Post-Mortem Examination (Autopsy) Explained: Types, Consent, Cost and Results

A post-mortem examination, called an autopsy in the US, is a medical examination of a body after death, carried out by a pathologist to find out the cause of death. A medical examiner or coroner can order one without your consent when a death is sudden, violent or unexplained. A hospital can do one only with consent from the legal next of kin. The examination itself takes a few hours, and it does not rule out an open-casket funeral.

What kinds of post-mortem are there?

The CDC's National Center for Health Statistics describes two types in the US: hospital (clinical) autopsies, which family or doctors request to clarify the cause of death or assess care, and medicolegal autopsies, which legal officials order to investigate the circumstances of a death. A third kind, a private or "second" autopsy, is one the family hires a pathologist to do.

Autopsies are less common than most people expect. In 2020, 7.4% of US deaths (249,337 of 3.38 million) were autopsied, down from 19.1% in 1972. The rate depends heavily on how the person died: 98.7% of homicide deaths, 49.3% of suicide deaths and 47.5% of unintentional injury deaths were autopsied, against 3.0% of deaths from disease. Deaths in hospital inpatient units, hospices and nursing homes were the least likely to be autopsied.

When does a coroner or medical examiner order an autopsy?

State laws differ, but the CDC's handbook for medical examiners and coroners says deaths that typically require investigation are those from unusual or suspicious circumstances, from violence (accident, suicide or homicide), and from natural disease when the death was sudden and without warning, the person was not being treated by a physician, or the death was unattended.

Investigation does not always mean an autopsy. In 2018, US medical examiner and coroner offices were referred more than 1.3 million deaths and accepted 605,000 for further investigation. On average, the offices did one full autopsy for every seven cases referred and for every three accepted. Many of the other cases are closed after an external examination or a records review. The office decides whether to take a case, so you generally cannot demand a free autopsy if it declines. Our guide to coroners and medical examiners explains who does what in your area, and the coroner investigation guide covers the wider process.

Can you refuse or limit an autopsy?

It depends on who is asking.

• Hospital autopsy: Yes. It needs written consent from the legal next of kin, and families can usually choose between a full autopsy (head, chest and abdomen) and a limited one that covers only certain areas. At the University of Rochester's hospital in New York, the order of consent is spouse, domestic partner, adult child, parent, adult sibling, then other adult relatives, and a health care agent's authority ends at death. Your state's order may differ.
• Coroner or medical examiner autopsy: Usually no. Johnson County, Kansas, tells families that some autopsies are required by law regardless of what the family wants, but that families can ask for alternatives for religious, cultural or other reasons.
• Religious objections: A few states have specific protections. New York law says no autopsy may be performed over a relative's objection that it is contrary to the deceased's religious beliefs, with at least 48 hours' notice so the objector can go to court. The exceptions are a criminal homicide investigation, an immediate public health threat, or a court order, and any autopsy must be the least intrusive procedure consistent with the state's interest.

Many faith traditions place weight on keeping the body whole and on burying promptly, and views vary within each tradition. If this matters to your family, tell the office at the first call. Our guide on whether a family can refuse an autopsy goes through the rules in more detail.

What happens during an autopsy?

A full autopsy follows a set order. Exact practice varies between offices.

1. Review of the circumstances. The National Association of Medical Examiners (NAME) describes a medicolegal autopsy as one part of a death investigation that also looks at the scene, medical history, imaging and toxicology.
2. External examination. The pathologist records the condition of the body, including any injuries and medical devices.
3. Internal examination. A Y-shaped cut across the upper chest and down the abdomen gives access to the organs, which are examined. A full autopsy also covers the head.
4. Samples. Small tissue samples are studied under a microscope (histology), and blood, urine and other fluids are tested for drugs, alcohol or other substances (toxicology). Occasionally a whole organ, such as the brain or heart, is kept for specialist examination.
5. Closing. The incisions are closed and the body goes to the funeral home. NAME notes that dissected organs commonly stay in the body cavity inside a bag.

