Guide for healthcare providers

A patient has presented you with a bloodless.org Directive — an Advance Medical Directive documenting their decisions regarding transfusion and blood products.

Quick reference

What the Directive contains

• 10 blood product/procedure decisions — each marked Accept, Refuse, or Personal Decision
• Healthcare Agent contact — authorized to make decisions for "Personal Decision" items
• Special instructions — free-text qualifications and Directives
• Legal execution — signature, witnesses, jurisdiction

The three decision types

• Accept — patient consents to this product/procedure if medically indicated
• Refuse — absolute refusal. Legally binding. Do not administer.
• Personal Decision — defer to the Healthcare Agent. Contact them.

Products covered

Primary components: whole blood, packed RBCs, plasma, platelets

Blood fractions: albumin, immunoglobulins, clotting factors

Autologous procedures: cell salvage, hemodilution, cardiopulmonary bypass

Bloodless surgical techniques

If the patient accepts autologous procedures, consider:

• Intraoperative cell salvage (Cell Saver)
• Acute normovolemic hemodilution
• Controlled hypotension
• Meticulous surgical hemostasis
• Tranexamic acid / antifibrinolytics
• Preoperative iron and EPO optimization
• Thromboelastography-guided management

Legal standing

Blood-related advance Directives carry the same legal weight as any other advance Directive in most jurisdictions. The patient has the right to refuse any medical treatment, including blood transfusion. Document the Directive in the patient's medical record.

Resources

• Reading the wallet card — field-by-field breakdown
• Blood choices reference — what each product is and alternatives
• Knowledge graph — interactive map of bloodless medicine concepts