Medical legal issues in allogeneic blood transfusion

To review what we, as physicians, should know about informed consent when ordering transfusions for our patients.

In December of 1984 a patient having coronary artery bypass surgery was transfused with a human immunodeficiency virus (HIV) positive blood component. Sixteen years later, the patient died of acquired immunodeficiency syndrome (AIDS)-related pneumonia. This case led to the Krever Commission of Inquiry on the Blood System in Canada. PRINCPAL FINDINGS: Physicians should be aware of the medical/legal issues of ordering transfusion of blood or blood products. Central to this is the principle that "Every human being of adult years and of sound mind has the right to determine what shall be done with his or her own body". Justice Krever recommended physicians should obtain informed consent for the administration of blood and blood products. This should be documented in the chart as well as reported in the discharge summary and in a letter to the referring physician. Informed consent must be voluntary, the patient must have capacity to consent and must be properly informed. A patient has the right to refuse treatment even when it is clear that the treatment is necessary to preserve life or health. However, a refusal must also be informed and carefully documented.

Physicians should seriously consider abiding by the recommendations of the Krever Commission. Though not yet official standards of care, physicians following these recommendations will likely avoid successful litigation regarding allogeneic blood transfusions.