Blood transfusions should not go ahead without informed consent

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 0.019%.

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.