16 Del. Admin. Code § 4204 – Care and Transportation of the Dead

Department of Health and Social Services

Division of Public Health

Health Promotion and Disease Prevention

4602 Care and Transportation of the Dead

1.0 Purpose

This regulation establishes the standards for the care and transportation of dead bodies. This regulation describes the processes and requirements for the different methods of disposition of human remains and ensures the protection of Delaware residents.

2.0 Authority

The Department of Health and Social Services, Division of Public Health, may adopt, promulgate, amend, and repeal such regulations as may be consistent with law pursuant to16Del.C.§122(3)and 3103.

3.0 Definitions

The following words and terms, when used in this regulation, have the following meaning unless the context clearly indicates otherwise:

"Dead body" means any human dead body, including any products of human conception expelled weighing 350 grams or more, or after 20 weeks of gestation, whether born dead or dying thereafter.

"Department" means the Delaware Department of Health and Social Services.

"Final remains" means the body of a deceased individual, including what results following cremation or natural organic reduction.

"Funeral director" means an undertaker or mortician licensed in the State of Delaware.

"Natural organic reduction" means the contained, accelerated conversion of human remains to soil.

"Natural organic reduction facility" means a structure, room, or other space in a building or a real property where natural organic reduction of a human body occurs.

"Premises in which interments are made" means burying grounds, cemeteries, tombs or vaults, or any other places where disposal of bodies may be made.

"State Registrar" means the Director, Division of Public Health.

4.0 Burial, Removal, Cremation, or Other Disposition of Dead Bodies

4.1 Burial-transit permits. A licensed funeral director will print and sign the burial-transit permit in the electronic vital event registration system of the Office of Vital Statistics, after filing the death record. The burial-transit permit must be given to the person in charge of the cemetery or retained by the funeral director if there is no person in charge, in which interments or entombment occur.
1. 4.1.1 Upon receipt of the burial permit, both the temporary certificate and the burial permit shall be retained by the person in charge of the premises as a permanent record of authorization for burial.
2. 4.1.2 In the event that the person in charge of the premises receives a temporary certificate authorizing burial, the certificate shall be retained until the burial permit is received.
3. 4.1.3 If the person in charge of the premises does not receive the burial permit from the funeral director within a period of 10 days after burial takes place, they shall notify the State Registrar of Vital Statistics, Dover, Delaware.
4. 4.1.4 The permit must be accessible for inspection or other purposes when requested by the inspecting authority.
4.2 Cremation permit or natural organic reduction permit. A body may be cremated or subjected to natural organic reduction only after obtaining a special cremation or natural organic reduction permit signed by the Chief Medical Examiner or an assistant or deputy medical examiner.
1. 4.2.1 When a funeral director or the funeral director's designee requests the signature of the Chief Medical Examiner or the Chief Medical Examiner’s representative on the permit for cremation or natural organic reduction, the permit must be accompanied by a death certificate signed by the attending physician and by a cremation or natural organic reduction authorization form signed by the next-of-kin or legal representative of the deceased. The signature of the Chief Medical Examiner or the Chief Medical Examiner’s representative to the cremation or natural organic reduction permit shall constitute an affirmation that there is no medical reason why the cremation or natural organic reduction should not occur. The Chief Medical Examiner or an assistant or deputy medical examiner shall have the authority to hold the remains of the deceased pending any investigation into the cause and manner of death.
2. 4.2.2 The cremation permit or natural organic reduction permit must be given to and retained by the person in charge of any facility in which cremation or natural organic reduction occurs. The cremation permit or natural organic reduction permit must be accessible for inspection or other purposes when requested by the inspecting authority.
3. 4.2.3 Cremation permits or natural organic reduction permits for bodies where death occurred in Delaware and cremation, or natural organic reduction will be completed in another state require the signature of the Delaware Chief Medical Examiner or an assistant or deputy medical examiner.
4. 4.2.4 Cremation or natural organic reduction in Delaware when death occurred elsewhere is permissible if all the legal requirements of the state or jurisdiction in which the death occurred have been met.
5. 4.2.5 A second copy of the cremation or natural organic reduction permit must accompany the death certificate when it is filed in the Office of Vital Statistics.
4.3 Disposition of unclaimed body or remains of indigent person. Pursuant to29Del.C.§4711:
1. 4.3.1 In any case where there is an unclaimed body or there are remains of indigent persons and it is incumbent on the State or any political subdivision thereof to bury such person found dead, the Chief Medical Examiner or a duly authorized representative shall notify the Division of Social Services of the Department of Health and Social Services to arrange for the burial unless the case falls within the category described in subsection 4.3.2 of this regulation.
2. 4.3.2 When there is a written consent of the next of kin or other legally responsible party, the remains of an indigent person may be subjected to natural organic reduction, cremated, or donated for scientific research.

