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Controversies in transfusion medicine

THE USE OF PREOPERATIVE autologous blood donation (PAD), generally accepted as a standard of care in major elective surgery,’ might appear to be beyond analysis. For the individual patient, PAD appears to be a “no-lose’’ proposition: it represents a means of reducing both real and perceived risks of exposure to allogeneic blood, often at minimal personal cost. From a societal perspective, though, the costs implied by routine use of PAD are becoming increasingly important. With the recognition that health care resources are limited, there is growing acceptance that resources devoted to one medical intervention, such as PAD, may reduce those available for another. Measurement of the costs of PAD and its benefits allows the assessment of its value as a health investment relative to the other health services with which it is indirectly competing. In addition, by analyzing the risks, benefits, and costs of PAD in different settings, we may be better able to direct this form of hemotherapy toward those patients most likely to benefit from it.