G199-Cause-of-death-list.pdf

 
 
 
 
 
 
 
The Royal College of Pathologists         
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London E1 8QT 
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Registered charity in England and Wales, no. 261035  
© 2020 The Royal College of Pathologists               Unique document reference number: G199 
Cause of death list 
June 2020 
Author: Dr Suzy Lishman, Chair of the RCPath Medical Examiners Committee. 
 
Contents 
Foreword ............................................................................................................................................. 2 
Introduction ........................................................................................................................................ 3 
Registrars ........................................................................................................................................... 3 
Referral to the coroner ...................................................................................................................... 4 
Notes on the cause of death list ...................................................................................................... 4 
Key considerations for registrars of births and deaths ........................................................................ 4 
The Medical Certificate of Cause of Death.......................................................................................... 5 
 
Causes of death ................................................................................................................................. 8 
A ..................................................................... 8 
B ..................................................................... 9 
C ................................................................... 10 
D ................................................................... 12 
E ................................................................... 13 
F ................................................................... 14 
G ................................................................... 14 
H ................................................................... 15 
I ..................................................................... 16 
J .................................................................... 17 
K ................................................................... 17 
L ................................................................... 17 
M .................................................................. 18 
N ................................................................... 19 
O ................................................................... 19 
P ................................................................... 19 
R ................................................................... 20 
S ................................................................... 21 
T ................................................................... 22 
U ................................................................... 23 
V ................................................................... 23 
W .................................................................. 23 
 

Foreword

Achieving accuracy of Medical Certificates of Cause of Death is vital to the health of the nation and

is core to medical examiner work. The Cause of death list has an important part to play, also

helping remind which deaths must be notified to a senior coroner. Publication enables all involved;

registrars, doctors, coroners and coroners’ officers to speak from the same page. This is very

welcome, and I am delighted the Royal College of Pathologists brings medical expertise leading

the Cause of Death List to greater prominence.

Dr Alan Fletcher

National Medical Examiner

Introduction

The Royal College of Pathologists is the lead medical royal college for medical examiners,

providing training, guidance and continuing professional development for this important new

medical specialty. Medical examiners will scrutinise all deaths not reported to the coroner, ensuring

appropriate coronial referral and accurate certification and speaking to bereaved families, in

particular answering any questions they might have.

The College has worked closely with the Department of Health and Social Care, National Medical

Examiner, Chief Coroner, General Register Office (GRO), medical royal colleges and patient and

faith groups to support implementation of the medical examiner system, initially in acute trusts and

shared services partnerships and then to cover all deaths in England and Wales. The College is

grateful to these stakeholders for their contribution to updating this important document and their

support of medical examiner implementation in general. We hope that this guide will be helpful for

doctors completing death certificates, medical examiners supporting them and registrars

registering deaths, ultimately for the benefit of the bereaved.

This Cause of death list replaces the 2016 document issued to registrars by the GRO and

intentionally retains the same name and format as that document. It is not intended to be an

exhaustive list of all possible causes of death, but deals with conditions that have previously

prompted discussion between certifying doctors, registrars and coroners. It includes clarification

about common conditions, such as pneumonia and heart failure, and less common ones, such as

ankylostomiasis and spirochaetal jaundice. The list has grown organically and reflects previous

areas of contention rather than a systematic approach. This version seeks to provide consistent

guidance for all stakeholders, removing ambiguity and improving consistency. The College will be

responsible for updating the content as required and welcomes feedback.

The document offers guidance for those completing death certificates and those registering deaths.

In the current non-statutory medical examiner system, registrars will continue to refer deaths to the

coroner in line with the Notification of Deaths Regulations 2019.

The Cause of death list details some of the conditions that may be included on the Medical

Certificate of Cause of Death (MCCD). The MCCD is completed by the certifying doctor in line with

current legislation, which can be found at: www.gov.uk/government/publications/guidance-notes-

for-completing-a-medical-certificate-of-cause-of-death

This document is being published during the emergency legislation of the Coronavirus Act 2020.