5.0 Witnesses at Cremation or Natural Organic Reduction

A family member or representative of the family of the individual being cremated or subjected to natural organic reduction may be present at the time the cremation or natural organic reduction is being carried out, subject to crematory or natural organic reduction facility operational constraints.

6.0 Delivery, Transportation, and Disposal of Final Remains

6.1 The final remains resulting from the cremation or natural organic reduction process of a deceased human body may be delivered by the attendants of the crematory or natural organic reduction facility to any member of the decedent’s family designated to receive them, or to the person arranging for the cremation or natural organic reduction.
6.2 After the delivery of the final remains to the designated recipient or recipients, the final remains may be transported in any way within Delaware borders and disposed of in such a way as is desired by the person or persons receiving the final remains.

7.0 Report of Cremation or Natural Organic Reduction

7.1 Within 24 hours after the cremation or natural organic reduction is completed, a report shall be forwarded by the person in charge of the crematory or natural organic reduction facility to the central Office of Vital Statistics. The report shall contain the following:
1. 7.1.1 Registrant’s name.
2. 7.1.2 Registrant’s last known address.
3. 7.1.3 Date and cause of death.
4. 7.1.4 Names and professional titles of individuals signing the permit.
5. 7.1.5 Date of the completion of the cremation or natural organic reduction.
6. 7.1.6 Name or names of the designated recipient or recipients of the final remains for disposal.
7. 7.1.7 Date of delivery of final remains to the designated recipient or recipients of the final remains for disposal.

8.0 Cremation or Natural Organic Reduction; Prohibitions and Exemptions

8.1 No person may destroy or dispose of a deceased human body, regardless of cause of death, by burning or natural organic reduction, except in a crematory or natural organic reduction facility licensed for this express purpose and under the conditions provided in16Del.C.§§3158 and 3164.
8.2 A natural organic reduction facility may not admit human remains under the following circumstances:
1. 8.2.1 The human remains contain radioactive implants.
2. 8.2.2 The human remains are those of an individual who died as the result of a radiological incident or accident.
3. 8.2.3 The remains are those of an individual who had or is suspected of having 1 or more of the following conditions:
  1. 8.2.3.1 Prion disease infection.
  2. 8.2.3.2 Mycobacterium tuberculosis infection.
  3. 8.2.3.3 Ebola virus disease infection.
  4. 8.2.3.4 Any viral or other public health risk the Division of Public Health determines may not be eliminated in the process of natural organic reduction.
8.3 Human remains designated for cremation must be transported to a crematory using a rigid, leak-resistant container which meets all the following criteria:
1. 8.3.1 Is made of readily combustible material.
2. 8.3.2 Is of sufficient strength and rigidity for ease of handling.
3. 8.3.3 Complies with all local, state, and federal governmental emissions regulations.
4. 8.3.4 Is not composed of metal or polyethylene.
5. 8.3.5 Maintains a secure closure for the respectful conveyance of the decedent.
8.4 Human remains designated for natural organic reduction must be transported to a natural organic reduction facility using a leak-resistant container that maintains a secure closure for the respectful conveyance of the decedent.
8.5 A person who knowingly engages a Delaware-licensed funeral establishment to arrange for the cremation or natural organic reduction of the deceased human remains shall also be responsible, following cremation or natural organic reduction, for the identification and arrangement of the final disposition of the human remains, in accordance with all applicable laws and regulations. Failure to do so within 60 days of the date of death is grounds for the funeral establishment of record to submit notification to the Attorney General that the cremated remains or remains following natural organic reduction have been abandoned.
8.6 Cremated remains which have been unclaimed or abandoned for a period of more than 12 months from the date of death may be disposed of in a cemetery of the funeral establishment’s choice, in a manner to permit the return of the cremated remains to the appropriate authorized individual at a future date. All expenses surrounding the disposition and subsequent retrieval of the cremated remains shall be at the sole expense of the authorizing party. A record of the disposition of the cremated remains must be maintained by the funeral establishment of record.
8.7 Human remains following natural organic reduction which have been unclaimed or abandoned for a period of more than 2 months from the date of completion of the natural organic reduction process may be disposed of in a cemetery or other natural, protected area under the ownership or control of the funeral establishment, in accordance with all applicable laws and regulations. All expenses surrounding the disposition and disposal of the remains following the natural organic reduction process are at the sole expense of the authorizing party.

