Therapeutic apheresis is used to treat various types of disorders. The American Society for Apheresis (ASFA) publishes evidence-based guidelines every 3 years to assist apheresis practitioners in the rationale and management of apheresis patients and outlines basic technical specifications for procedures. However, the guidelines provide limited guidance on the urgency of the procedures and only comment on indications with enough published evidence available for categorization. In this session, a summary of the ASFA guidelines and a review of how to perform an apheresis consult will be presented. This session will then discuss how to approach consults with a clinical team, when the indication for a procedure is beyond the ASFA guidelines. Furthermore, the session will address the ethical and legal challenges for these discussions and decisions.