Under the Act, several processes relating to the certification and registration of death have

changed temporarily. The changes to the process of death certification do not affect the acceptable

causes of death that can be registered without coronial referral. This guidance will remain current

after the Coronavirus Act 2020 has been repealed.

Registrars

Registrars should use this guide in the first instance if they have a query about the acceptability

of a cause of death.

If a query is not covered in this guide, or if you have additional concerns, please call the GRO

on 0300 123 1837 (select option 2).

To provide feedback on this document, please contact the Royal College of Pathologists.

Referral to the coroner

The Notifications of Deaths Regulations came into force in October 2019. These made it a legal

requirement for certain deaths to be reported to the coroner. Briefly, a registered medical

practitioner has a duty to notify the coroner if any of the following circumstances apply:

• poisoning

• exposure to a toxic substance

• use of a medicinal product, controlled drug or psychoactive substance

• violence

• trauma or injury

• self-harm

• neglect, including self-neglect

• the person undergoing a treatment or procedure of a medical or similar nature

• an injury or disease attributable to any employment held by the person during the person’s

lifetime

• the registered medical practitioner suspects that the person’s death was unnatural but does

not fall within any of the circumstances above

• the cause of death is unknown

• the person died in custody

• there is no attending medical practitioner to sign the death certificate

• the deceased cannot be identified.

The regulations can be accessed at: www.legislation.gov.uk/uksi/2019/1112/made

The Ministry of Justice has issued guidance to medical practitioners on the Notifications of Deaths

Regulations:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/

851972/registered-medical-practitioners-notification-deaths-regulations-guidance.pdf

Notes on the cause of death list

Key considerations for registrars of births and deaths

This list is not exhaustive and needs to be used in conjunction with the Registrars Handbook,

particularly D2 and D4. The fact that a cause if death does not appear in this list does not

necessarily mean that it is, or is not, acceptable.

Each MCCD should be looked at on its own merits and consideration should be given to all

conditions recorded on the certificate and the order in which they are recorded.

The Medical Certificate of Cause of Death

The certifying doctor will complete an MCCD. It is the registrar’s legal responsibility to report

certain deaths to the coroner. Information about which deaths need referring to the coroner are at

D2 and D4 of the Registrar’s Handbook. Consideration should also be given to the expected

statutory provisions by medical practitioners.

The cause of death must be copied precisely from the MCCD – the registrar cannot amend the

cause of death and cannot correct any spelling mistakes. Please take care when completing the

MCCD and write clearly. If the death needs to be referred to the coroner, the registrar should refer

without discussing the cause with the certifying doctor. Under the current non-statutory scheme,

there is no obligation for the registrar to discuss the cause of death with a medical examiner. If in

doubt, the medical examiner may wish to discuss the acceptability of a cause of death with their

local registrar.

Information in the Medical Certificate of Cause of Death

Please note: This section is intended to provide a broad understanding of the type of information

shown in a MCCD. It is not intended to provide definitive definitions or guidance.

The MCCD is divided into two parts, the functions of which are described in more detail below.

When considering the information in Parts I and II, registrars should be alert to whether modes of

death have been recorded and whether a given cause of death appears to be unnatural.

Part I

This is the sequence of causes, conditions or events directly leading to the death and is split into

three parts: a, b and c. There must be an acceptable cause of death in Part I (either in a, b or c). A

condition which is not acceptable as a casue on its own may become acceptable when

accompanised by another condition. However, an acceptable condition does not remain

acceptable if another cause of death in a, b, or c requires referral to the coroner.

Part II

Causes in Part II are other significant conditions contributing to the death, but not directly related to

the disease or the condition causing it.

If there is not an acceptable cause of death in Part I, an acceptable cause of death in Part II does

not mean a registration can be concluded.

Even if there are acceptable causes of death in Part I, Part II can still lead to referral to the coroner,

if it suggests the death might have been unnatural (please see list below).

Remember: Part II cannot make Part I better but it can make it worse.

