Re: Return of Specimen to Patient

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To:a i d a n s c h u r r <>
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We have a similar policy at York Hospital, York, PA, USA.

We try to discourage these requests as much as possible but we are
prepared to release things like gallstones or tonsils.  Other tissue we
release after discussion with our Risk Management department.

We have used this process frequently for fetal remains less than 16 weeks
gestational age (GA) as well.  In Pennsylvania, fetal remains greater than
or equal to 16 weeks GA require a fetal death certificate signed by the
county coroner and an authorized disposal of some sort (burial or

Remains less than 16 weeks GA are consided tissue and receive traditional
tissue disposal UNLESS the mother prefers something else.  Our bereavement
services department explains to the moms that they may have the remains
for personal disposition, that the hospital does a mass burial of all
remains in the prior year at a local cemetery so that the family may visit
the spot, or that the hospital will dispose of the tissue.  Our patients
have really appreciated the options!

Getting back to our release procedure:

Our procedure is to complete a "Release of Tissue/Specimen" form which
includes the following statement/information:

I, __________________, have received from the York Hospital Department of
Pathology the tissue/specimen removed at the time of my surgery on
___________(enter date).

				(Patient/Authorized agent signature)

				   (Date of Receipt)

Tissue prepared by:  _____________

Released by:         _____________

Date:                _____________

The form is produced on Hospital letterhead.

The tissue is prepared in much the same way as described below.  We do
place anything that will fit into a large plastic heat sealable bag.  (We
purchased this heat sealer with heavy duty bags from Allegiance many years
ago.  We use it to store representative tissue for autopsy primarily.
The pathologist of record prepares the tissue, places the pieces in
appropriately labeled bags, and seals the bags.  The
sealed bags for one case are easily stored together in a large rigid
plastic container that the pathologists can easily find - we put the
case number and the MDs name on the container for them.) 

On the outside of a bag that will be released to a patient, we place a
specially prepared label that states:


Toxic by inhalation, irritating to the eyes, respiratory system, and skin.
May cause sensitization by inhalation or skin contact.  May cause cancer,
repeated or prolonged exposure increases the risk.

When the patient picks up the prepared tissue, s/he signs the release,
and we keep a copy of the release in our files.

Candra Garver, MT(ASCP)
Manager, Anatomic Pathology
York Hospital

On Tue, 2 May 2000, a i d a n   s c h u r r wrote:

> Sue,
> I have just finished putting together an extensive protocol regarding 
> this.  Here in New Zealand we pay special attention to the needs of 
> Maori (our indigenous people) and Pacific Islanders.  Their culture 
> holds the body as "tapu" (sacred), and thus we often have requests 
> to return uteri, placentae, foetuses, POC's, and other specimens 
> removed at surgery.  They generally bury these under the guidance 
> of their Kaumatua (elders or priests), so that when they die, their 
> body is made whole again.  From our point of view, when the 
> request is recieved (usu. written on the requisition form), we send 
> out a standard personalised letter explaining our testing process, 
> and when they can collect their tissue.  We also send an 'official' 
> chain of custody form, which covers the legal aspects.  We wash 
> the tissue to remove the formalin, dry it with paper towels, and 
> package with plenty of absorbent cotton wool in specially bought in 
> wooden boxes (the entire package is biodegradable).  The box is 
> tacked shut, placed in a plastic bag, and handed over to the 
> patient, who has to present appropriate ID.  We explain the 
> dangers of formaldehyde, and 'strongly discourage' them from 
> opening the package.  Disposable gloves are offered is this is 
> unavoidable.  It seems a long drawn out process, and could 
> become tedious if every second person wanted his or her tonsils 
> back, but it works well for us, and well covers some very particular 
> cultural needs.  I can forward you a copy of my protocol if you wish.
> Cheers,
> Aidan, New Zealand
> > Hi! I was wondering what others do when they receive a request for a
> > specimen to be returned. I realize that there are many levels to this
> > question. (e.g. are we talking about a gallstone - which we clean, disinfect
> > and document return; or a placenta - which we release to a funeral home
> > selected by the patient). I would appreciate input concerning how any
> > requests you have received were handled, as well as where I may go to find
> > any guidelines on this issue. Thanks for all your help!
> > Sue O'Brien
> > Burdette Tomlin Memorial Hospital
> > e-mail: <> 
> > fax: 609-463-2747
> > 
> ___________________________________________________
> a i d a n   c   s c h u r r 
>      mlso,  histology department
>       hutt valley health
>        lower hutt, new zealand
>      ph.  ++64 4 5709173
>      fax  ++64 4 5709214
> ___________________________________________________

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