SciELO - Scientific Electronic Library Online

 
vol.35 número4Efectos de los Monómeros de los Biomateriales Poliméricos Utilizados en Tejido RenalImplicancias Estructurales y Fisiológicas de la Célula Bacteriana en los Mecanismos de Resistencia Antibiótica índice de autoresíndice de materiabúsqueda de artículos
Home Pagelista alfabética de revistas  

Servicios Personalizados

Revista

Articulo

Indicadores

Links relacionados

  • En proceso de indezaciónCitado por Google
  • No hay articulos similaresSimilares en SciELO
  • En proceso de indezaciónSimilares en Google

Compartir


International Journal of Morphology

versión On-line ISSN 0717-9502

Int. J. Morphol. vol.35 no.4 Temuco dic. 2017

http://dx.doi.org/10.4067/S0717-95022017000401209 

Articles

Post-Mortem Organ Weights at a Medico-Legal State Facility in the eThekwini Region

Peso de Órganos Post-Mortem en un Servicio Médico Legal en la Región eThekwini

S. Govender1 

L. Lazarus1 

B. Z. De Gama1 

K. S. Satyapal1 

1 Department of Clinical Anatomy, School of Laboratory Medicine and Medical Science, College of Health Sciences, University of KwaZulu - Natal, Westville Campus, South Africa.

SUMMARY:

Organ weights may be influenced by various demographic parameters and environmental conditions, and they differ among populations. Numerous studies have been conducted in the Northern hemisphere, with paucity of literature regarding organ weights of many Southern hemispheric populations. This study aimed to document post-mortem organ weights of decedents in the eThekwini region, and to determine the influence of age, sex, population grouping and body length on the weight of these organs. The study utilised 500 decedent organs (n=500), obtained from a medico-legal state mortuary in the eThekwini region, KwaZuluNatal, South Africa. It entailed gross examination and weighing of the thoracic viz. heart, right and left lungs, and abdominal organs viz. liver, spleen as well as the right and left kidneys. All organs attained maximum or peak weights at various age intervals, with the heart continuing to increase in weight until 80 years of age. Organ weights illustrated statistical significance with age. The heart, lungs and liver were the only organs that showed statistical significance with sex. However, mean spleen weights were higher in females than in males, while the weights of both kidneys were higher in males. Organ weights of White decedents were higher than those of other population groups. There was a positive correlation between body length and all organ weights. Post-mortem organ weights of the present study are comparably higher than those reported in the Northern hemisphere. Therefore, organ weights reported from one geographic location may not be applicable to another and may lead to erroneous references ranges and possibly hinder interpretation during autopsy settings.

KEY WORDS: Anthropometry; Autopsy; eThekwini region; Organ weight

RESUMEN:

El peso de los órganos puede estar influenciado por diversos parámetros demográficos y condiciones ambientales; además estos difieren entre las poblaciones. Se han realizado numerosos estudios en el hemisferio norte, con escasa información en la literatura sobre el peso de órganos en poblaciones del hemisferio sur. Este estudio tuvo como objetivo documentar el peso de órganos post mortem en la región eThekwini y determinar la influencia de la edad, sexo, agrupación de la población y longitud corporal sobre el peso de los órganos. Para el estudio se utilizaron 500 órganos (n = 500), obtenidos del Servicio Médico Legal de la Región eThekwini de KwaZulu-Natal, Sudáfrica. Se estudiaron el peso y tamaño de las vértebras torácicas, el corazón, pulmones derecho e izquierdo, órganos abdominales, como el hígado, bazo, además del peso de los riñones derecho e izquierdo. Los pesos medios de órganos registrados para la población de la muestra fueron: corazón (328,93 g), pulmón derecho (581,73 g), pulmón izquierdo (485,92 g), hígado (1376,62 g), bazo (153,50 g), riñón derecho (146,67 g) y riñón izquierdo (154,32 g). Los órganos alcanzaron pesos máximos a diferentes intervalos de edad: el corazón continuó aumentando de peso hasta los 80 años de edad (438.00 g), mientras que los pulmones alcanzaron un peso maximo a los 61-70 años (720.70 g / 573.11 g). Los órganos abdominales, como el hígado (1550,67 g), el bazo (196,87 g) y los riñones (146,67 g / 154,32 g), alcanzaron todos el peso máximo entre los 41-50 años de edad. Todos los pesos de los órganos mostraron diferencias estadísticamente significativas de acuerdo a la edad. En el corazón, los pulmones y el hígado se observó una diferencia estadísticamente significativa de acuerdo al sexo. Sin embargo, los pesos medios del bazo fueron mayores en las mujeres que en los hombres, mientras que el peso de ambos riñones fueron mayores en los hombres. El peso de los órganos de los cadáveres de la muestra fue mayor al peso que en otros grupos de población. Al comparar los diferentes grupos de población, el riñón derecho fue el único órgano en el que no se observó una diferencia estadísticamente significativa. Hubo una correlación positiva entre la longitud corporal y los pesos de los órganos. Los pesos de los órganos post-mortem, del presente estudio, son comparativamente mayores a los reportados en el hemisferio norte. Por lo tanto, información sobre el peso de órganos de una ubicación geográfica determinada puede no ser aplicable a otra y puede conducir a una interpretación errónea durante la autopsia.