Modes of dying

A ‘mode’ of dying is one which does not explain ‘why’. For example, ‘coma’ does not explain the

underlying condition leading to death. Examples of modes of death (not a complete list) include:

• cardiac arrest

• coma

• exhaustion

• renal/kidney failure

• respiratory arrest

• syncope.

Terms such as ‘acute’, ‘chronic’, ‘acute on chronic’ or ‘multiple’ do not turn modes of dying into

acceptable causes.

The exception to this rule is ‘heart failure’, which is acceptable on its own, although ideally further

supporting information should be provided.

It is acceptable for a mode of dying to be supported/explained by an acceptable disease or

condition beneath it in Part I.

The terms ‘possible’, ‘probable’ and ‘suspected’ should not be used on the MCCD.

‘Unnatural’ causes of death

If there appears to be an unnatural cause of death in either Part I or II, the death must be referred

to the coroner.

Referral to the coroner

Deaths should be referred to the coroner in the usual way for your office.

Infections

The name of the organism responsible for an infection should be included on the MCCD where

known.

Malignancies

The specific type of malignancy should be included where known, e.g. squamous cell carcinoma of

the bronchus, rather than lung cancer.

Use of abbreviations

Abbreviations must not be used on the MCCD (but can be used on the counterfoil).

Unknown

In general, the term ‘unknown’ should be avoided on the MCCD. However, it is acceptable in

certain circumstances, such as metastatic malignancy of unknown primary, and septicaemia/sepsis

of unknown aetiology.

Possible/probable

‘Possible’ and ‘probable’ should not be used on the MCCD. The certifying doctor states the cause

of death to the best of their knowledge and belief. If they do not know the cause of death, they

must notify the coroner.

Industrial disease

Some conditions are commonly associated with occupational exposure to hazardous substances.

Mesothelioma, for example, is often due to occupational exposure to asbestos. In such conditions,

the death must be referred to the coroner unless the doctor states that the disease was

non-industrial or non-occupational. There are also some diseases that are occasionally related to

the deceased’s occupation, such as lung cancer or emphysema, but which also occur commonly in

the general population. In these conditions, the doctor completing the MCCD should check

carefully that they were not related to an occupation, but does not need to state ‘non-occupational’

on the MCCD. If the condition may have been related to the deceased’s occupation, the case must

be referred to the coroner.

Definition of terms

Acceptable – This cause of death does not need to be referred to the coroner, however if it is

used in conjunction with another cause that does need to be referred, the death should still be

referred to the coroner.

Some causes of death are acceptable only if further information is provided, for example:

• acceptable if noted to be spontaneous

• acceptable if supported by another acceptable cause of death

• acceptable over a certain age.

Mode of dying – refer to coroner unless supported by an acceptable cause of death. A mode of

dying has to be supported by another cause of death which is acceptable in Part I of the MCCD.

Refer to coroner unless doctor states non-industrial – doctor should write ‘non-industrial’ after

the cause. The informant should not be asked whether the condition was caused by the

deceased’s occupation.

Refer to coroner – death needs to be referred to the coroner wherever this condition appears on

the MCCD, regardless of any other conditions recorded or where on the MCCD it is written.

Refer to coroner if not accompanied by another acceptable condition – the acceptable

condition must be in part 1.

Causes of death

Cause of death

Action

Abdominal aortic aneurysm

Acceptable

Acute alcoholism

Refer to coroner

Acute dehydration

Refer to coroner

Acute left/right ventricular failure

Acceptable

Acute aortic syndrome

Acceptable

Acute respiratory distress syndrome

Refer to coroner unless supported by another

acceptable condition

Adult respiratory distress syndrome

Refer to coroner unless supported by another

acceptable condition

Advancing years – old age

Acceptable if deceased was aged 80 or over

Acquired Immunodeficiency Syndrome

Acceptable, unless the informant or MCCD states

due to contaminated blood products or needles

drugs etc.; do not ask question – only if this

information is volunteered

Alcohol abuse

Acceptable if long standing (chronic), refer to

coroner if sudden (acute)

