Some reflections on the Code of Ethics of the International Society of Blood Transfusion.

Abstract

Following its then President’s reflections1, the International Society of Blood Transfusion (ISBT) is reviewing its Code of Ethics2 (“the Code”), which was developed over the 1970s and first published in 1980, to “define the ethical principles and rules to be observed in the field of transfusion medicine”3. Dr Flanagan drew particular attention to the tension between the Code and commercial plasmapheresis as a route to the manufacture of plasma products. It may well be expected that a document reflecting practice in the transfusion industry, mainly embedded in the Not-for-Profit (NFP) sector and specifying blood as a public resource, could grate with the predominantly commercial plasma product sector, particularly over the issue of paying plasma donors. This issue has long drawn controversy from different perspectives, which are unavoidable given that the transfusion sector itself is connected to the plasma product sector through the sale of its plasma for manufacture into commercial products. This article attempts to synthesise these perspectives into a practical framework for the delivery of these therapies today. One perspective, in agreement with the principles asserted in numerous documents, including that the human body and its parts should not be commercialised, is that the donation of blood should be a freely made and unpaid voluntary gesture. According to this perspective, any “reimbursement” should not be such as to distort the nature of the act, which should remain a donation and a gesture of altruism. Recent contributions4–6 suggest that there are certain contradictions between the principle of non-commercialisation, the enormous movements of money inevitably involved in centralised blood systems, and the need to make the most of the system. As will be discussed in this article, from the ethical point of view these contradictions could be at least partially mitigated. We reflect on areas which have stimulated controversy and debate and offer a synthesis of views which may assist in the development of guidance for members of the ISBT in approaching a less absolutist, but more realistic, set of aspirational ethical principles in their practice. We consider that such a synthesis is preferable to an attempt at consensus, believing that such attempts, as discussed by Farjaudon and Morales7, could reflect the imposition of one set of dominant interests over another. We will exemplify where we feel that this has happened in the particular landscape covered by this work. The individual Clauses of the Code are addressed in turn.