European Journal of Cardiovascular Medicine

Autopsy (also known as necropsy, post mortem examination, or thanatopsy) is the precise and detailed study of a person's corpse following death. An autopsy can be of various types. However, the two types listed below are typically the most essential. A] Pathological or clinical autopsy. Performed by physicians or pathologists to determine the cause of death when a determination cannot be reached during treatment, to confirm a doubtfully diagnosed case, or to investigate the effect/effectiveness of treatment. The deceased's relatives must provide their consent. B] Medico-Legal Autopsy. It is carried out as part of an official investigation into a suspicious, sudden, or unnatural death, and the results are used in judicial proceedings to aid in the administration of justice. It is a special type of examination of a dead body to find out the cause of death examining all the body parts, all the organs, opening all the body cavities to corroborate with the evidences of eyewitnesses as per laws of the land towards admission of justice and prosecution of guilty[1] Study of weight of human body organs plays a significant role in almost all the branches of medical sciences as any deviation in weight from the normal range may suggest some pathological change in the organ. Weighing of organs at autopsy not merely an exercise but has great medico-legal importance. Any deviation in weight from the normal range usually indicates some pathological change in the organ and thus helps in interpreting the opinion regarding the cause of death in various pathological conditions[2] Recording of organ weights is one of regular work of the forensic pathologists during an autopsy. The findings were compared to the standard or average of a particular organ for a particular age range and specific sex. The determination of weight of brain in particular has vast clinical value. As for example, liver volumes are important not only for determining disease states and disease progression but also in estimating segmental liver volumes for transplant donors and planning the extent of hepatectomy in cancer patients. The spleen commonly increases in size in response to some infection and hematologic or metabolic disorders. A good correlation can be seen between platelet count and spleen volume, and splenic volume detects serious liver disease and correlates with splenic hyper function. Kidney size usually bears a relation to the degree of renal diseases [3].  A vast variation is seen in the organ weights due to several factors in different regions of the world. The reason for this may be due to the variation in the dietary habits, climatic conditions, usual water intake, ethnicity, customs, and genetic predisposition of different population groups. Hence the normal organ weights of a particular region may not be accurate enough for another[4]. Human organ weights besides state of nutrition etc. were also reported to be dependent on socio-economic and environmental conditions which are quite different in various parts of India.[5] Hence, the organ weights reported from other parts of India are definitely not applicable directly to the population of West Bengal.[6] As literature available on the internal organ weights for the population of this region, in particular is scanty, hence the present study is an attempt to provide such information. This study was designed to address the issue and to determine a normal weight range of the brain in population of both sexes and different age groups in this locality and also to correlate the visceral weights with variables such as age, body length and body weight.

The liver and kidney weights of the middle-aged adults were heavier than those of any other age groups (P<0.05). The weights of all organs except for lungs and brain were more related to body weight than height. These results are considered for useful anatomical data to understand the disease properties in Koreans.[7]

In 2006, two scientists Anil Kohli and N.K Aggarwal done extensive study on Normal Organ   weights of Indians. In that study organs were collected from dead bodies within the age group of 18 to 75 years brought for autopsy. The organs taken for the studies did not show any gross pathology and the survival time in the hospital (for admitted cases) varied from 1-2 days. Excluding the cases surviving for more than two days omitted for the chances of any alterations in organ weights due to treatment or disease process setting in during treatment. The following organs were considered - brain, liver, lungs, kidneys and spleen.[8]

The study revealed following results:

A study titled as “Correlation of Internal Organ Weight with Body Weight and Length in Normal Thai Adults”, done by Piyanun Mathuramon et al. at Ramathibodi Hospital, Bangkok during the period between 2003-2007, revealed that relationship was found between internal organs weight and body weight and body length of males whereas, in females the weight of internal organs except the kidneys was not related to body length.[9]

