Transfusions and operating room ethics

So I was chatting with the anaesthesiologist during Susan's caesarean section this morning (while peering over the shield to boggle at what all was going on over on the other side). There was some risk that Sue might wind up needing a transfusion as things got a bit complicated.

[Note: Stress and nervous tension are now serious social problems in all parts of the Galaxy, and it is in order that this situation should not be in any way exacerbated that the following facts will now be revealed in advance. Susan and the wee girl are fine. While the caesarean took a while, all wound up all right in the end. In order that some sense of mystery should still be preserved, no revelation will yet be made concerning the second decimal place of the girl's weight, the first digits of which were 4.3 kilograms. The second decimal place may safely be made the subject of suspense since it is of no significance whatsoever given measurement error.]

As I'm O negative, I noted that should Sue only need a small top-up, I'd happily provide. The anaesthesiologist said that would not be possible. The rest of the conversation went roughly as follows:

Me: Why not?
Her: Well, we'd need to do the blood tests to make sure it was all clean for transfusion.
Me: So, that would take too long then?
Her: No, that's not the problem. Rather, if we ever found something that the other partner might find cause for concern, we'd then face an ethical problem. So there's a rule banning these kinds of husband-wife transfusions.
Me: Ethical problem?
Her: Imagine the case where we find the one partner has an STD which the other partner would find out about because we wouldn't be using the blood.
Me: So if Susan needed a kidney and I were a match, I'd be banned from giving it then?
Her: No, we'd just make sure there were proper pre-counselling available so everyone were ready in case such a thing were found.
Me: Is there anything that ethicists don't completely screw up?
Her: Well, it's a complicated issue. I suppose if someone jumped up and down a lot and got a lawyer in...

In a rare instance of clarity, I realized that arguing medical ethics with the anaesthesiologist during the caesarean section might not be the very best idea, especially as things were starting to look very busy on the other side of the sheet and as the anaesthesiologist almost certainly wasn't the one responsible for the policy.

There is, of course, a dead simple mechanism design solution to the ethical problem here. The blood is taken, the donor and the recipient both signing a form that if any ethically troublesome problem is found in the blood, blood from the standard donor pool would instead be used without additional notice to the recipient; the donor would later confidentially be informed of the ethical problem encountered. Problem solved. The doctors don't need to tell the recipient of the donor's possible philandering while in the middle of surgery; the donor finds out about any blood problems; and, if there's a blood problem, the recipient is no worse off than would have been the case had they just gone to the standard pool in the first place. It's not that far from the solution they had a while back allowing folks from high risk groups to donate blood while ticking a box indicating that their blood really shouldn't be used.

Why the hell anybody lets ethicists ban things before they ask an economist for a mechanism design solution to the purported problem....

If we wind up finding that Sue comes up a bit anemic and tomorrow needs a transfusion, I may jump up and down a bit arguing for my solution through mechanism design.

And now we can safely reveal, without ethical dilemma about the risks of imposing stress on you our dear reader, the number in the second decimal place was 1.  4.31 kg; head circumference 39 cm, length 55 cm.

Her name, however, will not be revealed as yet. Those who care may follow my Twitter feed for updates of that sort.