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Ethical dilemmas

Code of ethics in action: vignettes from ISBT congresses

Code of Ethics

Did you know that the ISBT has a Code of Ethics related to Transfusion Medicine?

This document outlines the basic ethical principles of dignity, autonomy, beneficence, non-maleficence (not doing harm), and justice, and how they apply to blood donors, recipients, and the stewardship of the blood supply. The Code of Ethics was first developed in 1980, updated in 2017 and is currently undergoing revision. It is available in eight languages and can be found on the ISBT website.

At the ISBT Congresses in Gothenburg (2023), Barcelona (2024), and Milan (2025), members of the ISBT Standing Committee on Ethics—supported by Working Party members—presented clinical vignettes illustrating ethical challenges in transfusion medicine. During the sessions, audience members engaged in live voting on questions related to these scenarios. Now, you can participate too by completing the quiz below.

Vignettes will be published in the coming Transfusion Today issues. In these cases, you will have a chance to reflect on your practice, compare with others completing the quiz, and see some points to consider when making decisions.

Vignette 2. Donor notification and counselling

The case

A 35-year-old, voluntary repeat donor donated on March 3 2024. Hepatitis B surface antigen (HBsAg) testing showed reactivity by both ELISA and chemiluminescence immunoassay (CLIA), while nucleic acid testing (NAT) was non-reactive.

byDuplicate testing on the same sample gave similar results. The donor was contacted and returned in April 2024 and again in June 2024 to provide follow-up samples. On both occasions, HBsAg was again reactive on the CLIA test, but non-reactive on ELISA.

NAT testing was still negative. There was no history of jaundice, recent vaccination for Hepatitis B, or recent exposure to hepatitis.

What would you do?

Submit your answers through the below survey:

Click the below button to see what others think. The page will show you the accumulative results.

Click here to see the results

Discussion points

Informed consent is a process based on the ethical principles of autonomy and respect for the individual. Donors provide informed consent for donation, including accepting the risks associated with donation and the testing that will be performed. The ISBT Code of Ethics provides guidance concerning donor autonomy that is relevant for both these situations.

  1. Informed consent should include: Knowledge of all known risks associated with the donation, of the subsequent legitimate use of the donation and how information pertaining to the donor and donation will be treated confidentially.
  2. The consent should, where appropriate, include information on possible commercialisation of the products derived from the donation and whether the donation might be used for research, quality control or any other purpose.
  3. Information provided by the donor and generated about the donor (ie test results) must be treated confidentially. The donor should be informed in advance of the release of any such information.
  4. Principles of dignity and non-maleficence also help guide the development of policies related to donor notification of transmissible disease test results.
  5. Donors must be informed if they have, or may have been harmed, or in the event that any results or information regarding their donation may have an impact on their health.

The Author

The case is presented by Dr. Ratti Ram Sharma, MD Professor and Head of the Department of Transfusion Medicine at PGIMER, Chandigarh, India. He is also a member of the Standing Committee on Ethics and the Chair of the Haemoglobinopathies Subgroup of the Clinical Transfusion Working Party.

If you can't get enough of these ethical issues...

In the April 2025 issue of Transfusion Today, the first ethical vignette was published. Click the button to read about the first case, complete the polling questions and see what other think about the ethical issue.

Take me to vignette 1

Did you know?

The Standing Committee on Ethics (SCE) gives advice or opinion on ethical issues as requested and directed by the ISBT Board of Directors. ISBT members can submit (ethical) issues, however, the Board of Directors decides whether or not the SCE will work on the submitted issues. The SCE has a broad international representation and comprises individuals who have experience or an interest in ethics.

Read more about the committee and its work here.

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