9.0 Crematory or Natural Organic Reduction Facility; Approval for Construction; Requirements; Inspection

9.1 A person, firm, organization, or association desiring to acquire, erect, or construct a crematory or natural organic reduction facility shall first obtain approval from the Department of Natural Resources and Environment Control.
9.2 The crematory or natural organic reduction facility must be constructed in accordance with 7Del.C.Chs. 60 and 79, and may not be located, managed, or conducted at any time in such a way as to be a public nuisance.
9.3 The crematory or natural organic reduction facility is always subject to inspection by the Department of Natural Resources and Environmental Control, the Department of Health and Social Services, and by officers of the state law enforcement departments as may desire to inspect it.
9.4 Analysis of material samples for natural organic reduction. A natural organic reduction facility shall be responsible for the requirements as listed in16Del.C.§3165.
9.5 Ensure that the natural organic reduction vessel maintains a minimum temperature of 131° F for a minimum of 72 hours during the process of natural organic reduction.
9.6 Collect material samples for analysis that are representative of each instance of natural organic reduction.
9.7 Develop and use a natural organic reduction process in which the final remains resulting from the process do not exceed the following limits:
1. 9.7.1 Metals and other testing parameters Limit (mg/kg dry weight), unless otherwise specified;
2. 9.7.2 Fecal coliform < 1,000 Most probable number per gram of total solids (dry weight);
3. 9.7.3 Salmonella < 3 Most probable number per 4 grams of total solids (dry weight);
4. 9.7.4 Arsenic ≤ 11 ppm;
5. 9.7.5 Cadmium ≤ 7.1 ppm;
6. 9.7.6 Lead ≤ 150 ppm;
7. 9.7.7 Mercury ≤ 8 ppm; and
8. 9.7.8 Selenium ≤ 18 ppm.
9.8 Analyze, using a third-party laboratory, the natural organic reduction facility’s material samples of final remains according to the following schedule:
1. 9.8.1 After receiving an initial permit, the natural organic reduction facility must analyze each of the first 20 instances of final remains for the parameters identified in subsection 9.7 of this regulation.
2. 9.8.2 If any of the first 20 instances of final remains yield results exceeding the limits identified in subsection 9.7 of this regulation, the natural organic reduction facility must conduct appropriate processes to correct the levels of the chemicals identified in subsection 9.7 of this regulation and have the resultant remains tested to ensure they fall within the identified limits.
3. 9.8.3 If any of the first 20 instances of final remains yield results exceeding the limits identified in subsection 9.7 of this regulation, the natural organic reduction facility must analyze each additional instance of final remains for the parameters identified in subsection 9.7 of this regulation until a total of 20 samples, not including those from remains that were re-processed under subsection 9.8.2 of this regulation, have yielded results within the limits of subsection 9.7 of this regulation on initial testing.
4. 9.8.4 After 20 material samples of final remains have met the limits outlined in subsection 9.7 of this regulation, the natural organic reduction facility must analyze, at a minimum, 25% of the natural organic reduction facility’s monthly instances of final remains for the parameters identified in subsection 9.7 of this regulation until 80 total material samples of final remains have met the requirements of subsection 9.7 of this regulation, not including any samples that required re-processing to meet those requirements.
5. 9.8.5 After 80 material samples of final remains have met the limits of subsection 9.7 of this regulation, the natural organic reduction facility must analyze, at a minimum, 1 instance of final remains each month.
6. 9.8.6 Comply with all testing requirements established by the Delaware Division of Public Health for all content parameters contained in this regulation.
7. 9.8.7 Not releasing any final remains that exceed the limits identified in subsection 9.7 of this regulation.
8. 9.8.8 Preparing, maintaining, and providing upon request by the Delaware Division of Public Health an annual report each calendar year. The annual report must detail the natural organic reduction facility’s activities during the previous calendar year and must include the following information:
  1. 9.8.8.1 Name and address of the natural organic reduction facility.
  2. 9.8.8.2 Calendar year covered by the report.
  3. 9.8.8.3 Annual quantity of final remains.
  4. 9.8.8.4 Results of any laboratory analyses of final remains.