PALABRAS CLAVE: Antropometría; Autopsia; Región eThekwini; Peso de órganos

INTRODUCTION

The use of organ weight at autopsy aids forensic pathologists in the detection of gross anatomical abnormalities and pathology (Sheikhazadi et al., 2010). Furthermore, deviations from the “normal” range of organ weights may aid the pathologist in the interpretation of cause of death (Singh et al., 2004; Kohli & Aggarwal, 2006; Tanna et al., 2011). Organ weights are also a crucial factor during cardiothoracic and abdominal organ transplantation surgeries (Chan et al., 2011; Reed et al., 2014). However, a number of parameters are noted to influence organ weight.

Demographic parameters such as the age, sex, population grouping and the body length of an individual; as well as environmental conditions have an influence on organ weights (Kohli & Aggarwal; Prakash et al., 2013;

Kumar et al., 2014). These factors vary vastly throughout the world and therefore, organ weight ranges should be formulated for each target population, allowing for the correct interpretation of cause of death (Wong et al., 2008). A review of anatomical textbooks and available literature, indicates extensive data with regard to the Northern hemisphere. However, there is paucity in the available literature with regard to the Southern hemisphere and regions within South Africa in specific.

Therefore, this study aimed to document postmortem organ weights of the heart, lungs, liver, spleen and kidneys of decedents in the eThekwini region, and to determine the influence of age, sex, population grouping and body length on the weight of these organs.

MATERIAL AND METHOD

Standard autopsy protocol and procedures were implemented on 500 decedents (n=500). These decedents were obtained via convenience sampling from a medico-legal state mortuary in the eThekwini region, KwaZulu-Natal, South Africa (Ethics Number: BE522/14). Each organ underwent gross examination and was subsequently weighed on a calibrated electronic scale. The “wet weight” of all the organs was recorded. “Wet weight” refers to the state of the organ as soon as it is removed from the body cavity. The exclusion criteria were as follows: i) decedents with an incomplete demographic profile, ii) decedents with significant injury to surrounding tissue, and iii) organs that were decomposed. The heart weight was recorded after dissection and removal of clotted blood from within its chambers. It should be noted that the liver was weighed without the gallbladder and the kidneys without the adrenal glands and ureters. Body length was measured from the heel of the foot of the decedent in the supine position, to the crown of the head.

The obtained organ weights were correlated with the age, sex, population grouping and the body length of the decedent. Decedents were categorised into 10 year age intervals: 1-10, 11-20, 21-30, 31-40, 41-50, 51-60, 61-70, 7180, 81-90, 91-100. Of the 500 decedents, 395 were males and 105 were females; with a population grouping of 417 Black Africans, 11 Coloured, 42 Indians and 30 Whites.

Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS, Version 23.0). The following statistical tests were used: The Pearson productmoment correlation, One- way Anova with Tukey HSD comparison and Independent Sample T- test, as well as frequency tests. Descriptive statistics were utilised to determine the mean and standard deviation. A p- value of less than 0.05 was considered statistically significant.

RESULTS

This study documented post-mortem organ weights and the influence of parameters such as: age, sex, population grouping and the body length of decedents on these organ weights. The corresponding values are shown in the tables below.

The mean organ weights of the examined organs are reflected in Table I. In the thorax, mean weights of the right lung were heavier than the left lung. In the abdomen, mean weights of the left kidney were heavier than the right kidney (Table I).

Table I Mean organ weights (g). 

Organ n Mean SD
Heart 500 328.93 101.87
Right lung 500 581.73 266.51
Left lung 500 485.92 239.06
Liver 500 1376.62 435.36
Spleen 500 153.50 91.19
Right kidney 500 146.67 55.86
Left kidney 500 154.32 55.84

Age. A Pearson product-moment correlation test was utilized to assess the relationship between age and organ weight. There was a statistically significant correlation between the age of the decedent and all the organ weights (p<0.001, n=500) (Table II). In the thorax, the heart weight showed a moderate positive correlation (r=0.530) with age, with the right and left lung having a weak positive correlation (r=0.322 and 0.295). The heart attained peak weight at the 71-80 year age interval which was later than that of the lungs, which attained peak weight at the 61-70 year age interval (Table II). All the abdominal organs viz. liver, spleen and kidneys attained peak weight at the 41-50 year age interval and showed a weak positive correlation with age (Table II).

Table II Correlation of age with organ weight. 

Organ Age
Peak weight (g) Peak age interval (years) Pearson correlation (r value) Pearson Product-moment correlation (p value)
Heart 438.0 71-80 0.530 <0.001*
Right Lung 720.70 61-70 0.322 <0.001*
Left Lung 573.11 61-70 0.295 <0.001*
Liver 1550.67 41-50 0.319 <0.001*
Spleen 196.87 41-50 0.181 <0.001*
Right Kidney 146.67 41-50 0.230 <0.001*
Left Kidney 154.32 41-50 0.246 <0.001*

*statistically significant values.

Sex. An independent samples t-test was conducted to compare the weight of the organs between males and females. There was a statistically significant difference between sexes of all the thoracic organs and one abdominal organ i.e. liver (p=0.006) (Table III). These organs illustrated heavier organ weights in male decedents than female decedents. The spleen and the kidneys were the only organs that showed no statistically significant difference between sexes (p>0.05). The weight of the spleen was seen to be heavier in female decedents (161.63g) than in male decedents (151.34g). However, the weight of the male kidneys was heavier than the females (Table III).

Table III Correlation of organ weight between sexes. 

Organ Sex Independent Samples T-Test (p value)
Male Female
Heart 335.90 302.70 0.013*
Right Lung 608.32 481.68 <0.001*
Left Lung 505.86 410.90 <0.001*
Liver 1408.68 1256.04 0.006*
Spleen 151.34 161.63 0.305
Right Kidney 148.29 140.59 0.210
Left Kidney 155.97 148.11 0.200

*statistically significant values.

Population Grouping. A one-way Anova test was conducted to compare the influence of population grouping on organ weight. There was a statistically significant influence between population groups and all of the organs with the exception of the right kidney (p=0.115) (Table IV). The left kidney showed a marginal significance between groups (p=0.043). In the eThekwini region, decedents of White population grouping illustrated significantly higher organ weights in comparison to the other population groups of the sample population.

Table IV Correlation between population groups with organ weight. 

Organs Population Groups One way Anova Test (p value)
Black African Coloured Indian White
Heart 319.71 353.64 339.43 433.40 <0.001*
Right Lung 571.35 613.09 553.90 753.43 0.005*
Left Lung 478.71 486.91 455.21 628.73 0.004*
Liver 1333.58 1384.36 1468.26 1843.87 <0.001*
Spleen 145.85 120.82 181.29 233.00 <0.001*
Right Kidney 145.05 125.09 155.33 164.97 0.115
Left Kidney 152.19 136.36 162.38 179.3 0.043*

*statistically significant values.

