“People who experience the death of a loved one often are enveloped in a fog regarding what comes next. What we bring, first and foremost, is skilled care to direct them toward what they need to think about — to provide them with some clear blue sky in that fog.” With that, Timothy Thomas, a specialist in Mayo Clinic’s Office of Decedent Affairs (ODA), succinctly sums up the purpose of his job.

Thomas’ work, and that of his colleagues, goes unseen by most Mayo patients and staff. For the people who do meet them, however, the ODA team is a crucial component of Mayo Clinic’s culture of care. Office of Decedent Affairs staff are experts in navigating the complexities associated with death. But more than that, they are caring, compassionate guides to those who find themselves grieving the loss of a loved one at Mayo Clinic in Rochester, Minnesota.

Timothy Thomas, Office of Decedent Affairs specialist, meets with families after the death of a loved one to guide them through their next steps with skill and kindness.

“When you talk about Mayo Clinic's approach to care, and its emphasis on the needs of the patient, I feel ODA is the logical continuation of that philosophy,” says Kristina Peters, the office’s supervisor. “The care doesn't end the moment a patient dies. We are part of the team approach. We provide the final, compassionate care for that patient and their family.”

Ensuring comfort and consistency

Mayo Clinic’s Office of Decedent Affairs began five years ago, on May 2, 2016, with the purpose of standardizing the process that takes place when a patient dies. Before the office was established, when a death occurred, the patient care staff were responsible for filling out the necessary documentation, directing family members to appropriate resources, assisting with logistics, and answering loved ones’ questions. While those tasks are important, research found that each hospital death required almost four hours of dedicated time from the patient care team.

“Nursing staff, residents, and clinicians who were doing this work felt they were at a loss,” says Angela Regnier, the office’s assistant supervisor. “I was an autopsy technologist before I joined ODA. We went to the units when a patient died, and we saw how staff struggled through the death process. It’s complicated. Many, many questions come up. The patient care staff wanted to help. But they often didn’t have the expertise needed, and it was hard for them to focus on it because they still had other patients that required care.”

ODA staff help families navigate the paperwork and other logistics they need to deal with after a death.

As part of the Division of Anatomic Pathology in Mayo Clinic’s Department of Laboratory Medicine and Pathology, ODA now offers the expertise, focus, and time that death care requires. Its 24/7 team is dedicated to assisting families and staff with inquiries regarding death certificates, autopsy services, tissue and organ donation, and other end-of-life and death-care inquiries.

R. Ross Reichard, M.D., a Mayo Clinic anatomic pathologist and ODA’s medical director, sees the consistency and skill that the office provides as key to its value. “When it comes to how to manage the process when someone dies, in many health care facilities, it's often just a checklist the clinical staff go through. And it can be so variable. A patient death might be a very low frequency event in some areas, and the staff have little experience in how to manage it,” Dr. Reichard says.

“ODA provides high-quality, standardized care that families need and that staff want them to have.”

R. Ross Reichard, M.D.

Offering crucial expertise

The unique patient population at Mayo Clinic makes the Office of Decedent Affairs’ work even more vital than it might be at other health care organizations that draw mainly from a local area.

“The majority of our patients are from out of state or out of the country,” Regnier says. “When they arrive, most don't come thinking they're going to go home without their loved one. Mayo Clinic inspires hope that this won't be your last stop — and that’s wonderful — but for some people, sadly, it is, and that initial shock can be overwhelming.”

Figuring out how to make arrangements to transport the remains of a loved one home to another state or country is beyond the capabilities of many people who are coping with loss. But with the Office of Decedent Affairs in place, they don’t have to.

“Our subject matter experts know everything about those logistics,” Regnier says. “When we reassure families about that, you can see the sense of relief that comes over them.”

Angela Regnier

In addition to helping families with travel and transport details, the office staff carefully walk them through other topics that might be unfamiliar, such as choices about tissue donation.

“Although we hear a lot about organ donation, in reality, few people meet the criteria to be organ donors after death. But almost everyone can be a tissue donor. That includes corneas, heart valves, skin, bone, and ligaments,” Thomas says. “If a patient can donate and has indicated an interest in being a donor, a tissue procurement agency may call the family. We let them know they could be getting that call. That’s valuable because no one wants to be surprised by something like that out of left field. We make sure they understand they can accept or decline. It's up to them.”

Families often express gratitude for receiving that kind of information — details they often wouldn’t know about otherwise — and many have responded favorably. In fact, the Office of Decedent Affairs has been such a solid advocate for tissue donation that it is the recipient of the Eye Donation Champion Award from the Lions Gift of Sight, an eye bank that serves the needs of donors and recipients in Minnesota.

Mayo Clinic’s Office of Decedent Affairs received the Eye Donation Champion Award from the Lions Gift of Sight in April 2021.

Supporting the quest for further understanding

As another part of its services, the Office of Decedent Affairs makes families aware of their choices regarding autopsy. Mayo Clinic offers, at no charge, an autopsy for any Mayo patient, as long as the death does not fall under the jurisdiction of a medical examiner or coroner. Autopsies may provide valuable information regarding a loved one’s death and, in some cases, give insight into genetic disorders.

Since the ODA began, the autopsy rate at Mayo Clinic has increased by 30%. “That’s good for two reasons,” Dr. Reichard says. “One, it can give the families some useful information and helpful closure. Two, it can further Mayo Clinic’s medical research and education. Through our autopsy service, we currently support about 50 research projects that span a wide range of medical specialties. Many families feel good being part of that.”

As families move beyond the immediacy of a death, ODA continues to provide support. The specialists leave written information about all the topics they discuss with the families, so they can easily refer to it later. Staff also give out the office phone number for loved ones to call at any time.

“We're a resource long-term,” Peters says. “If people have questions in a month or in a year or in ten years about the death of a loved one, we're available to help with that. Anything death-related, you can contact us.

One of the greatest parts about our excellent staff is that we know that the family one of us meets with today, if they call with a question at 3 a.m., the person that answers the phone will have the knowledge they need to be able to help.”

Kristina Peters

Being a knowledgeable, caring resource families can rely on is at the heart of all the Office of Decedent Affairs does. “Death is complicated. Without exception, each and every case brings challenges. And as we are all unique as individuals, every death is unique,” Thomas says. “We come to each situation ready to meet the unique needs of the newly bereaved, and offer our guidance and support. It’s an honor to do this work.”

Editor’s note: For the safety of its patients, staff, and visitors, Mayo Clinic has strict masking policies in place. Anyone shown without a mask was either photographed prior to COVID-19 or photographed in a nonpatient care area where social distancing and other safety protocols were followed.