Ethics

Ethics to be followed in transfusion service

“Ethics” word has been derived from the Greek adjective ‘Ethica’ which comes from the Greek substantive ‘ethos’ meaning customs, usages  and habits. It is also known as ‘Moral Philosophy’. The word moral is derived from the Latin substantive ‘mores’ which also means customs or habits. Customs are not merely habitual ways of acting. They are ways approved by the group or society. Thus ‘Ethics’ is the science of rightness and wrongness of conduct. Conduct is purposive action, which involves choice and will. It is the expression of character, which is a settled habit of will.
Character is the permanent habitual inner bent of mind, and naturally reflected in habitual conduct. This is how any textbook of ‘Ethics’ will explain the term; a term intimately connected with the ‘science of ideal involved in human life’. Blood transfusion is a complex science that links healthy blood donor with the ailing patient in quest of a new lease of life with various intermediaries and a system. The first requirement is the blood donor. Only four out of a thousand people in India can think of donating blood. Dearth of donors prompted many people to trade in human misery, to open commercial blood banks engaged in buying and selling of blood. Nowhere in the world can paid professional sellers ensure the quality of blood in spite of sophisticated post donation tests. So, all over the world stress is given on voluntary blood donors and switching over to total voluntary blood programme. To achieve this, the culture of blood donation should be the custom of the community.
This can be done by converting the Egoism of individuals to Altruism. The ideal life of one requires others to complement it, and it is by mutual help that the whole develops towards perfection. An individual is a member of a social unit, his supreme will should not simply be the perfecting of his own life, or the realisation of what appeals to him as the most fundamental values but also the perfecting of the society to which he belongs. To a great extent one end will coincide with the other.

When we seek simply our own individual ends, this attitude is called ‘egoism’ while the term ‘altruism’ has been used to devotion to the ends of others. We can realise the true self or the complete good only by social end. In order to do this, we must negate the merely individual self, which is not the true self. We must realise ourselves by becoming worthy of the society to be useful for others. The more fully we do so realise ourselves, the more do we reach an universal point of view – i. e., a point of view from which our own private good is no more to us than the good of anyone else. This  isself-realisation — self realisation for the sake of the whole. This good is clearly a social good.

With conviction and faith in this philosophy, any individual, group and organisation can take up the task of blood donor motivation, recruitment and retention by converting ‘egoism’ of individuals to altruism, remembering all the time that motive means what moves us or causes us to act in a particular way.

The means should not be overlooked. Education of soul is the only tool. The donor should be assured of absolute confidentiality about identity and blood test results and reasons of deferral.

Then comes the blood bank to collect blood to ensure safety of the donor and safety of the recipient. Scientific donor screening, maintaining confidentiality at every stage should be the creed of blood bank personnel to collect blood and maintain adequate stock. In storing and distribution of blood the administrative or personal balance of convenience should not get precedence but the need of the patient should be the supreme. For this, development of personnel at all levels through training, education and self-development would be necessary. The community should have appreciation for the blood donor, blood bank personnel including those behind the public eyes working faithfully in the laboratory, counter and other places. Then comes the doctors, the users of blood. Blood transfusion is transplanting from outside in large quantity to human circulation system. There are some hazards which may be fatal too. Unnecessary transfusion should be avoided to ensure safety of the recipient. In case of planned, cold or chronic cases, the attending doctor can deter a patient’s relatives
from going’ to commercial blood sellers. He/she can inspire the patient’s friends and relatives to donate blood for some one whom they love. He/ she can help the blood bank by sending the report of blood transfusion through feed back/reaction forms. One more thing. Asking for the so-called fresh blood every now and then puts the patient in the hands of paid donors in disguise and also to the hazard of untested blood transfusion. This ethics can be implanted among the doctors from their student days through education and demonstration and culture of the elders.

International Society of Blood Transfusion, International Federation of Red Cross and Red Crescent Societies, World Health Organization between the period 1948 and 2000 have released various documents on the ethics of blood transfusion service.

Finally, it may be said, that the laws of a country are made by the rulers and are therefore changeable. Laws of nature are constant, inviolable, all pervading and unchangeable. The laws of ethics evolve and cannot be changed but they may be violated. On the attitude of the community about the ethical laws/practices depends the quality of life of the people of the country.

A Code of Ethics for Blood Donation and Transfusion formulated
by International Society of Blood Transfusion on July 12, 2000.

The objective of this code is to define the ethical principles and rules
to be observed in the field of Transfusion Medicine.

• Blood donation including haematopoietic tissues for transplantation shall, in all circumstances, be voluntary and non-remunerated; no coercion should be brought to bear upon the donor. The donor should provide informed consent to the donation of blood or blood components and to  the subsequent (legitimate) use of the blood by the transfusion service.
• Patients should be informed of the known risks and benefits of blood transfusion and/or alternative therapies and have the right to accept
• or refuse the procedure. Any valid advance directive should be respected.
• In the event that the patient is unable to give prior informed consent, the basis for treatment by transfusion must be in the best interests of the patient.
• A profit motive should not be the basis for the establishment and running of a blood service.
• The donor should be advised of the risks connected with the procedure: the donor’s health and safety must be protected. Any procedures relating to the administration to a donor of any substance for increasing the concentration of specific blood components should be in compliance with internationally accepted standards.
• Anonymity between donor and recipient must be ensured except in special situations and the confidentiality of donor information assured.
• The donor should understand the risks to others of donating infected blood and his or her ethical responsibility to the recipient.
• Blood donation must be based on regularly reviewed medical selection criteria and not entail discrimination of any kind, including gender, race, nationality or religion. Neither donor nor potential recipient has the right to require that any such discrimination be practised.
• Blood must be collected under the overall responsibility of a suitably qualified, registered medical practitioner.
• All matters related to whole blood donation and haemapheresis should be in compliance with appropriately defined and internationally accepted standards.
• Donors and recipients should be informed if they have been harmed.
• Transfusion therapy must be given under the overall responsibiliiy of a registered medical practitioner.
• Genuine clinical need should be the only basis for transfusion therapy.
• There should be no financial incentive to prescribe a blood transfusion.
• Blood is a public resource and access should not be restricted.
• As far as possible the patient should receive only those particular components (cells, plasma, or plasma derivatives) that are clinically appropriate and afford optimal safety.
• Wastage should be avoided in order to safeguard the interests of all potential recipients and the donor.

Blood transfusion practices established by national or international health bodies and other agencies competent and authorised to do so should be in compliance with this code of ethics.