Ambiguity leads to uncertainty: ambiguous demands to blood donors

Transfusion safety in francophone African countries: an analysis of strategies for the medical selection of blood donors

BACKGROUND

The goal of selecting a healthy blood donor is to safeguard donors and reduce the risks of infections and immunologic complications for recipients.

STUDY DESIGN AND METHODS

To evaluate the blood donor selection process, a survey was conducted in 28 blood transfusion centers located in 15 francophone African countries. Data collected included availability of blood products, risk factors for infection identified among blood donor candidates, the processing of the information collected before blood collection, the review process for the medical history of blood donor candidates, and deferral criteria for donor candidates.

RESULTS

During the year 2009, participating transfusion centers identified 366,924 blood donor candidates. A mean of 13% (range, 0%-36%) of the donor candidates were excluded based solely on their medical status. The main risk factors for blood-borne infections were having multiple sex partners, sexual intercourse with occasional partners, and religious scarification. Most transfusion centers collected this information verbally instead of having a written questionnaire. The topics least addressed were the possible complications relating to the donation, religious scarifications, and history of sickle cell anemia and hemorrhage. Only three centers recorded the temperature of the blood donors. The deferral criteria least reported were sickle cell anemia, piercing, scarification, and tattoo.

CONCLUSIONS

The medical selection process was not performed systemically and thoroughly enough, given the regional epidemiologic risks. It is essential to identify the risk factors specific to francophone African countries and modify the current medical history questionnaires to develop a more effective and relevant selection process.

The informed consent process in whole blood donation

CONTEXT

Informed consent in transfusion medicine has been an area lacking of significant research and it is unknown if donors fully comprehend the risks associated with whole blood donation.

OBJECTIVE

To assess the adequacy of the informed consent process in whole blood donation.

DESIGN

A brief questionnaire was constructed and distributed to whole blood donors visiting various fixed and mobile donor sites of the Central Pennsylvania Blood Bank. Questions consisted of demographic information; donor opinions of information content, length, and comprehension; and a short quiz pertaining to donor risks and eligibility.

RESULTS

Analysis of 849 surveys demonstrated that donors comprehended a mean of 73.5% of the various donor eligibility and risks that were surveyed. Female and younger donors scored statistically higher on comprehension questions compared with male and older counterparts. Donors were most aware of (1) donor eligibility requirements related to acquired immunodeficiency syndrome comprehension, (2) the risk of dizziness postdonation, and (3) having lived in a certain country (93.7%-95.6% comprehension, respectively). Donors were least aware of (1) the risk of a possible referral to a physician for outstanding medical conditions or positive test results, (2) the risk of a positive test result, and (3) West Nile virus testing information (22.4%-49.3% comprehension, respectively).

CONCLUSIONS

Whole blood donors believed that they were giving informed consent, but a significant percentage of donors were unaware of several of the risks associated with blood donation, including participation in West Nile virus research testing. Our data suggest that donors do not fully comprehend the risks of whole blood donation and that repetition of information to the donor, and in multiple formats, strengthens the level of comprehension and thus the informed consent process.