Making blood transfusion safe
Jayashree D Kulkarni
Catherine Tay and Tien Sim Ling. Biomedical ethics and medical law in blood transfusion practice: case scenarios. Singapore: Armour Publishing Pte Ltd, 2010. Pp 153 ISBN 9814270938, 9789814270939
Multiple medical and paramedical professionals, right from blood transfusion technicians to staff nurses to doctors, play a vital role in making blood transfusion a safe procedure. The role of the donor is equally important because untruthful declaration on any point in the questionnaire will lead to unsafe blood donation. Biomedical ethics and medical law in blood transfusion practice has been written to bring about more awareness of safety in transfusion medicine among medical practitioners and other healthcare professionals and thus avoid litigation. Prof Tay and Prof Tien, being in the field of law and transfusion medicine respectively, are the most eligible persons to write such a book and have done a commendable job.
Clear communication plays a vital role in all fields of medicine, especially while taking consent. Mis-transfusions, which can be fatal, can occur due to incomplete or improper communication. Difficulties in the testing of transfusion-transmissible diseases arise due to negligence or non availability of the latest testing facilities. Transfusion services need to keep updated about the latest advances and availability of testing methods. The local regulations should help to monitor these issues. Other important aspects related to the donor, like fitness to donate, confidentiality of blood donation, and directed blood donation, have been explained.
The book enlightens the reader about the different possible medico-legal issues in transfusion medicine with the help of 20 different case scenarios. The case scenarios cover some of the most difficult situations faced in transfusion medicine like unexpected requirement of multiple units of blood and product transfusion in simple surgeries – cholecystectomy being the example used here – leading to delayed supply of products, morbidity and prolonged hospital stay. Each such scenario is followed by a take-home message which impresses upon the reader the need for safe and ethical practices.
The importance of explaining alternatives to homologous blood transfusion to individuals who, for a variety of reasons are opposed to it, and also the possible risks of refusing transfusion, and the physician’s role in such situations, have been illustrated with an example of a case of a Jehovah’s Witness. The authors also highlight the importance of explaining in detail, all possible complications which can cause serious disability, however remote the possibility, in order to prevent medico-legal issues.
Evidence-based medicine should be followed in clinical trials of unproven techniques (such as use of artificial blood). The authors show how financial considerations can alter the mode of treatment. Some documents regarding ethical aspects of medicine, such as the ISBT code of ethics, Declaration of Helsinki and the National Commission for the Protection of Human Subjects of Biomedical and Behavioural research reports, are given in the appendix for the benefit of the whole medical fraternity.
This book succeeds in providing all those concerned with blood transfusion with useful tips on legal and ethical issues regarding providing safe and informed care to patients requiring blood and blood components.