How safe should donor blood be?

Blood services apply various safety measures to prevent the transmission of infections through blood transfusion, some of which have very high cost-effectiveness ratios (over €1.000.000 per quality-adjusted life-year or QALY saved). This dissertation considers whether it is ethically acceptable to apply such inefficient safety measures. From a utilitarian perspective, these safety measures should be forgone: they consume resources that could probably be used more beneficially elsewhere in the healthcare system, thus saving more QALYs. Are there good ethical arguments to apply inefficient blood safety measures nonetheless? Part I presents qualitative empirical research that aims to identify such arguments. An analysis of policy-documents reveals the broad set of concerns that shape blood safety policies, while interviews and focus group discussions with stakeholders in the Dutch blood system identify arguments for tolerance or intolerance towards blood transfusion risks. Part II evaluates ethical arguments why blood safety measures should be applied even if they are inefficient (and more QALYs could be saved by not applying them). It discusses and ultimately rejects arguments based on the ‘rule of rescue’, on the idea that transfusion risks are imposed on patients, on the idea the blood products are manufactured medical products, on the precautionary principle, and on the idea that discontinuing safety measures harms patients or violates an acquired right of patients. In conclusion, this dissertation finds no good reasons to fund inefficient blood safety measures if funding other health care interventions saves more lives or QALYs, but its empirical part suggests directions for further inquiry