Alzheimer’s disease

Acceptable

Anaemia

Acceptable if deceased is over 70 years old (it

should be possible to give an underlying cause or at

least categorise it as e.g. iron deficiency or

megaloblastic); refer to coroner if deceased is under

70 years old and not supported by another

acceptable condition

Anaphylaxis

Refer to coroner

Ankylostomiasis

Refer to coroner unless doctor states non-industrial

Angiosarcoma of the liver

Refer to coroner unless doctor states non-industrial

Anorexia nervosa

Acceptable

Anthracosis, Anthracosilicosis

Refer to coroner unless doctor states non-industrial

Anthrax

Refer to coroner unless doctor states non-industrial

Cause of death

Action

Arrhythmia/Cardiac arrhythmia

Refer to coroner unless supported by an acceptable

cause of death

Arteriosclerosis/Atherosclerosis

Acceptable

Asbestosis

Refer to coroner unless doctor states non-industrial

Aspergillosis

Acceptable

Asphyxia

Refer to coroner

Aspiration pneumonia

Refer to coroner unless supported by an acceptable

cause of death

Asystole

Refer to coroner unless supported by an acceptable

cause of death

Atrial fibrillation

Acceptable

Cause of death

Action

Bacterial meningitis

Acceptable

Bagassosis

Refer to coroner unless doctor states non-industrial

Barotrauma

Refer to coroner

Berylliosis

Refer to coroner unless doctor states non-industrial

Biliary (biliary tract) infection/sepsis

Acceptable

Bilateral pleural thickening

Refer to coroner unless doctor states non-industrial

Birth asphyxia

Refer to coroner

Birth injury

Refer to coroner

Biventricular failure

Acceptable

Bladder – Cancer of the bladder or renal

pelvis or urethra or ureter

Refer to coroner if deceased’s occupation took them

into contact with industrial chemical or dyestuff

preparations or process; otherwise acceptable

Bleeding peptic ulcer

Acceptable

Blood Poisoning/septicaemia

Refer to coroner if on its own or in association with

an injury

Cause of death

Action

Bone marrow failure

Refer to coroner unless supported by an acceptable

cause of death, e.g. myelodysplasia or old age

Bowel obstruction

Acceptable if qualified as spontaneous or with an

acceptable underlying cause

Brain failure

Mode of dying – refer to coroner unless supported by

an acceptable cause of death

Bronchial or bronchus cancer

Refer to coroner if deceased’s occupation took them

into contact with nickel fumes or vapour or

associated with fibre board or wooden goods;

otherwise acceptable

Bronchopneumonia

Acceptable

Bronchospasm

Refer to coroner if not supported by another

acceptable condition

Brucella/Brucellosis

Refer to coroner unless doctor states non-industrial

Byssinosis

Refer to coroner unless doctor states non-industrial

Cause of death

Action

Cachexia

Mode of dying – refer to coroner unless supported by

an acceptable cause of death

Caisson disease

Refer to coroner

Cancer of the bladder or renal pelvis or

urethra or ureter

Refer to coroner if deceased’s occupation took them

into contact with industrial chemical or dyestuff

preparations or process; otherwise acceptable

Cancer of the lung/bronchus

Refer to coroner if deceased’s occupation took them

into contact with nickel fumes, vapour or associated

with fibre board or wooden goods; otherwise

acceptable

Cancer of the nose/nasopharynx/nasal

sinuses

Refer to coroner if deceased’s occupation took them

into contact with nickel fumes, vapour or associated

with fibre board or wooden goods; otherwise

acceptable

Cancer of the skin/squamous-cell

carcinoma

Refer to coroner if deceased’s occupation took them

in contact with tar, mineral, oil, pitch, bitumen, soot,

etc.; otherwise acceptable

Cause of death

Action

Cardiac arrest

Mode of dying – refer to coroner unless supported by

an acceptable cause of death

Cardiac tamponade

Refer to corner unless supported by an acceptable

cause of death

Cardiogenic shock

Mode of dying – refer to coroner unless supported by

an acceptable cause of death

Cardiorespiratory arrest

Mode of dying – refer to coroner unless supported by

an acceptable cause of death

Cardiovascular accident/event/incident

Refer to coroner unless supported by an acceptable

cause of death

Cellulitis

Acceptable

Cerebral/intracerebral haemorrhage

Not acceptable on its own unless it is qualified as

spontaneous* or primary; otherwise needs an

acceptable underlying disease as it can be caused

by trauma

Cerebral palsy

Refer to coroner (may be as result of birth injury)

