Transfusion medicine handbook

6. Special Circumstances

6.20 Individuals Refusing Blood Transfusion

Some patients may refuse to receive transfusion for personal, religious or cultural reasons. For example, Jehovah’s Witnesses may hold beliefs that preclude transfusion of blood components or fractionated products. These wishes and beliefs must be respected and patients treated in a non-emotional and logical way.

Some patients will refuse all blood transfusions while others will accept fractionated products. Others will accept autologous blood collection and transfusion, cell salvage and auto-transfusion of blood collected during surgery. Some patients do not wish their relatives or peers to know that they have been transfused.

When a patient indicates a wish to not receive transfusions there should be a confidential discussion about exactly what will and will not be accepted. This information should be recorded in the patient notes.

It is advisable that the matter is discussed with the clinical leader of the unit concerned. Where there are areas of difficulty or dissension, the Chief Medical Officer (CMO) of the hospital should be contacted for further advice and guidance as to management of the patient. The CMO will have access to the organisation’s legal support and appropriate patient advocate groups. Additional consultation may be necessary with anaesthetists and surgeons to ensure the best possible care is given to the patient when blood transfusion cannot be provided despite clear clinical indication.

For children, the same procedure should be followed with careful consultation of the parents and noting any comments or opinions from the child. For babies and infants, the clinical leader should be closely involved in the decision-making. In cases where the parents, whānau or guardians refuse consent for transfusion deemed necessary to save life, prevent permanent injury or prolonged and avoidable pain and suffering, the consultant responsible needs to consult with the CMO to discuss appropriate further action. Such action may involve meeting with a solicitor to discuss the need for legal action.

It is mandatory that a very careful procedure be followed, with full documentation and consultation with the relevant people, prior to any transfusion.