(f) Molecular/DNA testing: This is a rapidly developing technological area. The importance of liaising with the relevant laboratory cannot be overemphasized. Splenic tissue is one of the best organs for DNA recovery, although liver, muscle, kidney and brain tissue may also be used. At least 2g of tissue should be placed in a plastic tube without fixative or preservative. The specimen may then be frozen if it is not to be used immediately. In the case of decomposed or skeletonized remains, a sample of bone may be submitted, often the mid shaft of the long bones or teeth (without reparation or cavity), or part of the shaft of the femur. Techniques using less invasive samples such as cartilage, phalanges, fingernails, or toenails have been developed in some centres (g) In addition, other evidence that may need to be collected, recorded and secured includes: (i) All foreign objects, including projectiles, projectile fragments, pellets, knives and fibres. Projectiles must be subjected to ballistic analysis (ii) All clothes and personal effects of the deceased, either worn by or in the possession of the deceased at the time of death (iii) (Fingernails and under-nail scrapings (iv) Hair, foreign and pubic, in cases of suspected sexual assault (v) Head hair, in cases where the place of death or location of the body prior to its discovery may be an issue. As mentioned at the beginning of this Section on further testing, there must be active discussion between the prosector and the investigator, and concrete decisions made about the fate of all the specimens. 264. After the autopsy, all organs not retained should be replaced in the body, and the body should be well embalmed to facilitate a second autopsy in case one is desired at some future point. Cremation of the remains will of course prevent a second autopsy. 6. Concluding the cause of death 265. At the end of his/her investigation of the death, it is a fundamental responsibility of the prosector to conclude the cause of death and identification of the deceased. It is a surprise for many that only in a small number of deaths can the cause of death be determined from the autopsy findings alone without any other information about the death. In some jurisdictions, the forensic doctor is also required to conclude the manner of death; in other jurisdictions, the system leaves this conclusion to judicial officers. 266. The internationally accepted format for recording the cause of death is set out by the WHO in “The International Form of Medical Certificate of Cause of Death”.118 The part of the form on cause of death includes the following sections: (a) Part I – includes diseases or conditions directly leading to death (immediate causes) and antecedent causes (or underlying causes) (b) Part II – other significant conditions contributing to death, but not contributing to or causing the conditions listed in Part I. 267. All forensic doctors should clearly understand the following concepts involved in correctly concluding the cause of death according to the standard WHO format: (a) Underlying cause of death – defined as the disease or injury that initiated the train of morbid events leading directly to death or the circumstances of the accident or violence that led to the fatal injury (b) Contributory cause(s) of death – other significant diseases or conditions that contributed to the death but not to the disease(s) or condition(s) listed in the sequence in Part I as causing the death (c) A common error is to list the mode of death, such as cardio-respiratory arrest, respiratory failure or coma as the immediate cause of death (d) If there is only one cause of death (e.g. Gunshot wound to the head; where death has apparently occurred rapidly at the scene) this should be listed as I(a). In the terminology above, this is both the immediate and the underlying cause of the death (e) If the cause of death is unknown even after all investigations have been completed, then it is correct to record it as “unknown” or “unascertained”. 118 WHO, Strengthening civil registration and vital statistics for births, deaths and causes of death: Resource Kit, Geneva, 2013, available at: http://apps.who.int/iris/bitstream/10665/78917/1/9789241504591_eng.pdf. 45