Body Length. A Pearson product-moment correlation test was utilized to assess the relationship between the body length of the decedent and organ weight. There was a statistically significant correlation between the body length of the decedent and all organ weights (p<0.001, n=500) (Table V). According to Table V, all the organs illustrated varying correlations with body length. In the thorax, the heart (r=0.613) illustrated a moderate positive correlation and the right (r=0.451) and left lungs (r=0.417) illustrated a weak positive correlation. In the abdomen, the liver (r=0.580) illustrated a moderate positive correlation, while the spleen and both kidneys illustrated weak positive correlations Table V).

Table V Correlation of body length with organ weight. 

Organ Body Length
Pearson correlation (r value) Pearson product-moment correlation Test (p value)
Heart 0.613 0.001*
Right Lung 0.451 0.001*
Left Lung 0.417 0.001*
Liver 0.580 0.001*
Spleen 0.256 0.001*
Right Kidney 0.370 0.001*
Left Kidney 0.398 0.001*

*statistically significant values.

DISCUSSION

After a review of the available literature, it is apparent that there is paucity of information regarding the Southern hemisphere and the various regions of South Africa in specific. Standard references for organ weights are based on Northern hemispheric populations, with the bulk of studies from the Asian countries. However, this is of little value to the Southern hemispheric population groups as this would lead to erroneous interpretations, in autopsy settings.

This study documented mean organ weights for the selected sample population. Mean organ weights were higher than those observed by previous Northern hemispheric populations (Singh et al.; Kim et al., 2009; Molina & DiMaio, 2012a,b, 2015a,b). However, the study by Chirachariyavej et al. (2006) in a Caucasian population group documented higher organ weights than that observed in the current study.

According to a study by Singh et al. the heart is the only organ that showed a continual increase in weight with age. Previous studies have documented increasing heart weights over the age of 60 years (Singh et al.; Mathuramon et al., 2009; Sheikhazadi et al.); this differed from the current study as the heart weights increased until the 71-80 year age interval (Table II). Numerous authors have attributed the continual increase in the weight of the heart, to the deposition of epicardial fat as well as hypertension (Mathuramon et al.; Molina & DiMaio, 2012a, 2015a). Epicardial fat tissue may account for an increase of 20 % of the heart weight (Rabkin, 2007). The lung weights showed statistically significant differences when compared to age. In the present study, both lungs attained peak weight at the 61-70 year age interval, which was later than that reported by previous authors (Sheikhazadi et al.; Prakash et al., 2013). The weight of the liver in the present study showed a statistically significant correlation with age (Table II). Previous studies had documented increasing liver, spleen and kidney weights up to the fourth decade of life (Singh et al.; Narongchai & Narongchai, 2008), which is consistent with the present study, which documented the peak weights at the 41-50 year age interval.

In the present study, a significant difference of organ weight between sexes was noted for the heart and both lungs (Table III), concurring with previous studies (de la Grandmaison et al., 2001; Singh et al.; Chirachariyavej et al.). According to previous studies the weight of the male spleen is heavier than females (de la Grandmaison et al.; Singh et al.; Kim et al.; Sheikhazadi et al.). However, a study by Sprogøe-Jakobsen & Sprogøe-Jakobsen (1997) analysed weights of the spleen with equal numbers of males and females and found no significant differences between the two, hence in agreement with this study. In the present study, spleen weights did not have a statistically significant difference between sexes, with the weight of the female spleen being (161.63 g) heavier than in males (151.34 g). An assumption for this phenomenon may be due to decedents having underlying portal hypertension that may or may not be associated with pregnancy as the majority of the decedents were in the child-bearing age interval (21-30 years). In the kidneys, there was no statistically significant difference with regard to sex (p=0.210 and p=0.200). However, males had an overall higher organ weight than females in this study (Table III).

This corroborated with studies by de la Grandmaison et al.; Singh et al.; Kim et al. and Sheikhazadi et al.

