Donor Screening and Deferral

Key points

History

In the United States (US), donor selection and screening is an integral part of the blood collection process and stands at the forefront of blood supply safety and donor well-being. Although some form of donor qualification has existed since the onset of modern-day blood banking, it was not until 1953 that the AABB, formerly known as the American Association of Blood Banks, recommended the use of a donor record card to track demographics and health history, including a list of 21 diseases that would raise concern. The main focus was donor safety, but concerns for transfusion recipient health were also incorporated, namely, transfusion-transmitted infections such as malaria and syphilis. ¹ Over time, the concept of the donor record card underwent a series of refinements to become the Unified Donor History Questionnaire. 123

In 2006, the US Food and Drug Administration (FDA) released its first guidance document identifying the AABB Donor Health Questionnaire (DHQ) version 1.1 (no longer called the Unified Donor History Questionnaire) and its accompanying materials as acceptable for use in donor qualification in accordance with the code of federal regulations (CFR). ¹ This formal recognition allows US blood centers to implement the questionnaire in its entirety without having to develop supplemental materials or seek additional approval. ^1 , 4 Although most blood collection establishments use the AABB DHQ, it is not mandated. ⁵ An alternative process can be used as long as it is FDA approved.

A donor is determined to be eligible to donate blood when found to be in good health and free from transfusion-transmitted infection. This review defines the processes used to select, assess, qualify, defer and reenter donors in the United States as defined by FDA and AABB standards.

Donor recruitment and retention

Regardless of the donor’s health status, the first step in donation is recruitment. In the United States, voluntary nonremunerated donors are the mainstay of blood resources. A previous study suggests an individual’s willingness to give blood is a reflection of their integration in society. ^6 , 7 In a 2016 national survey, 5.7% of individuals 18 years of age or older reported donating in the preceding 12 months. ⁸ The highest reported rates of donation were from younger, US-born, non-Hispanic White males living in either the Midwest or the South. Compared with nondonors, donors were more likely to be college educated, employed, from a higher income family, and physically active nonsmokers. ⁸ The major donor group inaccurately reflects the demographics of the general US population. These findings reflect the need to diversify the blood supply. To do so, it is important to understand why individuals donate and ways to incorporate different recruitment strategies.

The main framework used to predict blood donor activity is the theory of planned behavior. ⁹ This model attributes behavior mainly to the intention to act. In turn, intention is affected by attitude toward a behavior, the perceived social acceptability to perform or not perform a task, and the perceived level of feasibility in performing the behavior. ^{7 , 9 , 10}

Although altruism is often reported as a major stimulus for donation, there are many theories modeling the motivation behind giving blood and the desire to continue. 111213 In a 2014 study, Evans and Ferguson ¹⁰ challenged the notion of pure altruism and highlighted that donors may have other motives such as positive feelings (ie, warm glow) after donation. The study suggests that there is a correlation between intention within the theory of planned behavior construct and various motives (eg, impure altruism) that can be used to predict donor behavior. ¹⁰

Other theories such as attribution and the model of commitment accredit the desire to donate to an individual’s acceptance of their predisposition to give or the development of a “self-sustaining habit” of donation, respectively. ⁷

It is essential that blood centers use social and behavioral tools to target and recruit donors to sustain a blood supply that accurately represents the community it serves.