PREOPERATIVE AUTOLOGOUS BLOOD DONATION - CLINICAL, ECONOMIC, AND ETHICAL ISSUES

Many patients are donating their own blood before surgery to avoid blo od-borne infections, often on the advice of their physicians. But auto logous blood transfusion, while safer than allogeneic transfusion, is not completely risk-free. it is also expensive, its benefits are diffi cult to assess, and its increasing popularity raises many difficult et hical issues, such as whether the benefit of allogeneic transfusion su pports its additional expense. KEY POINTS Record-keeping, collection, and transfusion errors are occasional risks of autologous transfusions . In addition, risks associated with blood donation, from mild dizzine ss to precipitation of angina, should be considered when high-risk pat ients are referred for autologous collection. Only approximately half of autologous units collected are actually used, and the cost per qual ity-adjusted year of life saved may be as high as $1 million, dependin g on the type of surgical procedure. Although recombinant human erythr opoietin can stimulate red blood cell production before autologous don ation and decrease the need for transfusion, it is not clear whether t his strategy, which can cost thousands of dollars per patient, will be cost-effective. Perioperative hemodilution may become an important co mponent in efforts to reduce patient exposure to allogeneic blood, but its use remains controversial.