5b Pre-operative autologous blood and plasma donation and retransfusion

Pre-operative autologous blood donation (PAD) has become a widely distributed practice in many countries pushed forward by the fear of acquired immunodeficiency syndrome transmission by transfusion of allogenous blood. With the declining risk of transfusion-transmitted infection as a result of improved testing and the increasing limitation of health care resources the cost-effectiveness of PAD has become of great interest. This article describes the most widely used procedures of PAD and discusses the topics that the recent debate has been focused on. It is demonstrated that a clear medical indication for PAD is indispensable and that the inherent risk of PAD has to be balanced against the alleged benefit. We provide a mathematical approach to tackle this problem. Furthermore, we suggest measures able to reduce the costs of PAD without neglecting the medicolegal aspects and the legitimate claim of the patient in order to reach an acceptable cost: benefit ratio of PAD.