Informed Consent for Transfusion
Transfusion of blood and blood components is one of the most commonly performed hospital procedures in the United States. Transfusions can be lifesaving, but are also associated with serious infectious and non-infectious risks. Patients requiring blood transfusion need to be fully informed about the potential benefits and risks.
Informed consent should be obtained prior to all blood and blood product transfusions, except in emergency situations. Informed consent for blood transfusion is a requirement of The Joint Commission as well as AABB (formerly the American Association of Blood Banks). Specifically, AABB standards indicates that at a minimum, elements of consent shall include all of the following:
- A description of the risks, benefits, and treatment alternatives (including nontreatment)
- The opportunity to ask questions
- The right to accept or refuse transfusion
In order to be legally valid, the following elements of informed consent must be present:
- The patient must be competent.
- The treating provider, or the treating team, who decides that the transfusion is necessary is the only person(s) who may obtain the consent.
- The provider must explain the procedure in terms and language that the patient understands.
- The patient should be informed of common risks and serious uncommon risks of transfusion, potential benefits of transfusion, alternatives to transfusion and risks if declining transfusion.
- The patient must have the opportunity to ask questions.
- The patient must have the opportunity to make an uncoerced choice.
- The provider should document the discussion.
Practical Issues Regarding Informed Consent
Consent for nonemergent transfusion does not have to be obtained before each individual transfusion of blood or blood products but should be obtained when management decisions are made. For inpatients, consent is valid throughout the entire hospital stay. For outpatients, consent may be valid as long as the clinical situation or treatment plan has not changed, which is usually up to one year.
If a patient is incompetent by age or mental status, and if the patient’s wishes regarding transfusion are not known, consent should be sought from the parent or legal guardian.
If no one is available to provide consent and the need for transfusion is considered a medical emergency, blood components may be administered based on the doctrine of implied consent. The emergent need for transfusion should be carefully documented in the medical record.
Common risks of allogeneic transfusion include fever, chills, hives and pruritis. Uncommon serious risks include circulatory overload, hemolysis, sepsis, or infection with HIV, Hepatitis B and C viruses and other microorganisms.
Alternatives to transfusion include autologous donation, directed donation, drug therapy, and intraoperative salvage of blood. When applicable, the consent and discussion should occur well in advance of any elective procedure, so that the alternatives may be obtained if the patient desires.
References
Goldman, E. Legal Considerations for Allogeneic Blood Transfusion. American Journal of Surgery, 170 (6A Suppl), Dec 1995,p.27S.
Sazama, K. Practical Issues in Informed Consent for Transfusion. American Journal of Clinical Pathology, 107(4 Suppl 1), Apr 1997, p.S72.