Cerebellar ataxia

Acceptable

Cerebrovascular

accident/event/haemorrhage

Acceptable (but ‘accident’ should be avoided if

possible)

Chest infection

Acceptable

Cholecystitis

Acceptable

Chronic airflow limitation

Refer to coroner if deceased’s occupation was an

underground coal miner; otherwise acceptable

Chronic bronchitis

Refer to coroner if deceased’s occupation was an

underground coal miner; otherwise acceptable

Chronic obstructive airways disease

(COAD)

Refer to coroner if deceased’s occupation was an

underground coal miner; otherwise acceptable

Chronic obstructive pulmonary disease

(COPD)

Refer to coroner if deceased’s occupation was an

underground coal miner; otherwise acceptable

Chronic alcoholism†

Acceptable

Circulatory failure

Mode of dying – refer to coroner unless supported by

an acceptable cause of death

A spontaneous cerebral haemorrhage is natural and the same as a haemorrhagic stroke.

†

Or Alcohol dependence syndrome.

Cause of death

Action

Circulatory collapse

Mode of dying – refer to coroner unless supported by

an acceptable cause of death

Clostridium difficile

Acceptable

Coma

Mode of dying – refer to coroner unless supported by

an acceptable cause of death

Compressed air illness

Refer to coroner

Congenital

Acceptable as a generic term qualifying a condition

at any age

Congenital ventricular septal defect

Acceptable

Congestive cardiac failure

Acceptable

Congestive heart failure

Acceptable

Coronavirus infection/disease

Acceptable

Cot death

Refer to coroner

COVID-19

Acceptable

COVID-19 infection/pneumonia

Acceptable

Creutzfeldt Jakob disease

Acceptable

Cryptogenic* fibrosing alveolitis

Refer to coroner

Cause of death

Action

Debility

Mode of dying – refer to the coroner unless

supported by an acceptable cause of death

Debility of old age

Acceptable provided the deceased is 80 or over;

otherwise refer to coroner

Dehydration

Refer to coroner

Dementia

Acceptable

Depression

Not acceptable as a standalone cause of death

Also Idiopathic

Cause of death

Action

Diabetes mellitus

Acceptable

Diabetic foot gangrene

Acceptable

Dissection of thoracic aorta/aortic

aneurysm

Acceptable

Diver’s palsy, Diver’s paralysis

Refer to coroner

Diverticulitis/diverticular abscess

Acceptable

Digoxin toxicity

Refer to coroner if in Part I

Duodenal ulcer

Not acceptable as a standalone cause of death but

acceptable if supporting, e.g. upper gastrointestinal

haemorrhage

Dust reticulation

Refer to coroner unless doctor states non-industrial

Dysbarism

Refer to coroner unless doctor states non-industrial

Cause of death

Action

Escherichia coli (E-coli)

Refer to coroner if not supported by another

acceptable condition

Escherichia coli (E-coli) septicaemia

Acceptable

Electromechanical dissociation

Refer to coroner if not supported by another

acceptable condition

Emphysema

Refer to coroner if deceased’s occupation was a coal

miner/worker exposed to dust for more than 20

years; otherwise acceptable

Empyema

Acceptable

Encephalitis

Acceptable

Exhaustion

Mode of dying – Refer to coroner unless supported

by an acceptable cause of death

Extreme prematurity

Acceptable

Extrinsic allergic alveolitis

Refer to coroner unless doctor states non-industrial

Cause of death

Action

Farmer’s lung

Acceptable

Fibrosing alveolitis*

Refer to coroner if deceased’s occupation brought

them in to contact with dust; otherwise acceptable

Fracture

Refer to coroner unless doctor states that it was

caused by a disease (e.g. osteoporosis)

