The Taoiseach has said questions need to be answered as to why hospitals in Ireland have continued until recently to use the practice of incineration for the disposal of organs, contrary to HSE guidelines.

Michéal Martin was responding to findings identified in an internal HSE audit which found Ireland's post-mortem system is unsatisfactory and is at serious and substantial risk of systemic failings.

The highly critical report - details of which have been obtained by RTÉ Investigates - ranks its findings as unsatisfactory.

In all the report makes eight recommendations - six of which are categorised as High-level category red, meaning major non-compliances of policy were identified.

These recommendations are also listed as "potentially systemic" with the authors stating in their opinion the issues identified may be replicated nationally.

The remaining two recommendations are categorised as Medium-level orange.

The internal audit was commissioned by the HSE following an RTÉ Investigates report last year that revealed the organs of 18 babies delivered at Cork University Maternity Hospital had been sent abroad in 2020 for incineration along with clinical waste, without the knowledge or consent of bereaved parents.

Following the organ retention scandal here, which came to light in 1999 and 2000 a set of standards and guidelines concerning retention, cremation, burial or return of organs to families was put in place in 2012. All HSE and HSE funded hospitals are required to adhere to the guidelines.

All 25 HSE owned or funded hospitals were audited to seek assurances these guidelines were adhered to. However, the audit found significant failures in the standards of care and dignity provided by several hospitals.

As reported by RTÉ Investigates last week they include University Hospital Limerick where organs from two perinatal post-mortems were incinerated since 2019.

Our Lady of Lourdes Hospital Drogheda

The report also highlights Our Lady of Lourdes Hospital in Drogheda where it found it was policy to send retained organs for incineration as recently as 2020.

During the period reviewed, organs from three adults and one baby were incinerated.

However the audit only examined a 10% sample of all post-mortem files between January 2018 and October 2021 with the auditors recommending a wider review take place.

Reacting, the Taoiseach said he was "shocked" by the incineration revelations.

"This should have ended and questions will have to be answered in respect of why in particular hospitals that happened, answers will have to be forthcoming. It's a terrible trauma and stress to visit on the parents concerned and it's unacceptable," he told RTÉ's Prime Time.

Another major finding of the audit relates to the significant and inappropriate lengths of time which organs are being retained at numerous hospitals here.

For instance, at the Children's Hospital in Crumlin, they found organs from 24 post-mortems had been retained for longer than a year – one of those cases dated as far back as 2000 meaning organs have been held at the hospital for 22 years.

At the Midlands Regional Hospital Tullamore, eight organs were retained with one dating back 12 years to 2010.

St Columcille's in Loughlinstown, retained ten organs for over a year – the oldest case there dating back to 2017.

And at St Vincent’s Hospital, another ten organs were retained - again with the oldest case dating to 2017. While smaller numbers of organs were retained for inappropriate lengths of time at University Hospital Waterford and the Midlands Regional Hospital Portlaoise.

The report also makes several disturbing findings specific to perinatal post-mortems.

In this regard, the auditors found substantial non-compliance with many organs being held for well over a year.

At Galway University Hospital, the organs from 28 babies were held for between 12 and 32 months.

At St Columcille’s in Loughlinstown, 16 organs from six perinatal post-mortems were retained for between 18 and 32 months.

At Portiuncula Hospital in Galway, organs from two babies were kept between 18 and 26 months.

MRH Tullamore held organs for a up to 55 months

Midland Regional Hospital Tullamore, held organs from six other babies for periods between 19 and 55 months.

At University Hospital Limerick, organs from five perinatal post-mortems were retained for between 24 and 48 months.

While in Dublin's Coombe Hospital, contrary to policy, there was no organ retention register in place at all when the audit was carried out.

The audit found the majority of these unacceptable delays were linked to the severe shortage of perinatal pathology consultants in Ireland.

This has led to the re-employment of some retired specialists. One such person described in the report as Consultant A is 70+ years of age and works on an ad-hoc basis for the HSE. A similar arrangement also exists with another retired perinatal pathologist.

The report states the HSE is overly reliant on Consultant A's services and recommends any outstanding post mortem reports by this consultant be finalised as soon as possible to allow for the disposal of any remaining retained organs in a sensitive manner.

The report goes on to recommend that the services provided by Consultant A should be reviewed. A determination as to whether the current services are fit for purposes should be performed, and associated remediation actions taken (if required).

All these audit's findings are in contravention of the HSE's own 2012 guidelines.

The audit found training in those guidelines is not readily provided across the HSE and a review of the guidelines which was due to happen in 2015 did not take place.

In fact, no review has taken place to date.

The audit found there is a severe shortage of perinatal pathology consultants in Ireland. This has led to the re-employment of some retired specialists.

There were several other findings uncovered as part of the audit. At Our Lady's Hospital in Navan, bodies being transferred from the hospital to the mortuary are taken 300m across the hospital carpark on trolleys not designed for outdoor transportation.

While the audit found that a consent policy to cover all aspects of the post-mortem process was not in place in almost one in every three of the hospitals audited.

The audit also highlighted how the relationship between the HSE and the coroner service is not defined and documented.

If you have been affected by any of the issues in this article, you can contact the Patient Advocacy Service, which offers free, independent and confidential support, on 0818 293 003 from 10am–4pm, Monday–Friday, or by emailing info@patientadvocacyservice.ie.