In the case of Baby W, using blood from a directed donor was not a safe alternative in the baby's interests, a High Court judge has ruled.
On 7 December, Justice Ian Gault ruled in favour of health authorities who sought court guardianship of the four-month-old baby, after his parents refused a blood transfusion and called for a court order to receive blood from exclusively donors who had not received the Covid-19 vaccination.
In his decision, Justice Gault said doctors from Te Whatu Ora had been made agents of the court to carry out the surgery, including the administration of any blood products.
A request by the family's lawyer to force the NZ Blood Service (NZBS) to take blood from an unvaccinated donor of their choosing for the surgery was declined.
Dr Sarah Morley, chief medical officer at the NZBS, gave evidence at the hearing and said the NZBS did not separate blood according to donor Covid-19 vaccination status because there was no scientific evidence that there was any Covid-19 vaccine-related risk from blood donated by donors previously vaccinated with any Covid-19 vaccine approved for use in New Zealand.
Directed donation offered no advantage to the recipient and had been shown, in some studies, to increase transfusion risk, she said. It also introduced unnecessary complexity into well-established blood collection and processing systems that increased the risk of errors and inadequate supply for the patient.
The baby at the centre of this case may need rapid access to the full range of blood and plasma products to support his complex cardiac surgery, which the NZBS may not be able to supply through directed donation.
This is because some products (including albumin, which the baby is expected to require) are collected using specialised collection techniques, from carefully qualified donors, and then manufactured using regulated procedures. Some products are manufactured in bulk in Australia.
Morley stated in her evidence the only way to ensure Baby W had access to the right transfused therapies at the times he needed them was through the safe and comprehensive portfolio of blood and blood products donated by, and manufactured from, blood collected from NZBS' voluntary donors.
Directed donation was not recommended in international expert consensus guidelines and most national blood providers, including the UK, Australia and Canada, did not support them, she said.
According to international best practice, the NZBS has detailed procedures which govern how it collects, tests, processes, stores, releases and delivers blood and blood products. Guidelines do address 'designated' and 'directed' donations but say designated donations should only occur where there is a clear medical indication for example, a patient with a rare blood type where no compatible anonymous donations are available. According to Morley's evidence, this did not apply to Baby W's case.
In his decision, Justice Gault noted the parents wanted the best for their child and accepted they had genuine concerns about the risk of using blood from vaccinated donors. However, he agreed with advice from clinicians that it was safe.
Using blood from a donor of their choosing was not an available alternative, nor supported by doctors, so was not a safe alternative in the baby's interests.
"For these reasons, and given that Baby W needs urgent surgery, an order enabling the surgery to proceed using NZBS blood products without further delay is in Baby W's best interests," he said.