Fracture – pathological

Acceptable if underlying disease stated

Frailty of old age

Acceptable provided the deceased is 80 or over,

otherwise refer to coroner

Frailty syndrome

Refer to corner unless supported by an acceptable

cause of death

Cause of death

Action

Gangrene

Refer to coroner if not supported by a circulatory

disease

Gastric aspiration/aspiration of gastric

contents

Refer to coroner if not supported by another

acceptable condition

Gastroenteritis

Acceptable

Gastrointestinal bleed/haemorrhage

Refer to coroner unless stated to be spontaneous

General debility

Mode of dying – refer to coroner if not supported by

an underlying condition

General system failure

Refer to coroner if not supported by another

acceptable condition

Goodpasture’s syndrome/Anti Glomerular

Basement Membrane disease

Acceptable

Gram negative septicaemia

Refer to coroner unless supported by an acceptable

cause of death

Grinder’s asthma

Refer to coroner

Grinder’s phthisis

Refer to coroner

Insertion of the word Idiopathic will reassure not industrial or drug-related

Cause of death

Action

Haematemesis

Refer to coroner if not supported by another

acceptable condition

Haemothorax

Refer to coroner

Haemorrhagic shock

Refer to coroner if not supported by another

acceptable condition

Hartmann’s procedure

Refer to coroner

Heart attack

Refer to coroner

Heart Block (Complete or Möbitz Type 2)

Acceptable (See arrhythmia)

Heart failure

Acceptable

Hepatic failure

Refer to coroner if not supported by another

acceptable condition

Hepatitis

Refer to coroner if deceased was a health or care

worker; otherwise acceptable

Hepatitis Australian antigen

Refer to coroner if deceased was a health or care

worker; otherwise acceptable

Hepatitis B

Refer to coroner if deceased was a health or care

worker; otherwise acceptable

Hepatitis viral

Refer to coroner if deceased was a health or care

worker; otherwise acceptable

Hepatorenal failure

Refer to coroner if not supported by another

acceptable condition

Hernia

Acceptable, if described anatomically and supporting

another acceptable cause of death (e.g. intestinal

obstruction/peritonitis); refer to coroner if

incisional/parastomal (may be related to surgical

procedure)

Huntington’s chorea/disease

Acceptable

Hydrocephalus

Refer to corner unless supported by an acceptable

cause of death (or state congenital)

Hypertension

Not acceptable as a standalone cause of death but

acceptable if supporting, e.g. intracerebral

haemorrhage

Hyperthermia

Refer to coroner

Cause of death

Action

Hypothermia

Refer to coroner

Hypovolaemia/hypovolaemic shock

Refer to coroner, unless supported by an acceptable

cause of death

Hypoxic brain injury

Refer to coroner unless supported by an acceptable

cause of death

Cause of death

Action

Iatrogenic

Refer to coroner if anywhere on the MCCD

Inanition

Refer to coroner unless supported by an acceptable

cause of death

Inflammatory bowel disease

Acceptable

Infective endocarditis

Acceptable

Influenza

Acceptable

Injury*

Refer to coroner

Intestinal bleeding/haemorrhage

Refer to coroner unless supported by an acceptable

cause of death

Intestinal ischaemia

Acceptable

Intestinal obstruction

Refer to coroner unless supported by an acceptable

cause of death (or spontaneous)

Intracerebral haemorrhage (duplication

with cerebral)

Refer to coroner unless supported by an acceptable

cause of death (or spontaneous/primary)

Intracranial haemorrhage (duplication

with cerebral)

Refer to coroner unless supported by an acceptable

cause of death (or spontaneous/primary)

Intraoral squamous-cell carcinoma

Refer to coroner if deceased’s occupation brought

them in to contact with tar; otherwise acceptable

Ischaemic heart disease

Acceptable

Ischaemic bowel

Acceptable

Unless as acute kidney injury supported by an acceptable underlying cause of death.

