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About collection of blood and clinical use of blood components and ethical considerations--Thoughts from the Ethical Committee of the National Institute for Blood Transfusion, France Volume 24, issue 3, Mai-Juin 2018

Authors
1 Institut national de la transfusion sanguine, Paris, France
2 Université de Lyon/Saint-Étienne, faculté de médecine de Saint-Étienne, EA-3064, Saint-Étienne, France
3 Personnalité qualifiée, hématologie clinique, Libourne, France
4 Établissement français du sang, La Plaine-Stade de France, France
5 Personnalité qualifiée, hématologie clinique, Paris, France
6 Université Paris-Descartes, faculté de médecine, laboratoire d’éthique médicale, Paris, EA-4569, France
7 Fédération française pour le don de sang bénévole, Paris, France
8 Inserm, UMR-1134, Paris, France
9 Faculté de médecine et de biologie, Lausanne, Suisse
* Tirés à part

The Ethics Committee of the National Institute for Blood Transfusion has put together reflections about the state of the art and prospection regarding blood collection and use of blood components. Such blood components are intended to be transfused either under the form of labile blood units or as plasma derivatives. In France, collection of blood to produce labile blood unit or as source plasma to be fractionated originates exclusively from donation. Blood donation obeys the voluntary non-remunerated standards donors and falls into the not for profit system for the organizations. The demand in labile blood components is substantially declining in high-income countries (such as France). However, profound changes within the society seems to result in a more difficult self-sufficiency inlaid in spontaneous candidacy only; stimulation of promotion by many types of communication action prove to be necessary to achieve this goal. This Ethical Committee has identified key points deserving vigilance regarding techniques used to elicit blood donation candidacy, as tools initially developed for the for profit sector tend to be applied to this particular non-for profit sector. This is even more care-sensitive when plasma for fractionation is considered. In France, all plasma being collected obeys the same ethical consideration than blood for labile blood component production. This is not the worldwide gold standard as source plasma is most frequently considered as a good likely because the European Union Directive that applies makes plasma derivatives being goods for open markets. The globalization of source plasma to be cracked into drugs is supported by a limited of wealthy industries. One may questions ethical issues of plasma source globalization. Further, contrasting with the global quantitative decline in labile blood component, there are increased qualitative demands, with specific phenotypes. This poses novel ethical issues. Next, whereas most prescriptions follow guidelines, an increasing number of indications seem off use. This commission has thus enlisted a number of topics which--in its opinion--would worth being regularly revised or questioned, relative to blood collection or administration to patients, with the safe guard of justice and equity. This reflection parallels initiatives launched by scientific societies.