What have we learnt from the Alder Hey affair?

That monitoring physicians' performance is necessary to ensure good practice

In 1999 it emerged that various whole organs, including hearts and brains, had been removed at necropsy from children at Alder Hey Hospital in Liverpool without the knowledge and consent of parents. Parents buried their children without knowing that many had been “nystematically stripped of their organs.”1 As parents and physicians we join in the general condemnation of this activity. The important question, however, is what remedies are necessary to ensure that these events—or others that show a similar disrespect for patients' feelings and wishes—do not occur again.

The report of the Royal Liverpool Children's inquiry, published at the end of January,1 identifies malpractice by one particular pathologist, who removed thousands of organs without consent and stored them unexamined and uncared for. But it also highlights confusion about the coroner's role, management failings in the hospital and university, and, perhaps most pervasive of all, evasive and paternalistic attitudes towards bereaved parents—both during the tenure of the particular pathologist and after the retention of organs came to light.2

Among the report's major conclusions are that there were flagrant violations of the Human Tissue Act 1961 relating to organ or tissue removal, retention, and disposal and that Alder Hey and the University of Liverpool, which manages the hospital's Institute of Child Health, failed to provide adequate oversight of staff and to respond …