Cause of death

Action

Jaundice

Refer to coroner unless qualified by an acceptable

underlying cause of death

Cause of death

Action

Kidney failure/injury

Refer to coroner if not supported by another

acceptable condition

Kidney stones

Acceptable

Cause of death

Action

Leaking aortic aneurysm

Acceptable

Left ventricular failure

Acceptable

Leptospira canicola

Refer to coroner unless doctor states non-industrial

Leptospira icterohaemorrhagiae

Refer to coroner unless doctor states non-industrial

Learning disability/difficulties

Not acceptable as a standalone cause of death; this

non-medical term should be avoided where possible

Lewy body dementia

Acceptable

Linitis plastica

Acceptable

Liver failure

Refer to coroner if not supported by another

acceptable condition

Lower respiratory tract infection

Acceptable

Lung cancer (cancer of the lung,

bronchus or bronchial)

Refer to coroner if deceased’s occupation brought

them into contact with nickel fumes or vapour or

associated with fibreboard or wooden goods;

otherwise acceptable

(Systemic) lupus erythematosus

Acceptable

Lymphoproliferative disorder/disease

Acceptable

Cause of death

Action

Malignant disease (cancer or sarcoma or

leukaemia or anaemia)

Refer to coroner if deceased’s occupation brought

them into contact with X-rays or radioactive

substances or radiation; acceptable if qualified as of

unknown primary

Malnutrition

Refer to coroner

Medical techniques

Refer to coroner

Meningitis

Acceptable

Meningococcal meningitis

Acceptable

Meningococcal septicaemia

Acceptable

Mesothelioma

Refer to coroner unless doctor states non-industrial

Motor neurone disease

Acceptable

Meticillin Resistant Staphylococcus

Aureus (MRSA)

Refer to coroner if not supported by another

acceptable condition

Meticillin Resistant Staphylococcus

Aureus (MRSA) septicaemia

Refer to coroner if not supported by another

acceptable condition

Mycobacterium avium intracellulare

infection

Acceptable

Multiple sclerosis

Acceptable

Multiple organ failure

Refer to coroner if not supported by another

acceptable condition

Multiple system atrophy

Acceptable

Multiple organ failure/multiple organ

dysfunction syndrome

Refer to coroner if not supported by another

acceptable condition

Myelodysplasia

Acceptable

Myeloma

Acceptable

Myeloproliferative disorder

Acceptable

Myocardial infarction or degeneration

Acceptable

Cause of death

Action

Natural causes

This is not a cause of death and is not acceptable

anywhere on the MCCD

Nephrotic syndrome

Acceptable

Neurodegenerative disease of unknown

cause

Acceptable

Neutropaenic sepsis

Refer to coroner if not supported by another

acceptable condition

Non-cirrhotic portal fibrosis

Refer to coroner if not supported by another

acceptable condition

Norovirus

Acceptable

Cause of death

Action

Occipital lobe infarction

Acceptable

Old age

Acceptable provided the deceased is 80 or over,

otherwise refer to coroner

On chronic renal failure*

Refer to coroner if not supported by another

acceptable condition

Osteomyelitis

Acceptable

Osteonecrosis

Refer to coroner unless doctor states non-industrial

Cause of death

Action

Pancreatitis

Acceptable

Parkinsonism, Parkinson’s Disease

Acceptable

Pathological fracture

Acceptable provided cause is included and is natural

Chronic kidney disease is acceptable.

Cause of death

Action

Peptic ulcer

Not acceptable as a standalone cause of death but

acceptable if supporting, e.g. upper gastrointestinal

haemorrhage

Perforated (perforation of the)

bowel/intestine*

Refer to coroner unless supported by an acceptable

cause of death (or spontaneous)

Perforated intra-abdominal viscus†

Refer to coroner unless supported by an acceptable

cause of death (or spontaneous)

Perinatal asphyxia

Acceptable for a neonatal death

Peripheral vascular disease

Acceptable

Peritonitis

Acceptable

Pleural mesothelioma

Refer to coroner unless doctor states non-industrial

Pneumococcal septicaemia

Acceptable

Pneumoconiosis

Refer to coroner unless doctor states non-industrial

Pneumothorax

Refer to coroner unless supported by an acceptable

cause of death (or spontaneous)

