Ethics
Blood bank practices Patient-related practices Grade 20.1 Both blood donors and recipients must be protected through safe blood management practices. N/A 20.2 Blood transfusion services must comply with the provisions of the standards of practice for blood transfusions in South Africa N/A 20.3 All blood and blood products require informed consent prior to transfusion. N/A 20.4 If consent c
| Grade | ||
| 20.1 | Both blood donors and recipients must be protected through safe blood management practices. | N/A |
| 20.2 | Blood transfusion services must comply with the provisions of the standards of practice for blood transfusions in South Africa | N/A |
| 20.3 | All blood and blood products require informed consent prior to transfusion. | N/A |
| 20.4 | If consent cannot be provided by the patient, consent may be provided by a person mandated in writing by the patient, a person authorised by any law or court order or any surrogate decision maker | N/A |
| 20.5 | Advanced directives (or ‘living wills’), while having no legal force, should be ethically honoured. | N/A |
| 20.6 | An adult may refuse blood and blood products solely on religious grounds if the patient is of sound mind and understands the risks and consequences of such refusal. | N/A |
| 20.7 | No parent or guardian my refuse blood or blood products of a minor solely on religious grounds if the blood or blood product would be life-preserving. | N/A |
| 20.8 | If a clinician is uncertain of any reason a patient would refuse blood and there is a clear indication for the use of blood or a blood product to preserve life, the best interests of the patient must prevail. | N/A |
| 20.9 | Blood and blood products should be triaged in a resource-limited environment | N/A |
| 20.10 | Health authorities should ensure that blood services are progressively developed to ensure the needs of the patients are met. | N/A |
Blood bank practices
South African legislation regarding blood and blood products
The statutory provisions regarding all aspects of blood and blood product procurement, provision and use are set out in the National Health Act (Chapter 8, sections 56 to 68)83 and the Regulations to the National Health Act (Regulations Relating to Blood and Blood Products).84 While the National Health Act deals with the use of blood, blood products, tissue and gametes in humans, the regulation specifically deals with blood and blood products.
The regulations provide for the following:
i. licensing of a national blood service provider,
ii. operational oversight,
iii. appointment and duties of health officers,
iv. aims of the blood transfusion service,
v. donor recruitment, vi. mandatory donor blood testing,
vii. management of requests and administration of blood and blood products, and
viii. record keeping, including untoward reactions.
South African has two registered blood service providers: (i) South African National Blood Service (SANBS) and (ii) Western Cape Blood Service (WCBS).
Standards of practice
Ethical and professional standards relating to the collection, processing and testing, prescription and use of blood and blood products are set out in the Standards of Practice for Blood Transfusions in South Africa.85 Apart from setting the requirements for establishing a blood management system, blood collection, processing and testing, the document sets donor selection criteria with the aim of protecting both donors and recipients. Notification of abnormal test results is an ethical standard requirement of blood donor management.
Patient-related practices
Consent
Informed consent is required prior to the transfusion of any blood or blood product. The patient must receive information relating to the range of therapeutic options available, the benefits, risks, costs and consequences of each option. The patient must also be of appropriate legal and mental capacity to make such decisions.83
Refusal of treatment
Patients may also be informed of their right to refuse blood and blood products.
They need to be informed of implications, risks and obligations of such refusal.
(a) Adult patients (>18 years old) of sound mind and comprehending the implications of refusal of blood and blood products have the right to exercise their constitutional right to protect one’s self and refusal of medical treatment. This refusal must be honoured even if this may result in fatality.83
(b) Children aged 12–18 years Children between these ages have the right to independently make informed consent decisions as stipulated in the Children’s Act. These children must be of sound mind and of sufficient maturity to understand the information presented to them.86
(c) Children <12 years
Children who are aged <12 years require a parent or guardian to consent to the provision of blood or blood products.86
Refusal of treatment based on religious grounds
No parent or guardian may refuse to provide consent to the transfusion of blood or blood products to a minor where the provision of such treatment would be considered life preserving.87 The legal burden rests with the parent or guardian to provide proof for an alternative treatment.
Advanced directives
Advanced directives in the form of a ‘living will’ or enduring power of attorney have no legal force in South Africa. If the authenticity of the advanced directive can be verified and it can be established that the instructions of the advanced directive are the current wishes of the patient, then the directive should be respected, failing which, the best interests of the patient should apply.
Limited resource/General ethical framework – utilitarian
Blood and blood products remain a scarce resource and should be managed accordingly. Fair and equitable distribution of these recourses must be justifiable. A utilitarian approach to blood and blood products prescriptions should be practiced.88
South African Society of Anaesthesiologists (SASA) Guidelines for Patient Blood Management 2020. Confirmed as current version on the SASA website as of November 2024.