During periods of blood shortages, however, the commitment was reduced to 75 units or to 50 units depending on the degree of shortage. I would never under any circumstances make it a standing policy to jeopardize transfusion support for the hospital for the sake of a single massive bleeding patient. In practice, they start a case no matter what we have available, although we have probably never had less than about 30-50 units available to us. Liver patients usually use less than 20 units. I don't believe we have ever used 200 units on a liver transplant patient, although we have used that much on aneurysms and trauma patients.
Communication is vital in any case in which the demands on the blood bank are extreme.
In one case, we requested an emergency Ethics Committee consultation to help resolve large usage of O- blood in a critically ill patient. The surgeon was forced to make a decision that the patient was not viable, albeit sooner than he envisioned - but it was his decision nonetheless. I await with anticipation the licensure of a viable blood substitute which might take some of the pressure off such situations. Overall, although I'd be angry at the surgeon, I think ethically that one has to do all one can to save the patient at immediate risk of death . You should send this whole correspondence to the planners of next year's annual meeting and perhaps to the Board.