Communicating autopsy findings to families after sudden cardiac death: an expert-informed framework from the Balkan network for quality improvement in forensic medicine

Sudden cardiac death (SCD) is a devastating event not only for determining the cause of death but also for the health of surviving relatives, as autopsy findings may reveal hereditary heart disorders that imply detailed cardiological evaluation, genetic counseling, and cascade screening of family members. Beyond their informative value, communication of autopsy findings raises ethical issues related to transparency, disclosure of hereditary risk, professional responsibility, and family-centered care. Despite advances in post-mortem diagnostics, communication remains inconsistent, and bereaved families frequently report unmet informational and emotional needs. To our knowledge, this is the first expert consensus-based, network-derived communication framework for the Balkan region the Balkan region, integrating ethical principles with forensic, genetic and cardiological perspectives to support structured, family-centered post-mortem care. The authors examined current evidence regarding the ethical and practical challenges of communicating autopsy findings following SCD. Afterwards, a structured, network-based development process was carried out within seven Departments of Forensic Medicine with the aim to improve the quality and consistency of communication with bereaved families in the Balkan region. Participants developed communication pathway following sudden cardiac death. The proposed pathway emphasizes early family engagement, continuous communication throughout the investigation, structured communication of autopsy findings, family counseling in cases of suspected heritable cardiac disease, including referral for cardiological evaluation and genetic counseling when appropriate, cascade screening of at-risk relatives, and long-term follow-up. The pathway is intended as a practical communication framework and as a good practice in forensic medicine for pathologists. Communication of autopsy findings is an important part of postmortem care following sudden cardiac death, not just the transmission of diagnostic information. Beyond the conversation, there is an ethical responsibility to bereaved families and next of kin. Although current evidence is limited, it consistently supports structured communication with the bereaved family, respects family autonomy, and facilitates appropriate assessment of relatives in cases where a hereditary disease is suspected. This proposed framework may improve communication skills in forensic practice, strengthen multidisciplinary collaboration, and provide a basis for future validation studies and the development of evidence-based guidelines.