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Why no autopsies on marathon deaths?

To the Editor: The July 2007 SAMJ featured a report on the deaths of two Comrades Marathon runners. (1) I agree with Mayosi of Groote Schuur Hospital that postmortem examinations should be performed on such cases to establish the cause of death with certainty, in so far as it is possible, because of implications for the surviving next of kin.

We expected that the Forensic Pathology Services in Durban would receive these cases, but neither was referred. Both deaths can be considered unexpected and unexplained sudden deaths, since there are no clear clinical diagnoses (owing to very short survival of only one of them) and both individuals were relatively young. However, the decision to request an autopsy is the duty of the clinician responsible for the patient. It is likely that both these deaths were considered and registered as natural deaths.

There is capacity for diagnostic autopsy examinations on sudden unexpected deaths mainly in the academic forensic pathology centres. Where the source of the case is not a public establishment, there is little provision in the academic anatomical pathology unit served by that establishment (now under the National Health Laboratory Service) for a diagnostic autopsy. In these cases, one was declared dead in the medical tent at the race finish, while the other was certified dead later in a local private hospital.

Previous medico-legal autopsy diagnoses after sport-related deaths in our personal experience in Durban included cardiomyopathy, coronary artery disease, Marfan's syndrome and ruptured cerebral berry aneurysms. It is regrettable that autopsies were not performed in the above cases. Whether they should have been considered natural or unnatural may be debatable, but postmortem examinations could have served to establish the cause/s and mechanism/s of death without need for speculation, and before considerations on their preventability. Routine autopsy examinations in such instances would enlighten issues of familial/genetic study and counselling, scientific research into this area, and for 'selective pre-competition screening' in sport.

Steve R Naidoo

Department of Forensic Medicine

University of KwaZulu Natal, and Forensic Pathology Services

Department of Health, KwaZulu Natal


(1.) Bateman C. Marathon deaths 'potentially preventable'. S Afr Med J 2007; 97: 492-494.
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Title Annotation:Briewe
Author:Naidoo, Steve R.
Publication:South African Medical Journal
Article Type:Letter to the editor
Date:Sep 1, 2007
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