Maintaining adequate donations and a sustainable blood supply: Lessons learned.

BACKGROUND: The availability of a safe blood supply is a key component of transfusion medicine. A decade of decreased blood use, decreased payment for products, and a dwindling donor base have placed the sustainability of the US blood supply at risk. STUDY DESIGN AND METHODS: A literature review was performed for blood center (BC) and hospital disaster management, chronically transfusion-dependent diseases, and appropriate use of group O-negative red blood cells (RBCs), and the Choosing Wisely campaign. The aim was to identify current practice and to make recommendations for BC and hospital actions. RESULTS: While BCs are better prepared to handle disasters than after the 9/11 attacks, messaging to the public remains difficult, as donors often do not realize that blood transfused during a disaster was likely collected before the event. BCs and transfusion services should participate in drafting disaster response plans. Hospitals should maintain inventories adequate for patients in the event supply is disrupted. Providing specialty products for transfusion-dependent patients can strain collections, lead to increased use of group O RBCs, and create logistical inventory challenges for hospitals. The AABB Choosing Wisely initiative addresses overuse of blood components to optimally use this precious resource. Group O-negative RBCs should be transfused only to patients who truly need them. CONCLUSIONS: Collecting and maintaining a blood supply robust enough to handle disasters and transfusion-dependent patients in need of specialty products is challenging. Collaboration of all parties should help to optimize resources, ensure appropriate collections, improve patient care, and ultimately result in a robust, sustainable blood supply.

How Should Decision Science Inform Scarce Blood Product Allocation?

Blood products are a scarce resource in our health care system. This article discusses a pediatric case involving large quantities of blood products transfused at the end of life. It argues that decision aids could help clinicians determine when to request ethics consultation or re-evaluation of blood product usage in a specific patient care situation and considers questions about scarce resource allocation, futility, and parental involvement in decision making.

Transfusion of Blood Products in the Neurocritical Care Unit: An Exploration of Rationing and Futility.

Rationing is the allocation of scarce resources, which in healthcare necessarily requires withholding potentially beneficial treatments from some individuals. While it often entails a negative connotation, rationing is unavoidable because need is limitless and resources are not. How rationing occurs is important, because it not only affects individual lives, but also reflects society's most important values. At the core of any rationing, decision is how much a limited resource may benefit a patient, which can be particularly difficult to determine in the practice of neurocritical care, as prognosis is often uncertain. We present a case for the consideration of futility and blood product rationing in neurocritical care.

Historical Perspectives, Current Status, and Ethical Issues in Granulocyte Transfusion.

The goal of this commentary is to provide a historical aspect of granulocyte transfusion, present practices in granulocyte transfusion, accentuate the complexity of the issue, and foster contemplation of ethical issues assimilated with this practice. Clinical aspects of granulocyte transfusion in the light of ethical issues are also discussed.

[Blood components: Are they drugs or special medicines?]. / Les produits sanguins thérapeutiques : des médicaments ou des produits de santé à part ?

Blood transfusion and plasma derived-drugs significantly differ from other medicines in that their availability strictly depends on blood and plasma collected from healthy donors. Blood collection must comply with a double objective: to maintain donor heath safety, and to avoid any transmitted infections in recipients. This raises several ethical concerns that appear to be different from usual ethical and deontological issues linked to other pharmaceutical and industrial processes. The main concern is the non-commercialization of the human body. Words and concept are of major importance in this context. This short review aims at presenting the main issues relevant to those questions with respect to the various stakeholders.

How do I allocate blood products at the end of life? An ethical analysis with suggested guidelines.

Blood products are scarce resources requiring prudent and reasoned allocation. The utilization of red blood cells and platelets in terminally ill patients can be complicated and requires guidelines tempered by individualized considerations. Representative cases are discussed in which blood products are requested or utilized by patients at the end of life. Relevant literature is reviewed and ethical issues pertaining to each case are discussed. A practical approach to blood product utilization at the end of life is suggested.

Evaluación y mejora del cumplimiento de la normativa sobre consentimiento informado para la transfusión de hemoderivados en un servicio de cirugía general / Assessment of improvements in compliance with the guidelines on informed consent for the transfusion of blood derivatives in a general surgery department

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The ethics of blood management.

Blood transfusion practices have evolved empirically, with few or no research data supporting them. In the past several decades, fuelled by fears of infection and reports of mistakes, patients have increasingly demanded their rights to choice, both in the components given to them as well as to refuse to receive these therapies based on religious convictions. In parallel, episodic blood unavailability and growing awareness of the need to apply evidence-based methods have caused physicians to begin re-evaluating traditional practices and to focus on minimizing or eliminating unnecessary transfusions while learning and applying methods that permit reuse of the patient's autologous blood or rely on pharmacologic agents. Ethical principles of autonomy, beneficence, non-maleficence and justice provide a rational basis for decision-making when a new blood management programme is instituted. By proactively considering the ethical dilemmas posed by the juxtaposition of patient needs with clinical judgement at the outset, institutions may devise workable programmes that improve patient safety and quality outcomes.

[Jehovah's Witnesses refusal of blood: religious, legal and ethical aspects and considerations for anesthetic management]. / Fundamentos del rechazo a la transfusión sanguínea por los Testigos de Jehová. Aspectos etico-legales y consideraciones anestésicas en su tratamiento.

The refusal of Jehovah's Witnesses to agree to blood or blood product transfusion based on religious beliefs is one of the most challenging conflictive issues health care givers have to face today. Such conflict is a by product of the ideological and religious diversity in society today. The perioperative care of such patients constitutes a genuine challenge for anesthesiologists and surgeons from technical, scientific, ethical, and legal perspectives. We review the reasons why Jehovah's Witnesses refuse transfusion and discuss the ethical, legal, and anesthetic aspects of their care. The literature up to August 2005 was reviewed by MEDLINE search. The following search terms were used: Jehovah's Witnesses, anesthesia (and anaesthesia), legislation and jurisprudence, ethics, blood transfusion, alternatives, anemia (and anaemia), erythropoietin, trigger, and critical care. To further cover ethical and legal aspects, we reviewed current laws in Spain and similar practice settings.