Young et al. (2009) documented no statistical differences of organ weight due to population grouping. On the contrary, this study yielded a statistically significant difference between organ weight and population groups (Table IV). Results of this study reflected White decedents having an overall higher heart weight than other population groups (Table IV). One may attribute such findings to better nutrition, physical activity and greater physical stature of individuals when compared to the other population groups in South Africa (Opie & Seedat, 2005). White decedents had an overall higher lung weight, while the Indian decedents had the lowest lung weights in the population groups. One may assume that this may be due to the high prevalence of smoking in the Indian community (Tanna et al.). Chirachariyavej et al. stated that variations in pulmonary oedema and congestion differ from person to person. Post-mortem lung weights may also depend on the individual’s lung volume, congestion and oedema prior to death (Mathuramon et al.). In this study, all the abdominal organ weights of White decedents were significantly heavier than the other population groups in the sample population.

Regarding body length, the findings of the present study documented a significant correlation between all organ weights for both sexes (Table VI). However, Mathuramon et al. documented a significant correlation in males only. Molina & DiMaio (2012a; 2015a) also found a positive correlation of body length to heart weight but found an inadequate or no association for the prediction of heart weights. However, this was not investigated in the present study. Regarding the lungs, the taller the individual the greater the need for increased ventilation (Frisancho, 1977). This may be justified by the r values for the heart and lungs in Table VI, which showed strong and moderate positive correlations with body length.

CONCLUSION

The use of organ weights at autopsy is one of the leading criteria considered in the interpretation of the cause of death of a decedent.The present study reported the organ weights from a select population group in the eThekwini region within South Africa. Organ weights illustrated statistically significant differences with the age, sex, population grouping and the body length of the decedents. In comparison, the organ weights reported from the Northern hemisphere were lower than that of our study. Therefore, the ranges from the Northern hemisphere may not be applicable to the population grouping of the eThekwini region and South Africa, as they may lead to erroneous judgements of the pathological and nonpathological features of organs. Organ weights for a given population may aid both regional pathologists and clinicians, in the accurate interpretation of the cause of death of a decedent and during surgical intervention.

ACKNOWLEDGEMENTS

The authors gratefully acknowledge the assistance Dr. S.M. Aiyer, Acting Chief State Forensic Pathologist.

REFERENCES

Chan, S. C.; Lo, C. M.; Chok, K. S.; Sharr, W. W.; Cheung, T. T.; Tsang, S. H.; Chan, A. C. & Fan, S. T. Validation of graft and standard liver size predictions in right liver living donor liver transplantation. Hepatol. Int., 5(4):913-7, 2011. [ Links ]

Chirachariyavej, T.; Ouyswat, K.; Sanggarnjanavanich, S.; Tiensuwan, M.; Peonim, V. & Sirikulchayanonta, V. Normal internal organ weight of Thai adults correlated to body length and body weight. J. Med. Assoc. Thai., 89(10):1702-12, 2006. [ Links ]

de la Grandmaison, G. L.; Clairand, I. & Durigon, M. Organ weight in 684 adult autopsies: new tables for a Caucasoid population. Forensic Sci. Int., 119(2):149-54, 2001. [ Links ]

Frisancho, A. R. Developmental adaptation to high altitude hypoxia. Int. J. Biometeorol., 21(2):135-46, 1977. [ Links ]

Kim, Y. S.; Kim, D. I.; Cho, S. Y.; Kim, M. H.; Yang, K. M.; Lee, H. Y. & Han, S. H. Statistical analysis for organ weights in Korean adult autopsies. Anat. Cell Biol., 42(4):219-24, 2009. [ Links ]

Kohli, A. & Aggarwal, N. Normal organ weights in indian adults. MedicoLegal Update, 6(2):49-52, 2006. [ Links ]

Kumar, N. T.; Liestøl, K.; Løberg, E. M.; Reims, H. M. & Mæhlen, J. Postmortem heart weight: relation to body size and effects of cardiovascular disease and cancer. Cardiovasc. Pathol., 23(1):5-11, 2014. [ Links ]

Mathuramon, P.; Chirachariyavej, T.; Peonim, A. V. & Rochanawutanon, M. Correlation of internal organ weight with body weight and length in normal Thai adults. J. Med. Assoc. Thai., 92(2):250-8, 2009. [ Links ]

