Undisclosed Sexual Risk Exposures: Results of a Nationwide Compliance Study among Whole Blood Donors in Germany

Background

Undisclosed sexual infection risks are the main reasons for transfusion transmissible infections in German blood donors that have qualified for donation by donor health interviews and questionnaires. Until now, data about compliance with deferral criteria were only available from post-donation interviews with infected donors, and information about the proportion of donors which did not disclose (sexual) risks at the donor health questionnaire was not available.

Methods

A prospective nationwide anonymous online survey was conducted to investigate compliance of whole blood donors with deferral criteria for sexual infection risks. Twenty-one blood establishments which represent 80% of the regular whole blood-donor population invited all donors which donated blood during an 8-week period between January and March 2020.

Results

14,882 participants completed the questionnaire. A relevant proportion of non-compliance was shown (3.0%, 95% CI: 2.7-3.3%) - with male donors being non-compliant significantly more frequently than females (3.5% vs. 2.2%, p < 0.001). A quarter of the non-compliant men were MSM (0.9%, 95% CI: 0.7-1.1%). Non-compliance was strongly associated with the perception that questions about sexual risk exposures are too private. This is in line with the finding that a large proportion of donors (21%) refused to answer at least one question about sexual infection risks.

Conclusion

The presented data, collected for the first time, is suitable for assessing the impact of changes in the donor selection process. Donor's limited willingness to provide detailed information about sexual risk behaviour has to be kept in mind when further strategies for fair appraisal of individual sexual infection risks will be discussed.

Sexual risk behavior questions: Understanding and mitigating donor discomfort

Background

Blood operators are working to improve donor screening and eligibility for gay, bisexual and other men who have sex with men (gbMSM), and trans and nonbinary donors. Many consider screening all donors for specific sexual risk behaviors to be a more equitable approach that maintains the safety of the blood supply. Feasibility considerations with this change include ensuring donor understanding of additional sexual behavior questions and minimizing donor loss due to discomfort.

Study design and methods

Qualitative one‐on‐one interviews were conducted with Canadian whole blood and plasma donors (N = 40). A thematic analysis was conducted to assess participants' understandings of the questions, examine their comfort/discomfort, and identify strategies to mitigate donor discomfort.

Results

All participants understood what the sexual behavior questions were asking and thought the questions were appropriate. Themes related to comfort/discomfort include: their expectations of donor screening, social norms that they bring to donation, whether their answer felt like personal disclosure, knowing the reasons for the question, trusting confidentiality, confidence in knowing their sexual partner's behavior, and potential for the question to be discriminatory. Strategies to mitigate discomfort include: providing an explanation for the questions, forewarning donors of these questions, reducing ambiguity, and using a self‐administered questionnaire.

Conclusion

While many blood operators and regulators view the move to sexual behavior–based screening for all donors as a significant paradigmatic shift, donors may not perceive additional sexual behavior questions as a significant change to their donation experience. Further research is needed to evaluate the effectiveness of strategies to mitigate donor discomfort.

Post-donation information management

Post-donation information (PDI) can be defined as any information provided by the donor or other source following a donation, that, had it been known to the blood establishment during the selection process, would have resulted in the donor's deferral. PDI reflects the shortcomings, limitations and complexity of the donor selection process. Knowledge of the causes of PDI events, their types and frequency, is a prerequisite not only for their effective management, but also for the implementation of measures to improve the selection process and the safety of donated blood. Managing PDI requires a considerable investment of time and close collaboration between the various stakeholders involved in this process. Despite its regular occurrence and the fact that PDI points to a possible problem of blood safety, very few studies have been published so far, mostly by US and Canadian authors. This review article aims at collecting and discussing available information on all aspects of PDI management, with particular reference to European experiences.

