Author(s): Francisco Alvarado-Ramy, Kendra Stauffer

Death of a friend, relative, or coworker can be immensely distressing. The situation is aggravated when the death occurs abroad, where grieving individuals might be unfamiliar with local laws, language, culture, and processes for investigation and release of the body. Whether dealing with the death locally or from their home country, next of kin could face large, unanticipated costs and labor-intensive administrative requirements.

Depending on the circumstances surrounding the death, some countries require an autopsy. For travel companions of the deceased, in addition to friends and relatives, sources of support might include the US consulate or embassy, a travel insurance provider (particularly if coverage included repatriation of remains), the airline, a tour operator, faith-based and aid organizations, or the deceased person’s employer. Official identification of the body will likely be needed, and official documents likely will need to be issued by the consular office. A body can be identified by witness statements of those who knew the person well, by analyzing DNA samples, by checking fingerprints, by reviewing dental radiographs, or by inspecting surgical implants.

Death Onboard a Conveyance

Federal regulations require that all deaths aboard commercial flights and ships destined for the United States be reported to the Centers for Disease Control and Prevention (CDC). For details, see Guidance for Airlines on Reporting Onboard Deaths or Illnesses to CDC and Guidance for Cruise Ships: How to Report Onboard Death or Illness to CDC.

Commercial Aircraft

The Federal Aviation Administration requires that flight attendants receive training in cardiopulmonary resuscitation (CPR) and in proper use of an automated external defibrillator (AED) at least once every 2 years. Under US laws, Good Samaritan laws offer protections for actions brought in a federal or state court that result from acts or omissions when people assist in a medical emergency during flight, unless there is gross negligence or willful misconduct.

If CPR is performed in an aircraft cabin for ≥30 minutes with no signs of life, and no shocks advised by an AED, the person can be presumed dead and resuscitation efforts halted. Airlines can choose to specify additional criteria for presuming death, depending on the availability of ground-to-air medical consultation services or a physician aboard the flight (see Sec. 8, Ch. 2, . . . perspectives: Responding to Medical Emergencies when Flying). In these cases, the body should be secured and covered for the remainder of the flight.

Cruise Ships

If death occurs on a cruise ship, the crew are usually able to provide logistical support to repatriate the body. Cruise ships are equipped with morgues and body bags and are staffed with health care professionals capable of providing clinical care. Any death involving an accident, violence, or foul play will require more extended and complicated processes. US consular officials will be able to provide general guidance and legal aid resource options. Some travel insurance products cover legal services abroad. Travelers should be aware of exclusions and limitations of travel insurance products prior to purchasing.

Obtaining US Department of State Assistance

When a US citizen dies outside the United States, the deceased person’s next of kin or legal representative should notify US consular officials at the Department of State. Consular personnel are available 24 hours a day, 7 days a week, to assist US citizens during overseas emergencies.

If the next of kin or legal representative is in the foreign country with the deceased US citizen, that person should contact the nearest US embassy or consulate for assistance. Contact information for US embassies and consulates overseas can be found at the Department of State website.

Family members, domestic partners, or legal representatives who are in a different country from the deceased should call the Department of State’s Office of Overseas Citizens Services in Washington, DC, from 8 a.m. to 5 p.m. Eastern time, Monday through Friday, at 888-407-4747 (toll-free) or 202-501-4444. For emergency assistance after working hours or on weekends and holidays, call the Department of State switchboard at 202-647-4000 and ask to speak with the Overseas Citizens Services duty officer. In addition, the US embassy closest to or in the country where the US citizen died can provide support.

The Department of State has no funds to assist in the return of remains of US citizens who die abroad. US consular officers assist the next of kin by conveying instructions to the appropriate offices within the foreign country and providing information to the family on how to send the necessary private funds to cover the costs of preparing and repatriating the deceased person’s remains. Upon issuance of a local (foreign) death certificate, the nearest US embassy or consulate can prepare a consular report of the death of an American abroad. Copies of that report are provided to the next of kin or legal representative and can be used in US courts to settle estate matters. If the deceased person has no next of kin or legal representative in-country, a consular officer will act as a provisional conservator of the deceased person’s personal effects.

Importing Human Remains for Burial, Entombment, or Cremation

CDC regulates the importation of human remains and provides guidance for their importation. The requirements are more stringent if the person died from a disease classified as quarantinable in the United States.

Except for cremated remains, human remains intended for burial, entombment, or cremation after entry into the United States must be accompanied by a death certificate stating the cause of death. A death certificate is an official government document that certifies that a death has occurred and provides identifying information about the deceased, including (at a minimum) name, age, and sex. The document must also certify the time, place, and cause of death, if known. If the official government document is not written in English, it must be accompanied by an English language translation of the official government document, the authenticity of which must be attested to by a person licensed to perform acts in legal affairs in the country where the death occurred.

In lieu of a death certificate, a copy of the Consular Mortuary Certificate and the Affidavit of Foreign Funeral Director and Transit Permit together constitute acceptable identification of human remains. If a death certificate is not available in time for returning the remains, the US embassy or consulate should provide a Consular Mortuary Certificate stating whether the person died from a disease classified as quarantinable in the United States. A person transporting human remains must also meet requirements of the country of origin, air carrier, the Transportation Security Administration, and Customs and Border Protection.

Exporting Human Remains

CDC does not regulate the exportation of human remains outside the United States, although other state and local regulations might apply. The United States Postal Service is the only courier legally allowed to ship cremated remains. Exporters of human remains and travelers taking human remains out of the United States should be aware that they must meet the importation requirements of the destination country. Information regarding these requirements can be obtained from the foreign embassy or consulate. Air carriers also might have their own requirements, of which individuals transporting remains outside of the United States should be aware.