Authors' objectives:

To evaluate the scientific rationale of universal leukoreduction in Belgium. An assessment of the clinical, economic, social and legal consequences is made.

Authors' results and conclusions: The safety and quality of transfusion blood is very high in Belgium, as it relies on unpaid voluntary donors and strict quality control. There is relative consensus that selective leukoreduction is highly effective and cost-effective relative to no leukoreduction. Selected patients groups include immuno-compromised patients, pregnant women, transplant patients, poly-transfusion patients and patients with HLA alloimmunisation. It is unclear whether universal leukoreduction, i.e. leukoreduction for all units of blood, is cost-effective. The basis of the decision to implement universal leukoreduction in most European countries was the prevention of transmission of variant Creutzfeldt-Jakob disease (vCJD) by blood transfusion. Outside the UK, however, this risk is very low and universal leukoreduction is probably of limited clinical benefit. The basic underlying problem is the legal accountability. The law is vague on this issue and as a consequence blood banks are increasingly faced with legal uncertainty. They pay huge insurance premiums that are not proportional to the quality and safety measures they take. The (European) law suggests that maximal blood safety should be pursued, which inevitably leads to investments defined by technological possibilities rather than by objective need and efficiency.

Authors' recommendations: The major issue is the financial and legal accountability for blood transfusion-related hazards. If the policy makers decide not to implement universal leukoreduction in Belgium, they need to take over this financial and legal accountability from the blood banks. If it is decided to implement universal leukoreduction, the general public should be appropriately informed about the consequences, i.e. the loss of efficiency in the allocation of scarce health care resources.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.kce.fgov.be/index_en.aspx?SGREF=5222&CREF=9363

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Belgium

Organisation Name: Belgian Health Care Knowledge Centre

Contact Address: Administrative Centre Botanique, Doorbuilding (10th floor), Boulevard du Jardin Botanique 55, B-1000 Brussels, Belgium tel: +32 2 287 33 88 fax: +32 2 287 33 85

Contact Name: info@kce.fgov.be

Contact Email: info@kce.fgov.be

Copyright: Belgian Health Care Knowledge Centre (KCE)