080903L - CASE ANALYSIS: TRANSFUSION

Background material by Professor Omar Hasan Kasule Sr. for Year 2 Semester 1 medical PPSD session on 03th September 2008

Background

Rafiuddin Rahman was a known patient of thalassemia. He had presented 3 years ago at the emergency room with profound life-threatening anemia that required immediate blood transfusion. In the ensuing confusion and panic a blood bottle that had not yet been cross matched and screened for infection was used for transfusion. Rafiuddin suffered a mild transfusion reaction. He was followed up after that by blood testing at monthly intervals for the first 6 months and thereafter at yearly intervals.

Q1. Identify ethico-legal issue(s) arising so far

Laboratory tests:

Month of Follow up	CD4 count per mm3	Viral load (HIV RNA per ml)	HBsAg	Anti-HBc/IgM	Anti-Hbc/IgG
0	900	0	+	-	-
1	50	900,000	+	+	-
2	300	200,000	+	+	+
3	650	100,000	+	+	+
4	800	110,000	-	-	+
5	750	120,000	-	-	+
6	720	120,000	-	-	+
12	700	125,000	-	-	+
18	650	130,000	-	-	+
24	570	135,000	-	-	+
30	500	130,000	-	-	+
36	400	150,000	-	-	+

Q2. What is your interpretation of the above results?

Q3. What is the ethico-legal implication of the results?

Subsequent anemic episode

Rafiuddin experienced a second episode of anemia requiring transfusion. The father was suspicious about the blood in the hospital blood bank because of the previous episode of infected blood. He asked who the donors were. When told that they were convicted criminals in the city jail, he refused any transfusion for his son. He told the staff that he knew that most of the convicts were drug addicts and were likely to have infectious diseases. He refused explanations by doctors and nurses that blood in the hospital bank was carefully screened for infection according to international standards. The doctors informed him of the adverse consequences of not transfusing including death but he still refused.

Q4. Does the father have the right to refused medically indicated transfusion?

Q5. Do you think that there are reasons to justify the father’s refusal of transfusion?

Blood from relatives

The father of Rafiuddin proposed to bring relatives to donate blood for the transfusion. The hospital staff welcomed the idea of donating blood to the general hospital blood bank but refused to guarantee that only blood from the relatives would be used in the transfusion.

Q5. What is your view about the refusal of the hospital to refuse using blood from relatives?

Blood from beggars

The father of Rafiuddin then suggested buying blood from a group of beggars in the town. The hospital rejected the idea.

Q6. What is your opinion about selling blood for transfusion?

Resort to courts of law

In desperation the hospital director took the case to court seeking an emergency injunction to transfuse against the wishes of the father

Q7. Imagine you are the judge in this case. List ethico-legal considerations that would guide your decision.