Ethical dilemmas

Discussion points

Procedures as to who should inform a patient that the donor of their blood component is now testing positive for a transfusion transmissible infection may vary in different jurisdictions and circumstances. For example, the name of the patient’s family physician may or may not be available to the blood bank. It is also possible that the hospital blood bank or obstetrics unit is aware that the patient had a negative HIV test years after the possibly infected transfusion, for example, when she was readmitted for a second delivery two years later; in such a case, the patient clearly was not infected by the earlier transfusion and there is no value in patient notification.

The Code of Ethics provides general guidance about beneficence and nonmaleficence related to patients: Patients should be informed if information becomes available following a transfusion that indicates they have, or may have been, harmed by the transfusion. Guidelines about transfusion thresholds and situations when transfusions are indicated have evolved over time, as more evidence is available from high quality randomized clinical trials. Medical records may not always provide a full picture of the patient’s clinical situation at the time of transfusion. As mentioned above, the Code of Ethics specifies that “decisions relating to transfusion of blood should be based on the best available evidence and treatments for patients”, however, there is no mention made about informing patients that different decisions could have been made about their past treatment.