Summary of presentation given at the Thirteenth Arab Transfusion - - PDF document

1 Summary of presentation given at the Thirteenth Arab Transfusion Medicine Forum (ATMF13) in Tunisia, April 2018 Development of the Code of Ethics in Transfusion Practice

This paper is intended to introduce the recently revised “ Code of Ethics Relating to Transfusion Medicine” adopted and published by ISBT in June 2017. Reading of the

revised ISBT code of transfusion practice is a must for all transfusion practitioners whether in blood donation and processing centres or in clinical facilities involved in prescribing and transfusing blood and blood products. It is available on the ISBT website: http://www.isbtweb.org/

The early role of the Red Cross

The International Red Cross (RC) movement was engaged, since the late 1920s in the provision of blood, at a national level, in several countries, through the activity of its National RC Societies. This establishment laid the early foundation for the development of the ethical, moral and professional principles related to the supply of blood for patients requiring transfusion.

• Dr. Zarco Hantchef, originally from Bulgaria, started as adviser in the RC health programme in

1947 and became head of the RC blood programme of the League of RC &RC national Societies in 1975. He later established its popular newsletter “Transfusion International” and continued as its chief editor until 1982. He died in 2002 and has been a dedicated pioneer in promoting the importance of ethics for blood collection. He also had a long list of publications early in 1961, 74, 75 and 77 confirming this important role in providing the seeds of what is now considered standard approach to blood safety, as well as the early code of ethics for good blood transfusion practice. The following quotes highlight the continued conviction of RC and dedication to support these principles:

“The gift of blood and some international aspects of blood transfusion”. Article by Dr. Z. S. Hantchef in “International Review of the Red Cross”, first year-No 7, October 1961 p355

“In fact, remuneration of the donor poses a moral problem: it debases the generous act of the donation which, it would seem, should remain an act of pure charity; it takes away from the donor himself and from the whole body which blood donors constitute among themselves, the character of generosity which one expects from them

On the mission and responsibility of transfusion centre, 1974

"If the mission of transfusion centres is to ensure the supply of blood products, their main concern must (must and not should) always remain the protection of blood donors in all circumstances.

First editorial of TI, March 1975

“We are well aware of our limitations, but we are convinced that in the near future, an ideal programme base on the RC principles of the voluntary gift of blood will be a living reality every

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where”.

Circular to all RC societies in June 1975

" We should like to remind your society that the name and emblem of RC sponsorship cannot be used for commercial purposes and that any RC sponsorship of a commercial plasmapheresis plant would be a violation of our principles” On the ethics of blood donation and transfusion in Transfusion International, December 1977 “...it appears that the ethical and legal problems inherent in blood transfusion are becoming more important as new techniques develop, but the moral value of blood donation remains intact, and now, more than ever it symbolises a humanitarian service which is at the very basis of RC ideals”

Cooperation with blood transfusion professionals

The next stage in the development of the code of ethics for transfusion will then follow due to the close cooperation with the International Society for Blood Transfusion (ISBT). Working together with this professional group resulted in publishing the first international code for blood transfusion practice that was adopted and published as a formal international document by the Red Cross and the ISBT in 1980-81. More efforts to improve it, followed in 2000 and 2006 until the most recent revision, was adopted by the ISBT General Assembly in June 2017, and subsequently endorsed by the international Federation of Red Cross and Red Crescent Societies as well as the World Health Organisation (WHO). It was mainly initiated and completed by Dr. Peter Flanagan who was ISBT Past President and Member of the Standing Committee on Ethics (SCE). It was adopted and published by ISBT in June 2017.

Amendments in the recently revised code

The last and main section of the presentation discusses the most salient amendments and additions to the previous documents. It also highlights the essential general role and contribution of professional groups and scientific societies in improving and maintaining the quality standards and safety of blood supply within the ethical principles required for modern transfusion practice.. It presents these principles in four clearly separated sections; the first one deals with donors, donations, blood collection and all aspects of donor care. The second highlights the ethics of clinical transfusion practice of patients, presented in a valuable table highlighting the five moral principles that constitute the basic elements in the revised Code of Ethics.

Dignity; any human being has an innate right to be valued and receive ethical treatment. Autonomy; it is the capacity of a rational individual to make an informed, un-coerced

decision.

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Beneficence: is the action that is done for the benefit of others. Non-maleficence; to do no unnecessary or unreasonable harm. Justice; is the equitable distribution of benefits and how the rights of various individuals are

realised The third and essential additional new section emphasises the role “Stewardship” and its components that include good governance, authority and delivery in influencing and urging blood services and health authorities to ensure that all activities are undertaken in a manner that is as close as possible to the recently published international code of practice. It revised code can also be very valuable to use as basic tool for advocacy to maintain standard good practice for national legislation and regulation Although the main content remains largely unchanged, from the original version, its final section covers briefly the scientific basis of bioethics and the application of the principles of ethics in practice of health services. In general the code endorses and emphasises the importance of the principle of voluntary non- remunerated donation as the basis for the establishment and development of Blood Services, encompassing the care of both donors and patients, while maintaining the protection of their Human Rights and Dignity. Gamal Gabra ATMF13, March 2018

• Dr. Zarco Hanchef