10.0 Timeframe for Disposition of a Dead Body

10.1 Except as otherwise provided in this subsection, all human bodies dead within the State of Delaware shall be cremated, disposed of by natural organic reduction, buried, or placed within a receiving vault within 5 days after death. Any dead human body to be kept longer than 24 hours shall be embalmed, placed in an industry standard refrigerator, or placed in a sealed casket which will not be opened at any time after this 24-hour period. Human remains, including unembalmed remains, shall not be kept in a refrigerated state for more than 15 calendar days unless medical/legal investigation or religious reasons require further holding in a refrigerated state, or the decedent is awaiting full burial at sea or casket placement at a national cemetery.
10.2 A dead human body may be kept longer than 24 hours before it is embalmed, refrigerated, or placed in a sealed casket if medical or legal investigation necessitates a longer period. The Department shall issue a special permit when a dead human body needs to be kept longer than 24 hours. Application for a permit shall be made to the State Registrar of Vital Statistics, Dover.

11.0 Burial of the Dead

11.1 Depth of graves. No interment of any human body shall be made in any public or private burial ground unless the distance from all parts of the top of the outer case containing the coffin or casket be not less than 18 inches (.5 meter) from the natural surface of the ground. EXCEPTION: Per subsection 13.5.3 of this regulation, bodies dead of designated high-risk diseases (Anthrax, Smallpox, Plague, and the various Hemorrhagic Fevers) must be buried at a depth of at least 79 inches/2 meters.
11.2 Responsible party. The superintendent, person in charge, caretaker, or other person in charge of a cemetery or burial ground shall be responsible that graves are of the depth required by this regulation. If there is no person in charge, it shall become the responsibility for ensuring of the person burying the body.

12.0 Permanent Entombment Facilities and Receiving Vaults

12.1 Permanent Entombment Facilities. When a body is placed in a permanent entombment facility, all exterior facings of the facility must be firmly and securely closed.
12.2 Receiving vaults may be used for a period not exceeding 15 days for the reception of bodies, provided the bodies are properly embalmed by a licensed funeral director. Beyond this period, special permission from the Department is required. In every case, the death certificate must be filed immediately after death.
12.3 The responsible person in charge of the receiving vault shall make written application to the State Registrar of Vital Statistics, Dover, for this special permission at least 1 week prior to the expiration of the 15-day period.
12.4 Section 10.0 of this regulation shall not apply to bodies turned over to bona fide medical and surgical groups for anatomical or study purposes.

13.0 Preparation, Transport, and Disposal of Bodies Dead of Designated High-risk Diseases

13.1 The Director of the Division of Public Health or Designee shall designate communicable diseases determined to be high-risk from the point of view of handling after death. Currently designated diseases include Anthrax, Smallpox, Plague, and the various Hemorrhagic Fevers.
13.2 Should death occur before a definitive diagnosis can be made and when there is even the remote suspicion of 1 of these illnesses, the physician or hospital should consult with the Chief Medical Examiner or the Director of Public Health. Should it be necessary to hold a body for longer than 6 hours pending completion of definitive diagnostic work, the body should be sealed immediately following the taking of such specimens as may be needed. The sealing should be completed as described in subsection 13.5.1 of this regulation and held in isolation (refrigerated when possible) pending removal. Otherwise, removal, transport, and cremation should proceed as prescribed by this regulation.
13.3 Whenever death occurs from a designated high-risk disease, immediate notification shall be provided by the reporting physician, other provider, or the hospital to the Division of Public Health, next of kin, and the funeral director who will have responsibility to handle, transport, or dispose of the body. These reports may be made by fax, telephone, or electronic mail. After business hours, the Division of Public Health emergency line is (302) 739-4700.
13.4 The Chief Medical Examiner, hospital, or funeral director shall ensure that anyone handling a body so designated shall follow strict universal precautions in a manner that minimizes contact between the body, other persons, and the environment.
13.5 Preparation
1. 13.5.1 The body shall be wrapped in a sheet saturated with a suitable disinfectant. This may be concentrated commercial disinfectant approved for this purpose or it may be embalming powder or high index cavity fluid. This shall be followed by enclosure in a heavy-duty impervious bag designed for such purpose to assure against leakage.
2. 13.5.2 For transport, the body prepared as in subsection 13.5.1 of this regulation shall be placed in a suitable firm container such as a "cremation container" in which case it shall be cremated therein, or it may be transported in a temporary firm protective container from which it may be removed for cremation.
3. 13.5.3 For burial or other exempted disposition, the body shall be enclosed in a metal casket liner or a casket that is constructed to not allow any seepage whatsoever therefrom and is to be sealed. Burial of bodies dead of designated high-risk disease must be at a depth of at least 79 inches/ 2 meters.
13.6 Labeling. It will be the responsibility of the funeral director to ensure that there are attached to the body and its containers in several visible , labels bearing in prominent legible letters, the words, "This body is infected with a designated high-risk disease specified by the Division of Public Health and must be handled and transported in accordance with the precautions required by this regulation".
13.7 Handling. Neither embalming nor autopsy shall be performed on these bodies unless specifically authorized by the Chief Medical Examiner or designee.
13.8 Transport. Transport of a body so designated must be under the conditions described above with the addition that the body must be protected in such a way as to assure that it shall not become uncovered in any reasonably foreseeable accident. Transport out of state shall be prohibited unless approved by the Director of the Division of Public Health or designee and the receiving jurisdiction.
13.9 Removal. A body may be removed from the firm protective container in which it was transported once it has reached the funeral home or crematory where the body shall be prepared for cremation or other disposition if authorized. The container used exclusively for transport may be re-used following suitable disinfection.
13.10 Services
1. 13.10.1 No viewing of the body or public services in the presence of the body shall be permitted.
2. 13.10.2 Cremation is the disposal method of choice for any designated high-risk communicable disease. If burial is permitted as an exception, it must be promptly performed, and the body must remain sealed as described in subsection 13.7 of this regulation throughout the burial process.
3. 13.10.3 The Director of the Division of Public Health or designee upon request may waive any requirement of Section 13.0 of this regulation to accommodate religious or traditional practices if the Director of the Division of Public Health or Designee is satisfied that the proposed practices present no substantial additional risk to any person or the environment.

