Autopsy on Unclaimed Bodies- Practical Issues

Expert Profile

Dr. Prateek Rastogi is currently working as Associate Professor in the Dept. of Forensic Medicine & Toxicology & Faculty Member in Medical Education Unit at Kasturba Medical College, Mangalore under Manipal University, Manipal and as an Honorary Medico-legal Consultant for Dist. Govt. Wenlock Hospital, Mangalore. He received his MBBS Degree in 2002 and MD (Forensic Medicine) from Manipal University in 2005. He completed Post Graduate Diploma in Medical Law & Ethics (PGDMLE) from National Law School of India University, Bangalore, Post Graduate Diploma in Criminology & Forensic Science (PGDCFS) from Annamalai University, Tamil Nadu and Diploma in Cyber Law (Dip. Cyber Law) from Asian School of Cyber Laws, Pune, Maharashtra. He is a certificate holder in Analytical Toxicology & Forensic DNA Typing from Amrita Vishwa Vidyapeetham, Kerala. He is also a certified counsellor in Consumer Protection Act & Medical Negligence, and a certified counsellor in Torture Medicine from IMA AKN Sinha Institute (Educational wing of Indian medical Association). He has published 78 articles in various National and International Journals. He has participated in 29 conferences and 66 workshops & CME’s at National and International levels and has presented 24 scientific papers. He has reviewed 8 books till date and has delivered guest lectures during 4 conferences and workshops. He is a reviewer for 17 reputed National & International journals and life member of 9 professional bodies in the medical field. He is a recognized PhD Guide for Manipal University in the subject of Forensic Medicine & Toxicology.

Foreground

Dr. Prateek Rastogi starts the talk with the quote,“Unknown is one who unknown dies” and “Fear of the unknown is the greatest fear of all”

According to him, it’s challenging sometimes to perform a postmortem on unknown dead bodies. So before going further lets me know some basic terminologies associated with the postmortem examination of unclaimed bodies

• Unclaimed - Not claimed, no ownership, 
• Unwanted  - Not wanted, Not needed, 
• Unidentified - Not identified, not recognized), and 
• Unknown - Not known, not familiar. 

Unknown and unidentified are somewhat similar terms and likewise unclaimed and unwanted. Let's have a look at some interesting cases discussed by Dr. Prateek Rastogi in his talk

• Case 1 : He starts with a case1 of a 61-year unknown old man whose body was found unconscious at a railway station. A post-mortem was done after 3 days when no one claimed the body of that man and his all histopathology and RFSL reports were negative and no injuries were found on his body. The cause of death remained unascertained however the possibility of death due to the natural cause was not ruled out. It’s the most common case which comes to the lab of the unknown body whose cause of death remains unascertained and it is considered as a natural death.

• Case 2: Then comes Case 2 in which the body of a 55-year-old man was found unconscious on road and was treated in hospital for one month during which he remained unconscious after which he died. A post-mortem was done which confirmed the scan finding according to which cause of death was cerebral necrosis due to natural causes.

• Case3: A 45–50-year-old emaciated man was found lying on the roadside. He was brought to the hospital and was diagnosed with pulmonary tuberculosis. He died after 2 months of treatment in the hospital after which his body was subjected to postmortem which confirmed the diagnosis of tuberculosis. 

In both case 2 and 3 the similarity was that the diagnosis was correct but the difference was that in case 2 the patient was unconscious and in case 3 the patient gained consciousness and later he died unclaimed although doctors were able to know his details.

• Case 4: In this case an unknown 60-70 years old man was found dead on the roadside. His body was preserved in the mortuary for 2 months after which an autopsy was done which showed a partially decomposed body with no signs of external or internal injuries. Histopathology showed autolysis of the tissues, RFSL was negative for poison and initial documents showed that the body was not decomposed at the time of preservation. 

• Case 5: Here, a middle-aged manual worker collapsed at the worksite. He was diagnosed with coronary artery disease. He died after one week in the hospital. No whereabouts were known to accept his name as he joined work just one morning before he collapsed. Postmortem was done which confirmed the clinical diagnosis. 

Objectives of Autopsy

The above-mentioned cases are usually the most encountered cases by the experts. So now it becomes important that what are the objectives of the Autopsy done for such cases? 

