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From American Journal of Clinical Pathology
Am J Clin Pathol. 2007;128(1):135-142.

Legal and Ethical Considerations in the Transfusion of Infected or Untested Autologous Blood

Posted 08/20/2007
Jay P. Brooks, MD, MBA,1 and Joan E. Ferrell, MT(ASCP), JD2

1Department of Pathology, University of Oklahoma Health Sciences Center and Veterans Affairs Medical Center; and 2OU Medical Center, Oklahoma City.

Abstract and Introduction

Abstract
Autologous blood transfusion grew in popularity in response to the recognition of transfusion-transmitted HIV and a lack of effective screening. Laboratory screening and donor deferrals have decreased the need for autologous transfusion. The issue of banking blood that has not been tested or has been tested and found positive for serious infectious diseases raises ethical and legal issues that must be addressed by transfusion services, transfusion committees, physicians, and administrators. This article provides a summary of pertinent federal and state laws regarding autologous blood transfusion and a framework to assess the ethical implications of various strategies.

Introduction
In terms of avoiding transfusion-transmitted infections, preoperative autologous blood donation yields the safest blood possible. Autologous blood transfusion has been performed for more than 150 years.[1] During the early to mid-1980s when the risk of transfusion-transmitted HIV was as high as 1:100 in some areas[2] and no test existed to detect its presence, interest in and demand for this lifesaving alternative increased. Studies have demonstrated that fear of contracting an infectious disease, particularly HIV, from transfusion has been a primary motivating factor in the decision to donate autologous blood.[1,3-6]

The number of autologous collections peaked at 1,117,000 in 1992, representing 8.5% of the blood supply. By 1997, autologous units collected had declined to 611,000 representing 4.9% of the blood supply.[7] The reasons for the decline in autologous donations have not been studied, but the fact that the allogeneic blood supply is now virtually free of HIV and hepatitis is a likely cause.[8,9] Other factors that have been cited for the decrease include increased costs, patient inconvenience, and possible clerical errors.[10] Although current demand for autologous transfusion is considerably less than it was in the 1980s and 1990s, it remains a staple of clinical transfusion medicine practice. If a transfusion-transmitted infection emerges in the future that is capable of evading screening procedures and capturing the public's attention, there would likely be a resurgence in autologous transfusion.

The justification for the use of autologous blood has traditionally been that it is the safest product available, providing patients with a source of blood free of infections that may still be escaping the screening processes of the allogeneic blood supply. However, in attempts to satisfy patient requests, transfusion medicine centers may be putting other patients at risk of acquiring a blood-borne infection by banking and then mistransfusing autologous blood that may harbor serious infectious diseases. We examined the ethical and legal issues surrounding the banking of infected and potentially infected autologous blood, and we describe various strategies that transfusion services can use to deal with them.

Section 1 of 8 Next Page: Autologous Transfusion