Molina DK et al (2012) in their study showed that the mean weight of the brain was 1407 g (range, 1070-1767 g), that of the liver was 1561 g (range, 838-2584 g), that of the spleen was 139 g (range, 43-344 g), that of the right lung was 445 g (range, 185-967 g), that of the left lung was 395 g (range, 186-885 g), that of the right kidney was 129 g (range, 79-223 g), and that of the left kidney was 137 g (range, 74-235 g). Correlation and regression analysis showed that there were insufficient associations between organ weight and body length, body weight, and body mass index to allow for predictability. The authors, therefore, propose establishing a reference range for organ weights in men, much like those in use for other laboratory tests including hemoglobin, hematocrit, or glucose. The following reference ranges (95% inclusion) were proposed: Brain-1179-1621 gm; Liver-968-1860 gm; Spleen-28-226 gm; Right lung-155-720 gm; Left lung-112-675 gm; Right kidney-81-160 gm and Left kidney-83-176 gm.[10]

Eminent forensic pathologist Jurgen Ludwig in his book demanded that the, weight of brain weight is 1.4 % of total body weight, liver weight is 1.9% to 3.1 % of total Body weight, lung weight is 1 % (mean wt. of right lung being 450 gm with a range, 360gm - 570 gm and of left lung being 375 gm with a range, 325gm – 480 gm). He showed that weight of spleen is 0.16% of total body weight (TBW), weight of heart is 0.45 % of TBW in men and 0.40 % of TBW in women. Weight of kidney found to be 0.3 % of total body weight. [11]

To add on the available limited anatomical and physiological data for compilation in the country to formulate an Indian Reference Man for radiation protection purposes in1992 S.C. Jain et all conducted a study which included following parameters like weight, height, body surface area, weight of various organs (brain, heart, kidney, lung, liver etc.), total body water, extra-cellular water, blood volume, specific gravity, total lung capacity, vital capacity etc. For that reason, the data were collected from post-mortem studies (566 males and 185 females) and other data from published work on 433 healthy male and 137 female volunteers. The data from various Indian sources indicate a similar trend. However, a significant difference (P less than 0.01) was seen in viscera weights and total body weights, in comparison to the Bhabha Atomic Research Centre (BARC) values. The study data was unable enough to suggest definitive norms of the Indian Reference Man.[12] The study had the following results regarding viscera weight-

In a scientific study conducted by De La Grandmaison et al collected the weights of normal organs retrospectively for four years (1987-1991) from 684 forensic autopsy cases of Caucasoids adults who died of external causes and with no pathological changes. The weights of the following viscera were available: the heart, both the lungs separately, the liver, the spleen, the pancreas, both the kidneys and the thyroid gland. The external parameters used for statistical correlation with the age, height, total body weight and the body mass index (BMI of the deceased) were the external parameters which were used for statistical correlations. Except the weight of thyroid in females, all the organ-wights were used to show correlation with at least one external parameter. The study showed that organ weights had inverse relationship with age except for the heart and the thyroid, and increased in relation to body height and/or BMI. Adding with this, all the organ weight except heart showed a better statistical correlation with the body height than the BMI.[13]

Dalbir Singh et al (2004) conducted a study with data of eight years on Mean organ weights over 2025 subjects who died and autopsied at PGIMER, Chandigarh which revealed that in general the organ weights were heavier than reported from other parts of India. They were more in concordance with the western population, possibly because the population of this zone in general is taller and heavier than rest of the population of the country and is more akin to western population so are their organ weights. The study showed that in both the genders, the weight of the brain increased up to 30 years. Lung, liver, spleen, pancreas, suprarenal attained their peak weights at 40-50 years and the kidney at 30-40 years. It may be due to the difference in dietary habits and socioeconomic conditions of both the regions. After attaining the peak, all organ weights declined with advancement of age with the exception of the heart, possible reasons being the deposition of fat and higher incidence of cardiomyopathies in the population under study. Comparison between the weights of liver and brain showed that, the mean weight of the liver was more than the mean weight of the brain in both the genders. Findings in this study were in consonance with the studies on the European and Japanese population. [14]