Validation of a standardized donor health questionnaire across substances of human origin

BACKGROUND AND OBJECTIVES

A donor health questionnaire (DHQ) aims to ensure the safety of donors and recipients of transfusions or transplantations with blood components, plasma-derived medicinal products, tissues, haematopoietic stem cells and medically assisted reproduction (in short substances of human origin; SoHO). Currently, many different DHQs exist across countries and SoHO. TRANSPOSE (TRANSfusion and transplantation PrOtection and SElection of donors) developed and validated a standardized DHQ to use across countries and SoHO. We tested whether participants understand the questions and provide honest answers.

METHODS

For the validation of the standardized DHQ, two demographically representative online surveys were conducted in Germany (N = 3329) and Austria (N = 3432). We surveyed whether participants understood each DHQ question and would answer the questions truthfully. We used experimental settings to test whether there is a difference between mode of administration (print vs. online), the order of the questions (subject vs. chronological order), and the positioning of the general state of health question (beginning vs. end) in the DHQ. Using regression models, we tested the DHQ's impact on participant mood after completion and on socially desirable response behaviour.

RESULTS

Participants understood the DHQ questions well and would answer them honestly. Nevertheless, the data show different levels of understanding and honesty when responding. Administration mode was the only characteristic that had a significant influence on mood, with the online version resulting in a more favourable mood in comparison to the printed version.

CONCLUSION

The DHQ was well understood and had a low dishonest tendency. Our findings can serve as an impulse for further research on DHQ criteria across other SoHO and countries.

Effectiveness of the post-donation instruction sheet in conveying information to repeat blood donors

BACKGROUND AND OBJECTIVES

Written materials are commonly used for blood donor education. While pre-donation materials are largely standardized across US blood collectors, the post-donation instruction sheet (PDIS) is variable and few have been evaluated to assess their effectiveness in conveying information as reflected by donors' attention, understanding and recall.

METHODS

An online survey was sent to two independent randomly selected samples of repeat donors, before and after implementation of the enhanced PDIS.

RESULTS

A total of 12 935 blood donors responded (33·4% response rate). Most donors did not read the entire PDIS - 34·3% less than half and 18·1% none. Of the 10 593 donors who reported reading any of the PDIS, 97·8% recalled instructions about immediate post-donation care (e.g. extra fluids/no exercise) and 88·0% to call with questions/problems. However, only 50·1% remembered reading about what to do if you felt dizzy/faint and 32·4% about care for bruises. Recall rates in every area were similar before and after revision; except after revision, more donors remembered seeing information about maintaining iron and fewer that you should call the centre back with additional health information (P < 0·0001).

DISCUSSION

Blood collectors rely heavily on written materials to convey instructions to donors. Most repeat donors do not read the entire PDIS, and many do not recall important information. More donors recalled seeing how to maintain iron with the enhanced PDIS, but recall deficits remained on how to care for adverse reactions. Written materials alone appear to be insufficient to educate some donors about new or updated topics.

Evaluation and improvement of blood donor educational materials: results from a multicenter randomized controlled trial

BACKGROUND

Blood collection centers are charged with creating donor educational materials (DnEM) that are easily understood across all prospective donor populations, while addressing mandates and recommendations from regulatory agencies and professional standard setting organizations. Donors must have sufficient information to understand the donation process with its risks and benefits, time to consider options before deciding, and opportunity to choose whether to proceed with or decline donating. The goal of this multisite randomized controlled trial was to evaluate knowledge acquired using standardized DnEM. America's Blood Centers' Working Group (WG) for Donor Education and Communication was formed to evaluate and suggest modifications of these documents. Based on pilot work, a randomized clinical trial was designed to test donor knowledge across a variety of populations. The WG identified several shortcomings in the current DnEM and proposed new DnEM. The new DnEM were tested against the same, current DnEM being used at all three sites (Blood Donor Educational Material, 2016 version 2.0, published in conjunction with the AABB uniform donor history questionnaire).

