Autopsy rates have not been reported at the University Hospital of the West Indies (UHWI) for more than three decades. Declining rates have been documented worldwide, and so we sought to define autopsy rates over the past three decades at UHWI. We conducted a retrospective analysis of the numbers and types of autopsies performed on deaths occurring in the institution, and calculated the relevant autopsy rates. The overall autopsy rate for the study period was 52.7%, with a statistically significant decline from 65.3% in the first decade to 39.3% in the third. The non-coroner's autopsy rate showed a concomitant decline from 57.5% to 31.5%, while the coroner's autopsy rate remained stable with a slight increase from 28.1% to 29.1%. The factors that might have led to the decline of the autopsy are discussed.