Pseudo-obstruction (of the intestine)

Acceptable

Pulmonary embolism

Acceptable

Pulmonary tuberculosis

Acceptable unless certificate states industrial

Cause of death

Action

Radiation colitis

Refer to coroner

Refusal to eat

Refer to coroner

Renal failure

Refer to coroner unless supported by an acceptable

cause of death

Renal/kidney injury‡

Refer to coroner unless supported by an acceptable

cause of death

Prefixed with ‘spontaneous’ is acceptable.

†

Prefixed with ‘spontaneous’ is acceptable.

‡

This refers to abnormal renal function, not traumatic injury.

Cause of death

Action

Respiratory arrest or failure

Mode of dying – refer to coroner unless supported by

an acceptable cause

Rheumatic heart disease

Acceptable

Rheumatoid arthritis

Acceptable

Right ventricular failure

Acceptable

Ruptured abdominal aortic aneurysm

Acceptable

Cause of death

Action

SARS-CoV-2 infection

Acceptable

Schizophrenia/psychosis

Refer to coroner unless supporting an acceptable

cause of death

Senile dementia

Acceptable if deceased was aged 80 or over. Refer

to coroner if deceased under 80 years old and not

supported by another acceptable condition

Senility

Acceptable if deceased was aged 80 or over

Sepsis

Refer to coroner unless supported by an acceptable

cause of death

Sepsis of unknown aetiology

Acceptable

Septic arthritis

Acceptable

Septic shock

Refer to coroner unless supported by an acceptable

cause of death

Septicaemia

Refer to coroner unless supported by an acceptable

cause of death (or unknown aetiology)

Siderosis

Refer to coroner unless doctor states non-industrial

Silicosis

Refer to coroner unless doctor states non-industrial

Smoking

Refer to coroner if not supporting another acceptable

condition

Spinal cord ischaemia

Acceptable

Spirochaetal jaundice

Refer to coroner unless doctor states non-industrial

Cause of death

Action

Spontaneous gastrointestinal

bleed/haemorrhage

Acceptable

Spontaneous intracerebral haemorrhage

Acceptable

Staphylococcus (aureus)

Refer to coroner if not supported by another

acceptable condition

Steele Richardson syndrome

Acceptable

Streptococcal septicaemia

Acceptable (See meningococcal septicaemia)

Streptococcus

Refer to coroner unless supported by an acceptable

cause of death

Streptococcus suis

Refer to coroner unless doctor states non-industrial

Stroke

Acceptable provided deceased is not a child

Spontaneous subarachnoid haemorrhage

Acceptable

Stent/stented

Refer to coroner

Subdural haematoma

Refer to coroner

Sudden infant death syndrome

Refer to coroner if not supported by another

acceptable condition

Syncope

Mode of death - Refer to coroner if not supported by

another acceptable condition

(Systemic) mixed connective tissue

disorder

Acceptable

Cause of death

Action

Tetanus

Refer to coroner

Toxic anaemia

Refer to coroner

Toxic jaundice

Refer to coroner

Toxicity

Refer to coroner

Tuberculosis

Refer to coroner unless doctor states non-industrial

Cause of death

Action

Ulcer duodenal/gastric/peptic

Not acceptable as a standalone cause of death but

acceptable if supporting, e.g. upper gastrointestinal

haemorrhage

Unknown

Refer to coroner unless cause of death given is a

malignant disease or septicaemia where the

site/cause is unknown.

Uraemia

Refer to coroner if not supported by another

acceptable condition

Urinary tract infection

Acceptable

Urosepsis

Acceptable

Cause of death

Action

Vagal inhibition

Refer to coroner if not supported by another

acceptable condition

Vascular dementia

Acceptable

Ventricular failure

Acceptable

Viral hepatitis

Refer to coroner unless doctor states non-industrial

Cause of death

Action

Weil’s disease

Refer to coroner unless doctor states non-industrial