**1. Introduction**

The decisions of blood, cells, and tissues banks, referred to as banks, are usually complex, considering the risk of failure during the collection, production, storage, and distribution of the blood, cells, and tissues. Differently from hospitals, where most of the clinical decisions are performed by physicians (an important and noncontrolled source of uncertainty), the clinical decisions in banks are taken according to what is required by the law or algorithms (a minor and controlled source of uncertainty). Decisions related to the specifications of products, such as based on laboratory quality control results, should happen using reliable methodolo‐ gies to assure an acceptable risk associated with the post‐transfusion or post‐transplantation

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safety [1, 2]. Clearly, critical decisions could not consider uniquely the safety of the receptor of blood, cells, or tissues. Some other variables are also significant to the selection of an individual product or service. Examples are the impact in the budget, which could be decisive in choosing of products or services satisfying the technical specifications. Unreliable deci‐ sions are happening from technical levels to the top management. Failures in decisions could contribute seriously to unsuccessful goals, such as the example of improper validation of an individual product is the cause of a receptor's infection.

The role of the decision maker is critical for the successful implementation of a methodology to the acceptance of new products or services. The decision must be carefully achieved. Erroneously, it could find that all the available information could be useful to contribute to accurate decisions. However, this is inappropriate since a larger quantity of information does not signify more substantial impact in the decision making (most of the information is nonsignificant). The decision maker identifies what is the critical information to a certain decision. This was already defined by Deming in the Pareto principles or "80-20 rule." This policy considers that approximately 80% of the effects come from 20% of the causes [3]. It is closely related to the cause-effect diagram, allowing an easier identification of the primary sources of a particular effect. The effect in the context of this chapter is the decision goal.

A methodology that is recognized in the industry and services is the analytical hierarchy process (AHP). However, it is not systematically applied in banks. Following this model, the goal is identified together with the criterion and subcriterion, stakeholders, and alternative actions. The options per criterion should be selected according to the considered priorities, usually ranked in a matrix table involving criteria and subcriteria [4, 5].

Frequently, banks are focused exclusively on the customer (donor and receptor). However, current management systems [6] consider it must not be uniquely centered in customer but also in all relevant interested parties (stakeholders). ISO 9000 defines stakeholder as the "person or organization that can affect, be affected by, or perceive itself to be affected by a decision or activity" (entry 3.2.3 of [7]). In the European banks, stakeholders are also the State (usually in the name of a regulatory agency) and the European Commission (the European banks must fulfill a set of directives transposed to the national law), manufacturers and suppliers including certification and accreditation providers

Despite ISO 9001 model is applied systematically to European banks, the use of decisionmaking models is not uniform and even rarely discussed. ISO 9001 is focused on the continuous satisfaction of the stakeholders. However, the management procedures are not standardized. The (AHP) is a recognized procedure that could be valuable to assure successful decision making. The use of this approach could also be helpful when setting the objective per process, such as when defining the target's criteria. Alternatives to the goal are considered. The AHP requires that the information related to the decision methodology is organized in a hierarchy tree using judgments to determine the ranking of the applied criteria. Banks staff easily recognize the major decisions critically related to the sustainability of the organization, such as:


This chapter briefly discusses the AHP theoretical approach applied to the banks. As an example, it uses an AHP methodology to the selection of a clinical chemistry laboratory test. Currently, the recommend methods to select a lab test are not related to AHP. Commonly, they are primarily focused on technical requirements, and in a second phase to the cost of reagent per result. However, there are other critical variables, such as reliability of the results, and the cost also has some components that are not considered. This example verifies if the application of the AHP approach could significantly improve the decision-making correctness. Although this is a unique case, the principles considered are generic.