A scientific study was done on Normal Internal Organ Weight of Thai Adults Correlated to Body Length and Body Weight, analysis with the help of data from 250 autopsies from the Ramathibodi Hospital, Bangkok, Thailand in 2005 by group of scientists led by Thamrong Chirachariyavej. Excluding the decomposed bodies, fire related deaths and cases where medical treatment had not been given rest of the cases were from sudden unnatural death the age ranged from 15 to 88 years and there were 51 females and 199 males. Pearson’s correlation coefficient was used to examine the relationship between the internal organ weight with body weight and body length.The mean + standard deviation (SD) were found for males and females respectively as follows:- Brain 1339 + 160/1165 + 184 gm, heart 311+ 66/278 + 160 gm, lung 910 + 347/675 + 255 gm, liver 1439 + 365/1214 + 275 gm, spleen 103 + 46/92.9 + 48 gm, kidney 260 + 68/230 + 42 gm. The relationship between internal organ weight and body weight showed each internal organ significantly correlated with body weight in males at p-value < 0.05, whereas in females it only correlated to liver, kidney and spleen at p-value < 0.05. For the correlation between internal organ weight and body length, it showed only brain, lung, liver and kidney correlated to the body length in males at p-value < 0.05, but not in females.[15]

Dr. Tanna J.A., Dr. Patil et al (2015) in their comparative study on Relation between organ weights and body weight in adult population in Vododara District of Gujrat showed that Liver weight is higher in Vadodara, which is 1812 –895gms for males and1285 – 888gms for females, than in study population of Delhi which is 1210gms for males and 1092gms for females. Whereas Spleen weight is found to be lower in study population of Vadodara, which is 154 – 99gms for males and 128 – 89gms for females than in Delhi, which is 131 gms for males and 121 gms for females. The high range of weight of liver may be attributed to problems with alcoholism in the area which is affecting the liver weight. When compared the results with weights as given in Essentials of Forensic Medicine –Reddy, Brain weight was given as 1.4% of body weight, but in that study, they found it 1.96% to 1.45% of body weight, that is on higher side than the book. Heart weight was also on higher side 0.60% to 0.42% of body weight in comparison to 0.40-0.45% of body weight. Both lung weights bit lower, but not significantly lower than the textbooks. No significant difference in the Kidney and spleen weights. Liver weight range was bigger 3.20-1.55% compared to textbook. Observation of their study in grams were Brain 1115.51 ± 156.42 / 1016.09 + 141.01, Rt. Lung 446.57 ± 201.06 /  334 ± 143 Lt. Lung 477.85 ± 201.22 / 344.37 + 140, Spleen 149.17 ± 105.61 / 153.09 ± 116.98 Heart 270.28 ± 54.41 / 204.35 ± 57.35, Liver 1419.80 ± 395.27 / 1204.52 ± 365.71, Rt. Kidney 136.65 ± 62.24 / 111.91 ± 32.29, Lt Kidney 132.42 ± 42.67 /104.24 ± 33.79 (Chandra Prakash, 2013). Spleen weight in their study was found to be 154-99 gms for males and 128-89 gms for females, which is lower than 149.17 ± 105.61 / 153.09 ± 116.980 for males and females respectively. Liver weight in that study was found to be 1812-895 gms for males and 1285-885gms for females which is higher than 1419.80 ± 395.27 / 1204.52 ± 365.71 for males and females respectively. Right Kidney weight in their study was found to be 136 – 114 gms for males and 135 – 89 gms for females which is higher than 136.65 ± 62.24 / 111.91 ± 32.29 for males and females respectively.[16]

Dr. Chandan Bandyopadhyay and Dr. Sujash Biswas, two eminent forensic experts of West Bengal studied Visceral Weight in Bengali Population Correlated with Age, Sex and Body Length. They found the average weight of brain, heart, right lung, left lung, liver, spleen, right kidney and left kidney was found to be 1209.25, 292.27, 549.95, 476.10, 1246, 142.47, 133.86 and 126.26 grams respectively in male; and 1125.16, 272.01, 438.04, 382.56, 1175.83, 123.75, 124.94 and 119.07 grams respectively in female. So, all the organ weights are found to be more in males than females. The weight of the heart and both lungs are found to be positively correlated with age and the weight of brain, liver, spleen and the kidneys are noted to be negatively correlated with age. That signifies that the weights of heart and both lungs increase with age and that of brain, liver, spleen and kidneys decreases with age but the correlation is of minor degree and not significant enough. The weight of all the organs are noted to be positively correlated with body length, which means that as the body length increases the weight of all the organs under study increases but here again the correlation is of minor degree and not significant enough.[17]

After getting the clearance from the institutional ethical committee, examination and weight measurements of both the kidneys of the bodies was done during the process of medicolegal autopsies in Burdwan Police Morgue of Burdwan Medical College over 12 months. This cross-sectional study included following criteria-

Inclusion Criteria

All the bodies came for postmortem examination following complete enumeration method Exclusion Criteria

• Decomposed body
• Evidence of gross pathology and trauma to internal organs
• Apparently Malnourished (BMI ˂ 18)
• Dead-bodies whose exact age is not documented.

