Adoption of Iran’s code of ethics for blood donation and transfusion as a public health policy
Blood is a public resource of human origin and its transfusion process is essential to individual and public health. This study aimed to develop a national code of ethics for blood donation and transfusion (BDT).
This was a qualitative research with a multi methods approach in which a combination of methods including situational analysis, focus group discussion and expert panels were used. After situational analysis and orientation, the code of ethics for BDT was developed based on the findings of a content analysis within the framework of the four principles of biomedical ethics.
The results were categorized into two sections: situational analysis and underpinnings measures, and the clauses of the code. The Iranian Blood Transfusion Organization has carried out three essential supportive measures over the past decades: approval of insurance coverage of blood recipients against communicable diseases; inclusion of 14 blood services in the book of “Relative Value Units of Health Services”; and formation of the National Ethics Committee of Transfusion Medicine. After recognition and orientation, the national code of ethics for BDT was adopted and imparted to blood donation centers. The code consists of two sections: “Blood Transfusion Centers: Donors and Donation” in 19 clauses, and “Hospitals: Patients” in 8 clauses.
The national code of ethics for BDT establishes moral norms in order to protect the rights of blood donors and recipients. It could also serve as a basis for addressing the related ethical challenges and right decision-making in the area of BDT.
Beauchamp T, Childress J. Principles of Biomedical Ethics, 7ed. UK: Oxford University Press; 2013.
Veatch RM. Cross-Cultural Perspectives in Medical Ethics, 2nd. USA: Jones and Bartlett; 2000.
Busby H. Biobanks, bioethics and concepts of donated blood in the UK. Sociol Health Illn. 2006; 28(6): 850-65.
Anonymous. World Health Organization: 19th WHO Model List of Essential Medicines (April 2015). [Cited on January 2019]; Available from: http://www.who.int/medicines/publications/essentialmedicines/EML2015_8-May-15.pdf.
Andre A. Montreal 1980: a code of ethics for blood transfusion. Vox Sang. 1981; 40(4): 303-5.
Flanagan P. The ISBT code of ethics and the altruistic donor. ISBT Science Series. 2012; 7(1): 303-6.
Anonymous. World Health Organization: Universal access to safe blood transfusion. [Cited on Januray 2019]; Available from: http://www.who.int/iris/handle/10665/69747
Anonymous. World Health Organization: Universal access to safe blood transfusion. [Cited on Januray 2019]; Available from:
Goodnough LT. Blood management: transfusion medicine comes of age. Lancet. 2013; 381(9880): 1791-2.
Kramer K, Verweij M, Zaaijer H. Are there ethical differences between stopping and not starting blood safety measures? Vox Sang. 2017; 112(5): 417-24.
Mahmoudian Shoshtari M, Pourfathelah A. An overview analysis of blood donation in the Islamic Republic of Iran. Arch Iran Med .2006; 9(3):200-3.
Mousavi F, Tavabi AA, Golestan B, et al. Knowledge, attitude and practice towards blood donation in Iranian population. Transfus Med. 2011; 21(5): 308-17.
Akrami F, Abbasi M, Karimi A, Shahrivari A, Majdzadeh R, Zali A. Analyzing the politico-moral foundations of the Iran’s health system based on theories of justice. J Med Ethics Hist Med. 2017; 10: 4.
Hall RF. Mixed Methods: In search of a paradigm. [Cited on January 2019]; Available from: https://www.researchgate.net/publication/259045135_Mixed_Methods_In_search_of_a_paradigm
Bowen GA. Document analysis as a qualitative research method. Qualitative Research Journal. 2009; 9(2): 27-40.
Abbasi M, Pourfathollah A, Asghari A. Legal analysis of the ethical code of blood donation and transfusion. Bioethics Journal. 2015; 5(16):143-82. [in Persain]
Anonymous. World Health Organization: Strategic framework for blood safety and availability 2016–2025. [Cited on Januray 2019]; Available from:
Sachdev S, Mittal K, Patidar G, et al. Risk factors for transfusion transmissible infections elicited on post donation counselling in blood donors: need to strengthen pre-donation counselling. Indian J Hematol Blood Transfus. 2015; 31(3): 378-84.
Akrami F, Zali A, Abbasi M, et al. An ethical framework for evaluation of public health plans: a systematic process for legitimate and fair decision-making. Public Health. 2018; 164: 30-8.
Akrami F, Abbasi M. Exploring the prominence of ethical principles and moral norms in the areas of clinical practice and public health. Ann Med Health Sci Res. 2018; 8: 11-15.
Beal R. The International Society of Blood Transfusion and a code of ethics for blood donation and transfusion (2000). Vox Sang. 2002; 82(3):165.
Petrini C. Between altruism and commercialisation: some ethical aspects of blood donation. Ann Ist Super Sanita. 2013; 49(4): 412-6.
Kasraian L., Torab Jahromi S.A. A motivation survey of blood donation in Shiraz blood transfusion center. Sci J Iran Blood Transfus Organ. 2006; 2(6):259-67. [in Persain]
Anonymous. 10 Essential Public Health Services. [Cited on Januray 2019]; Available from: https://www.apha.org/about-apha/centers-and-programs/quality-improvement-initiatives/10-essential-public-health-services
McKeown R.E, Weed D.L, Kahn J.P, Stoto M.A. American college of epidemiology ethics guidelines: Foundations and dissemination. Science and Engineering Ethics. 2003; 9(2) : 207-14
McKeown R, Weed D. Ethics in epidemiology and public health II. Applied terms. J Epidemiol Community Health. 2002; 56(10): 739-41.
Abbasi M, Majdzadeh R, Zali A, Karimi A, Akrami F. The evolution of public health ethics frameworks: systematic review of moral values and norms in public health policy. Med Health Care Philos. 2018; 21(3):387-402.
Turoldo F. Responsibility as an ethical framework for public health interventions. Am J Public Health. 2009; 99(7): 1197-202.
Anonymous. World Health Organization: WHO Global Forum for Blood Safety: Patient Blood Management.[Cited on January 2018]; Available from: https://www.who.int/bloodsafety/events/gfbs_01_pbm/en/
Shander A, Isbister J, Gombotz H. Patient blood management: the global view. Transfusion. 2016; 56(Suppl. 1): S94-102.
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