Q. What is the CAP’s stance on antibody identification software, which is available via subscription, middleware, or an open-source platform?
A. January 2026—The CAP’s stance is that it is acceptable to use antibody identification software that is approved by the Food and Drug Administration and validated in your laboratory as long as its intended use is clearly defined and described in your laboratory standard operating procedure. In my view, these tools are meant to supplement, not replace, the interpretive work done by medical technologists and transfusion medicine physicians. For difficult or challenging cases, the medical director should be involved.
Cappelle D, Willemse J, Boes J. Automated antibody identification using the Bio-Rad IH-AbID software. Transfus Apher Sci. 2019;58(1):32–33.
Matthew S. Karafin, MD
Chair, CAP Transfusion, Apheresis, and Cellular Therapy Committee
We periodically republish answers to questions that remain relevant. The following question and answer was first published in February 2021. At that time, Dr. Jones was a forensic toxicologist at the Office of the Chief Medical Examiner, Alberta, Canada, and a member of the CAP Toxicology Committee. Dr. Graham is a retired chief medical examiner for the City of St. Louis, Mo., and formerly a member of the CAP Toxicology Committee.
Q. Can toxicology testing be performed on a person who has been deceased for two years?
A.The short answer is maybe. Modern instrumentation and analytical techniques can, theoretically, detect a wide range of drugs and poisons (toxicants) at very low concentrations. But several questions must be asked before testing the deceased. Among them, what is the condition of the remains after two years, and what organs or tissues are available for testing?
If bone or bone marrow is available, the laboratory can test for some drugs or other toxicants (for example, heavy metals), depending on the scope of its analytical methods. That said, few forensic laboratories perform toxicology testing on bone or bone marrow. Blood is the specimen that most forensic toxicology laboratories test, but it is not available in an embalmed body and likely will not be available in an unembalmed person after two years. Some testing may be possible on tissue, depending on the extent of decomposition. However, many drugs and poisons break down over time and may no longer be detectable after two years, even if they were present at the time of death.
Obtaining answers to the following questions can also help determine whether a drug or poison can be detected after two years. Was the body found in a remote location and most of the tissue eaten by predators? Was the body buried in a cemetery? If so, was the body embalmed prior to interment? Formaldehyde, the active ingredient used in embalming fluid, destroys many drugs and poisons. Groundwater that has entered the casket can also accelerate decomposition and leach drugs and poisons from the body.
The biggest problem with performing toxicology testing on human remains, especially after two years, is not analytical measurement but interpreting the results. Drug concentrations are usually measured in serum or plasma for clinical testing of living people. As stated, those specimens will not be available in a body two years after death. It may be impossible to determine whether a prescription drug that is detected was a factor in a person’s death because the concentration in the blood or organs at the time of death would not be known. In rare cases in which a poison such as the potent and relatively stable strychnine is present, toxicology testing can be of value when coupled with a detailed forensic and police investigation. Analytical testing is relatively easy to perform on metals, such as arsenic, lead, and cadmium, though serious poisoning with these metals is rare. Again, the problem is interpretation. These metals occur naturally in organs, other tissue, and bone and can also be found in the soil and groundwater. Therefore, a body that has been buried in the ground could have higher concentrations of these metals. For example, some parts of the country have higher than normal concentrations of arsenic in the soil and groundwater.
In summary, toxicology testing of a body two years after death is possible theoretically, but meaningful interpretation of the findings is difficult or impossible in most cases.
Druid H, ed. Post-mortem toxicology. In: Karch SB, ed. Drug Abuse Handbook. CRC Press; 2007: 1069–1083.
Drummer OH. Drugs in bone and bone marrow. In: Jenkins AJ, ed. Drug Testing in Alternate Biological Specimens. Humana Press; 2008.
Graham R. Jones, PhD
Clinical Professor, Department of Laboratory Medicine and Pathology
University of Alberta
Edmonton, Alberta, Canada
Michael A. Graham, MD
Professor of Pathology
Saint Louis University School of Medicine
St. Louis, Mo.