Beyond “futility thresholds”: An ethical framework for massive transfusion decisions

When limitations reflect capability gaps rather than patient physiology, institutions should treat these as sentinel events requiring structured review and potential systems improvement. This framework addresses the risk that unit-based thresholds become self-fulfilling limits or mask implicit rationing. By clarifying whether stopping reflects patient physiology or system constraints, it appropriately assigns accountability and enhances transparency in scarcity-driven decisions while maintaining rapid clinical judgment.