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Earlier this month, Kentucky Republican State Representative Candy Massaroni introduced House Bill 752, which would give patients the right to receive blood transfusions from a donor they choose—including their own previously donated blood—while restricting hospitals and blood banks from refusing such directed donations and requiring insurers to cover them.
At first blush, one would think this bill strikes a blow for patient autonomy. The core idea, allowing patients to choose their own blood donor, including banking their own blood for later use, fits with the core principles of individual autonomy and voluntary exchange.
But a deeper dive into the bill’s specifics reveals its medical autonomy comes with a heavy dose of government compulsion. It requires private insurers, Medicaid, and state employee health plans to cover directed or autologous transfusions—another insurance mandate that overrides voluntary contracts between insurers and customers—and the added costs may increase premiums. It also creates new regulatory oversight and potential civil liability, empowering state officials to investigate hospitals and blood banks. And it forces private institutions with their own safety protocols and legal responsibilities to accommodate directed donations, whether they want to or not.
In other words, the bill promotes “medical freedom” by expanding government mandates over insurers and private medical providers.
Hospital associations and transfusion specialists have consistently opposed these directed-donation bills, mainly citing practical reasons rather than ideological ones. Modern blood banking depends on pooling donations and managing them as a shared inventory. Blood expires within weeks, requiring hospitals to continuously balance blood types, shelf life, and unpredictable patient needs. Reserving units for specific patients reduces flexibility and can cause waste if the blood isn’t used. It can also complicate emergency care. In cases of trauma or severe bleeding, patients often need blood within minutes, and hospitals depend on immediate access to compatible blood—not from a specific donor.
Hospitals also worry about regulatory conflicts, liability, and increased costs. Transfusion practices are governed by strict standards established by the FDA, the Joint Commission (which accredits hospitals and health organizations), and professional groups like the Association for the Advancement of Blood and Biotherapies. Hospitals fear that state mandates could conflict with these rules and expose them to legal risk if something goes wrong. Directed donations may also require additional testing, tracking, and sometimes irradiation of blood from relatives, raising expenses without necessarily enhancing safety. Many hospital groups quietly note that these bills are often driven by requests for “unvaccinated blood,” which blood banks do not track. Their main argument is that the anonymous volunteer blood system functions well. The real question is whether the government should compel private hospitals to accommodate patient preferences or let them set their own transfusion policies.
The current debate over “directed donations”—where patients request blood from a specific donor—recalls a similar controversy during the early HIV/AIDS crisis in the 1980s. Back then, before reliable screening tests existed, many patients feared the blood supply and asked hospitals to use blood from friends or relatives instead. But once HIV testing and other screening technologies improved, studies showed that directed donations were not safer and sometimes carried slightly higher risks than blood from anonymous volunteer donors. One reason is that anonymous donors may feel more comfortable disclosing sensitive risk factors during screening, while friends or relatives may feel pressure to donate even if they shouldn’t.
As a result, transfusion specialists and organizations like the American Red Cross shifted toward the modern system of a pooled, anonymous blood supply, which allows for consistent screening and efficient management of blood types and inventory. Today, the U.S. blood supply—regulated by the FDA and supported by advanced testing—is among the safest in the world, with an estimated HIV transmission risk of about 0.23 per one million donations. In that sense, today’s push for directed-donation laws is more a revival of a debate in transfusion medicine that was largely settled decades ago than a medical breakthrough.
If lawmakers truly want to promote medical autonomy, they should allow patients and providers to make voluntary arrangements without government interference. Mandating how hospitals manage their blood banks, what insurers must cover, and how medical professionals practice transfusion medicine does the opposite. You can’t promote medical freedom by imposing it through government compulsion.
Jeffrey A. Singer, MD, practices general surgery in Phoenix, Arizona and is a senior fellow at the Cato Institute.
