Adoption of Iran's code of ethics for blood donation and transfusion as a public health policy.

Blood is a public resource of human origin and its transfusion process is essential to individual and public health. This study aimed to develop a national code of ethics for blood donation and transfusion (BDT). This was a qualitative research with a multi methods approach in which a combination of methods including situational analysis, focus group discussion and expert panels were used. After situational analysis and orientation, the code of ethics for BDT was developed based on the findings of a content analysis within the framework of the four principles of biomedical ethics. The results were categorized into two sections: situational analysis and underpinnings measures, and the clauses of the code. The Iranian Blood Transfusion Organization has carried out three essential supportive measures over the past decades: approval of insurance coverage of blood recipients against communicable diseases; inclusion of 14 blood services in the book of “Relative Value Units of Health Services”; and formation of the National Ethics Committee of Transfusion Medicine. After recognition and orientation, the national code of ethics for BDT was adopted and imparted to blood donation centers. The code consists of two sections: “Blood Transfusion Centers: Donors and Donation” in 19 clauses, and “Hospitals: Patients” in 8 clauses. The national code of ethics for BDT establishes moral norms in order to protect the rights of blood donors and recipients. It could also serve as a basis for addressing the related ethical challenges and right decision-making in the area of BDT.

Blood is a public resource of human origin, and its donation and transfusion process is essential to protection and improvement of public health (3). The special nature of blood and its components distinguishes them from other medicines and therapies, and therefore the world medical organization (WHO) has categorized them as essential medicines (4).
In 1975, WHO adopted statement number 28

Method
In this qualitative study, the multi-method approach was used, which is a combination of methods that produce data of the same type (14). This approach brings about integrity of the findings and increases the credibility of the research (14,15). In the present study, the data obtained at different

B) Code of Ethics for Blood Donation and Transfusion
Using deductive content analysis, the following themes emerged under two main categories:

1) Blood Transfusion Centers: Donors and Donation
In this category 8 themes were extracted: treating illnesses and curiosity in that order (23). According to the regional strategic framework for blood safety and availability Therefore, being responsible entails commitment to a positive action, or the attempt to achieve a high value such as social or public good (25).
In public health, social responsibility has been considered as a moral norm, which, in addition to promoting participation, helps to protect and promote public health (26). In 3. Donors have the right to be fully informed about the blood donation conditions and processes. 4. Donors have the right to be informed about the potential risks of blood donation. In all cases, the priority is to protect the health and safety of the donor. 5. Donors should be aware of the hazards and consequences of donating infected blood, and of their moral responsibility toward potential recipients. 6. Donors should answer the questions honestly and clearly.
7. Blood transfusion centers must inform donors about cases of exemption from blood donation and the reasons. In the event of a voluntary exemption from donation or detection of infections during the screening process, the centers should inform donors about the type, cause and duration of exemption.
8. Post-donation care should be clearly communicated and it must be established that the donor has fully understood it. 9. Donors can cancel the blood donation at any stage. 10. The privacy of donors must be respected during the medical interview and the screening process.
11. The information of donors must not be disclosed, and they must be ensured about the confidentiality of their information and medical records.
12. Blood donors and recipients should not be aware of one another's identity, barring exceptional cases. Blood transfusion centers and hospitals must take all the necessary measures in this respect.
13. All the processes related to blood donation must be performed in accordance with the standards of the National Blood Transfusion Organization, and under the supervision of a qualified physician.
14. The only criterion for accepting or exempting donors is the standards of the National Blood Transfusion Organization. Physical examinations and interviews must be conducted under the supervision of a qualified physician. 15. Any discrimination based on gender, religion, ethnicity or nationality is prohibited. Blood donation centers and their staff should not make discriminatory requests from donors and recipients. 16. Blood donors and recipients must be informed about any possible complications. 17. Establishing blood transfusion centers and providing blood services must not be done for commercial motives and profitable purposes.
18. All measures from donation up to blood transfusion should be implemented in such a way as to prevent the loss of blood and blood components. 19. All patients must have access to blood and blood components when necessary.

Hospitals: Patients
1. Patients have the right to be clearly informed about the risks and benefits of blood transfusion as well as alternative therapeutic procedures by the physician.
2. The transfusion of blood and its components must only be performed after obtaining the written informed consent of the patient or her/his legal representative; if this is not possible, the decision for transfusion of blood and blood components should be based on the "best interests of the patient".
3. The patient has the right to refrain from receiving blood or blood components at any stage of the treatment. In this case, he/she should be notified of the possible consequences of the decision, and the final decision should be documented and approved by him/her. However, such a decision should not adversely affect the behavior of physicians and medical practitioners in providing the best alternative