Rapid fixation of brains: a viable alternative?

Aim: Recent events surrounding postmortem practices have necessitated several changes in the way necropsies are conducted both within the medicolegal and hospital settings. These changes have resulted in a striking reduction in the frequency of brain retention for neuropathological examination. Aberdeen Royal Infirmary, responding quickly to rising concerns among bereaved relatives regarding organ retention, instituted a change in practice regarding the examination of brains at necropsy as early as 2001. The new protocol involved subjecting the brain to rapid fixation using combined immersion and perfusion techniques. This allows return of the organ to the body without unreasonable delay to the funeral. In this article, we present the results of a retrospective audit comparing the efficacy of the new method against the conventional fixation protocol. Methods: An equal number of postmortem brains were selected randomly from the year 1998 (following the usual fixation protocol), and from the year 2001 (following the new method). A three tier scoring system was devised to assess section and staining quality, and a single observer scored all the cases. Results: No statistical difference was noted in the quality of sections prepared by rapid fixation those by conventional fixation. Furthermore, the rapid method was more frequently adequate for diagnosis (considering scores of 2 and 3 together) than the conventional method. Conclusion: Rapid fixation offers a viable alternative for detailed examination of brains at necropsy, without necessarily prolonging the retention of the organ.