Two legal experts argue on bmj.com today that informed consent should be obtained from competent patients before blood transfusions takes place.
Anne-Maree Farrell and Margaret Brazier, both from the
University of Manchester note that, in its recent report, the UK government's
Independent Advisory Committee on the Safety of Blood Tissues and Organs
(SaBTO) acknowledged that there is inconsistent practice in this area and that
there are concerns that patients are not given enough information about the
risks, benefits and alternatives to transfusion.
They argue that there is a question mark over the lack of
legal requirement in the UK for consent for blood transfusions. They say:
"National health policy and practice has put greater emphasis on patient
involvement and choice about medical treatment in recent years. Against this
background, there have been important legal developments regarding the
information that should be disclosed to patients concerning risks associated
with their medical treatment."
The authors state that there are serious infectious, as well
as non-infectious risks associated with blood transfusions and that it should
now be viewed as a legal requirement for patients to be informed about specific
risks posed by blood transfusions. This would work in the same way as they are
currently informed about risks associated with the medical treatment and/or
surgery they undergo.
The current state of the law is such, they say, that the failure
of healthcare professionals to advise patients of the specific risks of blood
transfusion and to obtain their consent leaves them open to a claim of
negligence or even battery in the event that the patient subsequently suffers
harm as a result of the transfusion.
In conclusion, the authors argue that obtaining specific
consent for blood transfusion in the UK is an important step towards
"recognising the importance of patient autonomy in the context of decision
making about medical treatment."
But an accompanying commentary questions whether the risks
of transfusion are high enough to warrant specific informed consent. Ravi Gill,
a consultant anaesthetist at Southampton University Hospital calculates that
the rate of serious adverse events associated with blood transfusions is
A patient signing a standard NHS consent form will be giving
their consent to a blood transfusion if required, he says. "I would hope that
this was an informed choice and that the clinician as well as mentioning the
possibility of a blood transfusion also mentions that transfusion itself has
some risks, albeit small."
A common sense approach - explaining things clearly,
tailoring what is said to what the patient seems to want, and checking
understanding - is required for good medical practice, he concludes.