Molina, D. K. & DiMaio, V. J. Normal organ weights in men: part I-the heart. Am. J. Forensic Med. Pathol., 33(4):362-7, 2012a. [ Links ]

Molina, D. K. & DiMaio, V. J. Normal organ weights in men: part II-the brain, lungs, liver, spleen, and kidneys. Am. J. Forensic Med. Pathol., 33(4):36872, 2012b. [ Links ]

Molina, D. K. & Dimaio, V. J. Normal organ weights in women: Part I-The heart. Am J. Forensic Med. Pathol., 36(3):176-81, 2015a. [ Links ]

Molina, D. K. & DiMaio, V. J. Normal organ weights in women: Part II-The brain, lungs, liver, spleen, and kidneys. Am. J. Forensic Med. Pathol., 36(3):182-7, 2015b. [ Links ]

Narongchai, P. & Narongchai, S. Study of the normal internal organ weights in Thai population. J. Med. Assoc. Thai., 91(5):747-53, 2008. [ Links ]

Opie, L. H. & Seedat, Y. K. Hypertension in sub-Saharan African populations. Circulation, 112(23):3562-8, 2005. [ Links ]

Prakash, C.; Deopa, D. & Thakkar, H. K. Study of internal organ weight and its correlation to body weight in Kumaon Region of Uttarakhand. J. Indian Acad. Forensic Med., 35(1):29-32, 2013. [ Links ]

Rabkin, S. W. Epicardial fat: properties, function and relationship to obesity. Obes. Rev., 8(3):253-61, 2007. [ Links ]

Reed, R. M.; Netzer, G.; Hunsicker, L.; Mitchell, B. D.; Rajagopal, K.; Scharf, S. & Eberlein, M. Cardiac size and sex-matching in heart transplantation: size matters in matters of sex and the heart. JACC Heart Fail., 2(1):73-83, 2014. [ Links ]

Sheikhazadi, A.; Sadr, S. S.; Ghadyani, M. H.; Taheri, S. K.; Manouchehri, A. A.; Nazparvar, B.; Mehrpour, O. & Ghorbani, M. Study of the normal internal organ weights in Tehran's population. J. Forensic Leg. Med., 17(2):78-83, 2010. [ Links ]

Singh, D.; Bansal, Y. S.; Sreenivas, M.; Pandey, A. N. & Tyagi, S. Weights of human organs at autopsy in Chandigarh zone of North-West India. JIAFM, 26(3):97-9, 2004. [ Links ]

Sprogøe-Jakobsen, S. & Sprogøe-Jakobsen, U. The weight of the normal spleen. Forensic Sci. Int., 88(3):215-23, 1997. [ Links ]

Tanna, J. A.; Patel, P. N. & Kalele, S. D. Relation between organ weights and body weight in Adult population of bhavnagar region. A post-mortem Study. J. Indian Acad. Forensic Med., 33(1):57-9, 2011. [ Links ]

Wong, J. L.; Arango-Viana, J. C. & Squires, T. Heart, liver and spleen pathology in chronic alcohol and drug users. J. Forensic Leg. Med., 15(3):141-7, 2008. [ Links ]

Young, J. F.; Luecke, R. H.; Pearce, B. A.; Lee, T.; Ahn, H.; Baek, S.; Moon, H.; Dye, D. W.; Davis, T. M. & Taylor, S. J. Human organ/tissue growth algorithms that include obese individuals and black/white population organ weight similarities from autopsy data. J. Toxicol. Environ. Health A, 72(8):527-40, 2009. [ Links ]

Received: December 20, 2016; Accepted: April 06, 2017

Correspondence to: E-mail: satyapalk@ukzn.ac.za

Corresponding author: Professor KS Satyapal Department of Clinical Anatomy School of Laboratory Medicine and Medical Sciences College of Health Sciences University of KwaZulu-Natal Private Bag X54001 Durban 4000 SOUTH AFRICA

Creative Commons License This is an open-access article distributed under the terms of the Creative Commons Attribution License