order or statutory mandate is required. To confirm, family permission is NOT required when a post mortem is compulsory by Law (ie. in the cases stated above). A family’s authorisation is required if a doctor decides he wants to perform a post mortem for reasons other than those where it is compulsory by Law, and the deceased did not express his consent or refusal to being subject to a post mortem when alive.

2. Post Mortem Procedures and Organ Extraction

2.1 Authorisation to Extract Organs as part of Post Mortem Procedure

When part of a standard post mortem procedure, permission from the family is not required to remove tissue sample or organs.

2.2 Replacement/Retaining of Extracted Organs

By Law and according to standard medical practice, removed organs and tissue must be replaced after the post mortem. By Law a doctor must treat the body with respect and recompose it as best s/he can, preventing unnecessary mutilations or dissections.

The health regulations do not consider any need to remove the organs and not replace them in the body. It is also not forensic practice to remove the organ fully, but only the necessary sample to carry out the analysis required by law.

Only those organs and tissues specifically extracted to be examined in detail as considered strictly necessary by the physician in obtaining certainty of death, will not be replaced. In this case, they will stay under the custody of the Central Morgue in specially conditioned jars and rooms in order to preserve them so they may be kept for records. Peruvian Law does not state how long they may be kept for.

If the relatives consider that the sample is significant and wish to have it back, this will have to be requested to the Central Morgue Directorate in liaison with the Prosecutor’s Office.

2.3 Organ Donation

When a Peruvian citizen obtains his/her National Identification Document (DNI), s/he is asked whether or not s/he wants to be an organ donor, and this information appears on the document (DNI).

In the cases of people that die from an accident or sudden death and have not yet obtained their voting card, but are over 18 years of age, the law presumes they are willing to donate their organs, unless proved otherwise. This regulation is specific to emergency patients. Other patients must express their will to donate organs in an admittance form on arrival to the hospital. If your friend or relative is incapable of doing this (if, for example, he is unconscious), his relatives may express it for him. If a relative is not present or contactable, it is presumed that he is willing to donate his organs.

As foreign nationals that die in Peru are subject to the same legal treatment as Peruvian nationals, if a foreigner suffers a sudden death, doctors are legally authorised to remove his organs for transplant purposes only, unless the deceased has a document stating that he does not wish to be an organ donor. Even if the assumption that the deceased did not have a document stating his refusal to donate is later proved to be wrong, relatives nonetheless have no legal rights.