The informed consent process should occur prior to a blood transfusion. When informing a patient and family of the risks, benefits, and alternatives of a proposed blood transfusion, the patient’s developmental level and the parents’ assessed ability to understand should guide the discussion. A “Rule of 7” is often used to determine capacity for medical decision-making based on the patient’s age. However, children vary significantly in cognitive ability, maturation level, and life experience; therefore, age alone may not determine decision-making capacity. Some minor patients do not require parental permission prior to a transfusion: those that are married, pregnant, financially independent, in military service, or adjudicated to be emancipated under state law. Parental decision-making responsibility has boundaries and is limited when there is a potential for harm. Today, parents in the United States (US) are not allowed to refuse a life-saving transfusion for their child when the benefit of transfusion outweighs the risk of death or imminent harm.