Total 570 cases were included in the study.

At first renal vessels were dissected length wise from the aorta or inferior vena cava to the hilus. Incision of kidney has been done in situ. The fibrous and adipose capsule was stripped, using the unsevered renal vessels as anchor. This prevents the organs from slipping out of one’s hand after they have been removed from the retroperitoneal fat tissue. The kidneys were then excised from their convexity toward the hilus, exposing the renal pelvis. During this procedure the organ was held in a firm grip by applying some tension to the renal vessels. Clearing from all fat, ureters and renal vessel, kidneys of both sides were weighted separately by using electronic weight machine.

After collection and compilation of all the data, they were analysed using SPSS® version 23 and Microsoft Excel. Correlation between ‘weight of the organs’ and ‘body weight and body length’ were established.

TABLE 1: One way ANOVA test between different Age groups and weight of Left Kidney (n = 569)

TABLE 2: Independent sample t-test between Sex and weight of Left Kidney (n= 570)

TABLE 3: Correlation coefficient test between weight of Left Kidney and Body weight (n= 570)

TABLE 4: Correlation coefficient test between weight of Left Kidney and Body Length.

TABLE 5: One way ANOVA test between different Age groups and weight of Right Kidney (n = 569)

TABLE 6: Independent sample t-test between Sex and weight of Right Kidney (n= 570)

TABLE 7: Correlation coefficient test between weight of Right Kidney and Body weight (n= 570)

TABLE 8: Correlation coefficient test between weight of Right Kidney and Body Length.

Weight Of Kidney:

Photograph showing measurement of Weight of One Right Kidney

RIGHT KIDNEY

• In this study there is a statistically significant differences of weight of Right Kidney between groups as demonstrated by one-way ANOVA F(8,561) = 19.015,  p= .000. The Bonferroni post hoc test showed that EXCEPT between few age groups (i.e. 81-90 age group with that of 11-20, 21-30, 31-40, 41-50, 51-60, 61-70 and 71-80 age group;   71-80 age group with that of 21-30, 31-40, 41-50, 51-60 and 61-70 age group;   61-70 age group with that of 21-30, 31-40, 41-50 and 51-60 age group;   51-60 age group with 21-30 and 31-40 age group;   31-40 age group with that of 21-30 age group) there is significant differences between weight of the right kidney and different age groups. (table 5)
• Independent sample t test between sex and weight of the right kidney showed that the mean weight of the right kidney among the male is 130.243 gm and that of female is 128.264 gm. 2-tailed p value (0.413 & 0.402) also showed that the differences between weight of right kidney between male and female is not significant. Levene’s Test also showed that the there is not significant Variances between two samples (p= 0.419, >0.05) (table 6)
• Correlation coefficient i.e Pearson’s r is 0.417 that means weak positive correlation – the persons having more the body weight likely to have greater weight of the Right Kidney and the 2-tailed significance value (0.00) also proofs that this correlation is very powerful and (it has enough statistical power to identify even the slightest change) (table 7)
• Correlation coefficient i.e Pearson’s r is 0.339 that means weak positive correlation – the persons having more the body length likely to have greater weight of the Right Kidney and the 2-tailed significance value (0.00) also proofs that this correlation is very powerful and (it has enough statistical power to identify even the slightest change) (table 8)
• Table 6 shows average, weight of the right kidney among the male is 130.243 gm and that of female is 128.264 gm in this study is observed to be similar to that mentioned in Dr. Reddy’ text book in males (130-160 gm/ females (120-150 gm).
• Observed values in the present study in both sexes are higher than those observed in the study by Gharpure PV et al [18] in Nagpur (113.0 gm in males, 86.3 gm in females).
• Buchnan WJ et al [19] observed from autopsies in Grant Medical College, Bombay the average kidney wt to be 199.45 gm in both sexes. Observation found in the present study has much lower value than that observed in that study.
• Table 6 shows mean ± SD is 130.24 ± 28.6 gm. in males and 128.26 ± 26.21 gm in females.
• Chandra Prakash et al [20] in their study at Kumaon district in Uttarakhand observed kidney wt.(rt.)—BW correlation coefficient ‘r’286 , p<0.01 in males and ‘r’ 0.678 ,p<0.001. Both were statistically significant.