St. Jude Children's Research Hospital says the examination takes two to four hours, while the University of Rochester says three to six depending on the case. If you want to avoid an internal examination, ask whether a limited autopsy, or a CT or MRI scan, is possible. Availability depends on the office, and where a state authorizes an autopsy over an objection, New York's law requires the least intrusive method.

Will an autopsy affect the funeral or an open casket?

St. Jude says an autopsy does not affect an open-casket viewing, because the marks cannot be seen after the funeral home prepares the body. Johnson County, Kansas, says its autopsies are done in a way that does not typically interfere with an open casket. Your funeral director can tell you what to expect in your case.

The timing is the practical issue. The funeral home can usually collect the body once the examination is complete, so ask the office for an expected release time before you set a date or pay a non-refundable deposit. If the medical examiner or coroner has the case, the office may also have to approve cremation. The Bureau of Justice Statistics found that about 72% of these offices provided cremation waivers or authorization in 2018, so ask the office and your funeral home early.

How long do autopsy results take?

Expect a short wait for the first findings and a longer one for the final report.

• Preliminary findings: St. Jude says initial findings often come within two to three days. The University of Rochester's hospital autopsy service reports preliminary results in about four business days.
• Final report: St. Jude says it may take several weeks. The University of Rochester says final reports are typically done within 60 business days, longer for complex cases. NAME's accreditation checklist sets a benchmark that 90% of an office's autopsy reports be completed within 60 calendar days of the autopsy, with a lesser 90-day benchmark, and it sets similar benchmarks for toxicology.
• Death certificate: If the cause is not settled when the certificate must be filed, the CDC handbook says it may be filed as "deferred pending further investigation" so a permit for disposal can be issued. A supplemental report follows when the cause is known. Our guide to the cause of death on a certificate explains what you will see.

The report gives a cause of death (the injury or disease that led to death) and, in medicolegal cases, a manner of death: natural, accident, suicide, homicide, or undetermined. NAME describes the manner as an opinion for public health and vital statistics purposes, not a legal finding of fault. "Undetermined" is used when the evidence for one manner is no stronger than for another, and it does not mean anyone did a poor job. If you think a finding is wrong, see our guide to contesting a cause of death.

What does an autopsy cost, and who pays?

When a medical examiner or coroner orders the autopsy, the government pays. Hospital charges vary: the University of Rochester says there is no charge if the person was seen at its medical center in the previous six months. A private autopsy is a different matter. National Geographic reported in 2020 that private autopsies can cost upward of $10,000 and are not covered by insurance, so get a written quote before you agree.

If you hire a private pathologist, NAME recommends a board-certified forensic pathologist for a second autopsy after a non-natural death. NAME also cautions that second autopsies are limited, because the first one alters the body, so a review of the first autopsy's records can sometimes answer your questions at lower cost and without another examination.

How do you get the report and understand it?

Rules on who can see an autopsy report vary by state. Johnson County, for example, has families complete a records request form. The report is full of medical terms, so it can help to go through it with your doctor. St. Jude notes that autopsies can reveal genetic factors, and if a finding suggests an inherited condition, your doctor can advise whether relatives should be checked.

What happens in England and Wales?

In England and Wales the usual term is post-mortem, and the coroner decides whether one is needed. The UK government's guide for bereaved people says:

• The coroner does not need your consent, and you cannot stop it, but you can discuss faith and cultural needs with the coroner's office.
• You cannot attend, but you can ask a doctor to attend for you, who may charge a fee.
• In some areas a CT or MRI scan can replace an internal examination. It is not available everywhere, and you may be asked to pay.
• If you disagree with the report, speak to the coroner's officer first. You can also pay for your own post-mortem after the body is released, or ask the coroner whether they will request a second one.

Official figures show 75,852 post-mortems were ordered in 2025, in 51% of the deaths reported to coroners. See our guide to coroner involvement in the UK for the full process.

What to do next

1. Ask the coroner's or medical examiner's office when the body will be released, and whether any religious or cultural accommodation is possible.
2. Tell your funeral home about the investigation before you set a date.
3. Ask how to get a copy of the report and the death certificate, and keep notes of who you spoke to.