Massive transfusion and severe blood shortages: establishing and implementing predictors of futility

Massive transfusion protocols were developed to deliver blood for life-threatening haemorrhage; however, there are no guidelines to advise when massive transfusion protocols may be considered futile. Early recognition of clinical futility remains a challenge as studies have not identified variables that can accurately determine early mortality. As blood is a scarce resource, efforts to distribute it equitably to all patients who would benefit are of paramount importance. In this editorial we discuss recent data and various aspects important in developing and implementing tools that assist with determining futility in massive transfusion.