LEFTKIDNEY

• In this study There is a statistically significant differences of weight of Left Kidney between groups as demonstrated by one-way ANOVA F(8,561) = 19.148,  p= .000. The Bonferroni post hoc test showed that EXCEPT between few age groups (i.e. 81-90 age group with that of 11-20, 21-30, 31-40, 41-50, 51-60, 61-70 and 71-80 age group;   71-80 age group with that of 21-30, 31-40, 41-50, 51-60 and 61-70 age group;   61-70 age group with that of 21-30, 31-40, 41-50 and 51-60 age group;   51-60 age group with 21-30 and 31-40 age group;   31-40 age group with that of 21-30 age group) there is significant differences between weight of the left kidney and different age groups.(table 1)
• Independent sample t test between sex and weight of the left kidney showed that the mean weight of the left kidney among the male is 130.547 gm and that of female is 128.837 gm. 2-tailed p value (0.500 & 0.485) also showed that the differences between weight of left kidney between male and female is not significant. Levene’s Test also showed that the there is no significant Variances between two samples (p= 0.115, >0.05) (table 2)
• Correlation coefficient i.e Pearson’s r is 0.409 that means weak positive correlation – the persons having more the body weight likely to have greater weight of the Left Kidney and the 2-tailed significance value (0.00) also proofs that this correlation is very powerful and (it has enough statistical power to identify even the slightest change) (table 3)
• Correlation coefficient i.e Pearson’s r is 0.337 that means weak positive correlation – the persons having more the body length likely to have greater weight of the Left Kidney and the 2-tailed significance value (0.00) also proofs that this correlation is very powerful and (it has enough statistical power to identify even the slightest change) (table 4)
• Table 2 shows average weight of the left kidney among the male is 130.547 gm and that of female is 128.837 gm in this study is observed to be similar to that mentioned in Dr. Reddy’ text book (130-160 gm in males) and (120-150 gm in females).
• Observed values in the present study in both sexes are higher than those observed in the study by Gharpure PV et al [18] in Nagpur (114.3 gm in males, 89.0 gm in females).
• Buchnan WJ et al [19] observed from autopsies in Grant Medical College, Bombay the average kidney wt to be 199.45 gm in both sexes. Observation found in the present study has much lower value than that observed in that study.
• Table 2 shows mean ±SD is 130.54 ± 30.44 gm in males and 128.83 ± 26.71 gm in females.

Chandra Prakash et al [20] in their study at Kumaon district in Uttarakhand observed kidney wt.(rt.)—BW correlation coefficient ‘r’0.222, p<0.05in males and ‘r’ 0.703, p<0.001. Both were statistically significant.

Weights of Kidneys of both sides have weak or moderately positive correlation to Body Weight and Body Length in the present study in both sexes.

A database might be formed from this study regarding normal range of the weight of organs and their relation with different external parameters of the subjects which can be applicable for the population of this specific region. In grossly mutilated bodies found in mass disasters or in homicidal killing, weights of isolated organs may give a very crude idea about the stature, built and age of the victims which will help in identification.

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Acknowledgment

We are sincerely thankful and grateful from core of our heart to Prof (Dr.) Sanchita Das Kundu, Professor and Head of the Department, FMT of Raigunj Medical College, WB to act as the orchestra master of our study

Conflict Of Interest

The authors declare that there is no conflict of interest. This research work is a part of the dissertation of the First Author, submitted at the West Bengal University of health sciences in compliance with partial fulfilment of eligibility for the MD Examination for the year 2022.

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