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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 3. Patients
The case
Due to severe weather, your hospital has not received any platelets for the past 48 hours. You currently only have two adult doses of platelets, and no further shipments are likely to arrive for another 48 hours.
You have received the 4 requests for platelets below.
Who will you allocate the platelets to?
Discussion points
These types of clinical decisions require knowledge of the evidence basis for platelet transfusion in the 4 scenarios.
- The first two patients with non-immune thrombocytopenia, no bleeding, and a platelet count less than 10 would usually receive 1 platelet dose in a situation of normal inventory.
- In a shortage situation, a lower dose (for ex. half a platelet dose) may be transfused in non-bleeding allogeneic stem cell transplant patients and acute leukemia patients.
- In contrast, transfusion may be delayed in non-bleeding autologous transplant recipients.
- Transfusion may be harmful in a patient with intracranial hemorrhage and platelet dysfunction due to antiplatelet medication use.
- Finally, transfusion may be indicated but is likely futile for the unfortunate trauma patient as he is not expected to survive or have a meaningful recovery.
Guidance
The ISBT Code of Ethics provides some guidance with respect to justice for patients who may require a blood transfusion, and beneficence and non-maleficence:
1. Patients should be treated equitably for the same healthcare condition. This implies that medical decisions relating to transfusion of blood should be based on the best available evidence and treatments for patients (adapted to the local healthcare situation).
2. The patient should, within the constraints of the local health system, receive the most appropriate blood product(s) that is (are) available. As far as possible the patient should receive only those particular products (whole blood, cells, plasma, or plasma derived medicinal products) that are clinically appropriate and afford optimal safety.
3. Blood and blood products should be considered as a public resource. Access to the products should be based on clinical need taking into account the overall capacity of the local health system. Discrimination based on factors such as patients’ resources should be avoided.
4. The patient has a right to be treated with dignity and therefore decisions on the need for transfusion should be based on genuine clinical need.
The Author
Vignette 3 is presented by Dr. Katerina Pavenski, past chair of the Patient Blood Management (PBM) Sub-group of the ISBT Clinical Transfusion Working Party.
If you can't get enough of these ethical issues...
In the April and July 2025 issues of Transfusion Today, the first ethical vignettes were published. Click the button to read about the first two cases, complete the polling questions and see what other think about the ethical issues.
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.
