The risks and benefits of a request for nonblood medical or surgical management must be weighed against a patient's constitutional right to refuse treatment. Thorough assessment, planning, and preparation optimize a patient's status to undergo surgery without transfusions. Thoughtful selection of surgical approach, meticulous hemostasis, and blood salvage with reinfusion can minimize blood loss. Continuous patient assessment, supportive measures, and selective phlebotomy allow safe recovery. An educated, organized, and well-equipped team can manage the medical and surgical care without the use of blood transfusions; not only do we have the tools but also the ethical responsibility to do so.
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