METHODS AND MATERIALS

One-hundred sixty-five first time and returning donors were randomized in a 2x2 model to review either new DnEM or current DnEM. Every participant completed a pre- and post-quiz that tested their understanding of the DnEM.

RESULTS

Returning donors had greater baseline knowledge compared to new donors, but new donors improved more versus returning donors. Donors using the new DnEM showed greater improvement in knowledge than those using current DnEM.

CONCLUSION

Comprehension of DnEM can be improved. With this sample size the results suggest that the findings are independent of demographic characteristics, but a larger study would be necessary to confirm this.

Quality of the blood donation campaign in the military: A sample from Turkey

OBJECTIVES

In this study, the conformity of blood donation services performed by Turkish Red Crescent Mobile Medical Team in a Basic Military Training Centre to quality standards was researched and the results were discussed by taking the principles of biomedical ethics into consideration.

MATERIALS AND METHODS

This descriptive study was conducted at the Basic Military Training Centre, Canakkale, Turkey. In total, 269 voluntary non-remunerated blood donors who made blood donation between 10 and 12 August 2015 formed the population of the study. All of the donors were recruits who had joined the army to carry out their military service. A questionnaire for assessing the quality of the blood donation services was administered to the participants after the blood donation. SPSS 15.0 software package was used for data analysis.

RESULTS

In the study, 232 voluntary non-remunerated blood donors were reached with a response rate of 86.2%. It was seen that the phlebotomists in the mobile medical team followed the quality standards in the blood donation process with the rate of 91.8% to 100%. However, outstanding omissions were found in informing the donors about blood donation process.

CONCLUSION

In blood donation campaigns conducted in the institutions such as military units, the quality standards developed in line with the principles of biomedical ethics should not be neglected citing some reasons such as excessive numbers of donors, time limitations and organisational deficiencies. Increasing the quality in blood donation services will increase both donor satisfaction and their motivation to donate blood again in the future.

Selecting the Right Donors - Still a Challenge: Development of a Uniform Donor Questionnaire in Germany

The selection of blood donors includes the assessment of the individual's health and medical history by using a donor questionnaire (DQ) in order to identify persons whose donation could present a health risk to recipients or to themselves. This way, DQs provide one layer of blood safety and contribute to the high safety profile of blood components currently available in Germany. This review reports the development of a new uniform questionnaire in Germany and its first evaluation using a field test approach. This development is set in context with the international experiences regarding donor selection and prospective challenges.

Context and social perceptions of blood donation in donors found positive for human immunodeficiency virus in France

BACKGROUND

In France, information collected during postdonation interviews showed that a majority of human immunodeficiency virus (HIV)-infected donors were not eligible to donate as per donor selection criteria. In the interest of blood safety, this study aimed to explore the mechanisms of noncompliance with blood donor selection criteria, notably the permanent deferral of men who have sex with men (MSM).

STUDY DESIGN AND METHODS

Semistructured individual interviews were conducted with 32 blood donors found positive for HIV between mid-2011 and 2014. Topics such as the experience and motivations for donating blood, understanding of selection criteria, sexual risk management, and opinions on donor selection were discussed. Transcripts were analyzed inductively.

RESULTS

More than 50% of study participants were noncompliant with donor selection criteria. Reasons for nondisclosure of risk factors in the predonation questionnaire or the predonation interview included stigma, test-seeking motivations, symbolic attachment to blood donation, and context of donation. Compliance to donor criteria was seen as secondary by donors who reaped personal benefits from the symbolism of their donation. Donors lacked self-reflexivity in their assessment of risky sexual behavior. The "window period" and the underlying epidemiologic arguments for donor selection criteria were poorly understood. Nearly all participants disapproved of the permanent ban on blood donations from MSM.

CONCLUSION

This study demonstrated the need for more communication on the epidemiologic basis for donor selection criteria and on the window period to facilitate donor compliance. These findings have already advanced improvements to predonation documents, in a larger context of 2016 donor selection criteria revision.