14.0 Shipment of Bodies Dead of Non-contagious Diseases

14.1 The body of any person dead of a non-contagious disease shall not be removed by common carrier from the registration district in which death occurred except under the following conditions:
1. 14.1.1 When the remains have been thoroughly embalmed and disinfected or when shipped to such a point as can be reached within 24 hours after death, the dead body shall be placed in a substantially constructed casket or coffin; every outside case holding any dead body offered for transportation by common carrier shall be an approved shipping case.
2. 14.1.2 When the body is not embalmed or the embalming destination cannot be reached within 24 hours after death, either the casket or outside case must be metal or metal lined and permanently sealed.
3. 14.1.3 When a body is transported by common carrier, State law requires a transit permit, which will be secured by the common carrier from the Office of Vital Statistics.

15.0 Burial - Transit Permit

A burial-transit permit will be issued by the Office of Vital Statistics upon the compliance of the funeral director with the provisions of Section 14.0 of this regulation and the presentation of the death certificate.

16.0 Disinterments

16.1 No dead body shall be removed from its place of original interment unless a permit from the State Registrar marked "Disinterment Permit" is secured by a licensed funeral director in charge of the disinterment (EXCEPTION –16Del.C.§3154). The qualified person making the application shall present to the State Registrar the correct name, age, date of death, and cause of death of the body to be disinterred, and place of disinterment (hundred and county), together with written consent of next of kin. The State Registrar may require legal proof of such kinship.
16.2 All disinterment permits shall be void after the expiration of 30 days from the date of issue.
16.3 Procedures
1. 16.3.1 The disinterment and removal must be under the direction of a licensed funeral director and in accordance with the rules governing the transportation of the dead.
2. 16.3.2 The casket in which disinterred bodies are contained shall not be opened at any time.
3. 16.3.3 The funeral director authorized to conduct a disinterment shall be held personally responsible for the enforcement of these requirements.
4. 16.3.4 Special Provision. A separate permit shall be secured in respect to each body to be disinterred, except that under special conditions the Department may make special provisions for the mass removal of more than 1 body from a cemetery or burial ground.

17.0 Disposition of Amputated Parts of Human Bodies

17.1 A human body part amputated during surgery or recovered from an accident may be kept for anatomical purposes. The amputated human body part may be disposed of by burial in a licensed cemetery, cremation in a licensed crematory, or natural organic reduction in a licensed natural organic reduction facility. If the hospital or institution has facilities for incinerating, the amputated part or parts may be incinerated in the hospital or institution upon the written approval of the patient or next of kin. Where a patient or the patient’s next of kin desires such amputated part to be buried, cremated, or naturally reduced by the respective licensed facility, a permit shall be secured by the funeral director from the Office of Vital Statistics upon presentation of a duly executed "Certificate of Amputation".
17.2 The director of the hospital or institution wherein the amputation was performed shall have completed a "Certificate of Amputation" on a form furnished by the Department for immediate delivery to the funeral director, who shall file the "Certificate of Amputation" within 48 hours with the proper local or deputy registrar. The "Certificate of Amputation" may be signed by the operating surgeon or by the intern who assisted in the case. No regular death certificate shall be filed for amputated parts.