Objectives include

• Identification of unidentified dead bodies 
• Cause of death
• Manner of death
• Time since death if it’s not the witnessed one

In the cases of unidentified bodies autopsy is of preliminary importance. There are various procedures that help in the identification of unknown bodies taken up by police and investigating authorities like giving details or photographs of the body or belonging or the location where a body was found in the newspaper to circulate the news. Then comes radio channel which is not so common. Next is through television by showing details or photographs of the body. The most common one in the present time is the Internet and social media. Some other sources can be the missing reports of any person available in police stations. All these modes can be used to collect or spread information about unclaimed dead bodies.

Now the identification is mainly done based on the clothing( in case of the decomposed body it’s very helpful), belongings found along with the dead bodies, facial features if the body is not in a decomposed state, body characteristics and deformities, identification marks like tattoos, scar, moles, bite marks, fingerprints and other prints like footprints, lip prints and horoscopy( although not easy to identify with prints as generally records are not present) and most talked thing i.e. DNA with the advantage of full proof but the disadvantage that you need to compare it someone so you should know where to investigate as we don’t have a database for it and it’s a costly process.

Problems and Challenges faced in the identification of unknown dead bodies

1. Decomposed bodies in which facial features and body structure is not clear. Also, maggots can be there, body fluids can be oozing out of the body which makes the identification process very difficult.
2. Dismembered body in the case of mass disaster or accident in which only some body parts are available so the one has to not only establish the identity of the body but also the dismembered remains.
3. Skeletonized remains when only bones are found the one has firstly identified that those bones are not artificial. Then you need to identify that those bones are of human or animal and then to determine race, stature and other features from those bones.
4. Commingling of body parts in the case of disaster where different body parts may be found at different locations
5. Unrecognizable facial features as play the most important role in body identification.

Other problems and challenges in the identification of the unknown body can be:

1. No prominent identification mark available on the body which helps in its identification
2. No clothing or belongings
3. Ambiguous information from clothing and belongings as lots of people purchase clothes of same brands so you can’t exactly get the information about the person
4. Unrecordable fingerprints or other prints and unavailability of data for comparison
5. No person missing report in the vicinity
6. Bodies recovered far from a place of origin or death and cost factor
7. No relatives or family members or relatives and family members not willing for identification
8. Body is damaged beyond recognition due to drowning or charring, etc.

Issues Related to the Disposal of the Body 

Now if the experts can identify the body or in case, they are not able to do so, in both cases the body needs to be disposed of. But there are lot of issues related to the disposal of the body like 

1. Religious issues in case if you are not able to identify the body then how you will dispose of the body
2. Then comes the cost factor i.e., who will bear the cost of the disposal
3. Unclear or suspicious manner of death.
4. Infectivity like in the cases of corona infection
5. Bodies can be used for organ harvesting or for research but it requires a lot of procedures to be followed and permissions need to be taken from higher authorities

Legal Issues 

So, in such cases, there are three main legal issues that arise are

• Preserving an unknown dead body (who will and how long)
• When to perform the autopsy of the unknown dead body and whether it’s required or not
• How to dispose of that unknown dead body

Ethical and Humanitarian Issues

Then comes the Ethical and Humanitarian issues which are

• delay in disposal
• religious matters
• careless attitude of authorities
• cost factor involved in disposal and establishing identity
• organ harvesting
• supply to medical colleges
• infectivity

Conclusion

Unidentified bodies made up only 4% of the total dead bodies brought to the department's mortuary for autopsy. However, as shown above, these cases take significantly more time and work to process, and the process is still unfinished. The following recommendations can be useful in speeding up the process:

• Additional legislation for the management of unidentified deceased corpses is being drafted.
• Police officers' identification efforts should be expedited, and procedures should be established and carefully followed.
• Unclaimed/unknown bodies should be presented for autopsy as soon as possible so that decomposition and other artefacts do not hide the findings of the postmortem investigation.
• To identify the body, active inquiry and new investigative techniques must be applied, the workload of police officers must be dispersed, and police accountability must be resolve

Personal Note

It was an extremely amazing session and I got to know many new and interesting things from this session which is of very significant importance in the postmortem examination of an unidentified body. I really loved the talk and these concepts and the material presented will definitely be incorporated into my resources. Prof. (Dr.) Prateek Rastogi is very knowledgeable and passionate about the subject and connected it in an amazing way. I recommend all the readers to visit the YouTube Channel Forensic 365 to have a better and detailed insight of the lecture