Plasmapheresis: recruitment, retention and flexible donors

What influences decisions to donate plasma? A rapid review of the literature

BACKGROUND AND OBJECTIVES

Plasma has become an essential ingredient for various medical treatments. Many blood collection agencies rely on voluntary non-remunerated donation when collecting plasma, but at present many do not collect sufficient plasma to meet domestic demands. This rapid review sought to explore the factors that have been found to influence people's decisions to donate plasma to inform future research.

METHODS

Searches were conducted in PubMed, PsycINFO, Social Sciences Citation Index and CINAHL for peer-reviewed journal articles that discussed plasma donation and the factors associated with donor behaviour. Pertinent information from included articles was extracted and arranged in themes.

RESULTS

In total, 33 articles were included in this review. Three main themes were identified by the authors. The first focused on site-level factors related to blood collection agencies' engagement with plasma donors and their influence on plasma donation experiences. The second theme considered how individual characteristics and experiences influence willingness to donate plasma. The third theme examined social and cultural-level factors, such as how social networks and community shape perceptions and experiences with donation.

CONCLUSION

Our findings suggest that the current understanding of plasma donation is focused mainly on converting whole blood donors and also centres on individual-level factors to donation. Further research must examine what factors attract non-whole blood donors to become plasma donors, focusing on broader social-level influences. This review will inform policies and interventions for blood collection agencies to increase plasma donors.

How to convert whole‐blood donors to plasma donors: An investigation of the mechanisms of awareness of need for plasma and donors' perception of response efficacy

BACKGROUND

Blood donation services need to increase plasma donations to match the rising demand. However, evidence on how to best recruit donors among whole-blood donors is limited. Therefore, this study evaluated the effectiveness of a conversion strategy based on two different mechanisms that drive donor behavior: (a) awareness of the need for plasma donation and (b) perception of response efficacy regarding plasma donation.

STUDY DESIGN AND METHODS

An online experiment with 246 German Red Cross whole-blood donors (possibility of plasma donation, blood group AB) was conducted using a 2 × 2 factorial, between-subject setup, and a pre-post treatment measurement. The mechanisms varied and were addressed with experimental treatments and measured. Analyses of variance and hierarchical regression models were used to analyze the effects on intention and behavior.

RESULTS

The intention to donate plasma was low, but increased with treatment (mean value_overall of intention_{beforeTreatment}  = 2.63, SD = 1.73 vs. intention_{afterTreatment}  = 3.28, SD = 1.92). Furthermore, 31% of participants expressed willingness to be forwarded to the appointment-scheduling system of the blood donation service for further information. Only the mechanism of response efficacy was significantly associated with the intention to donate plasma (β_Efficacy  = .254, p = .001; β_{Awareness of Need}  = .126, p = .070).

DISCUSSION

A conversion strategy based on making donors aware of their response efficacy is a promising way to optimize donor panels by shifting them to where they have the greatest impact. However, this study also substantiates the difficulty of such an effort. Blood donation services should invest in persuasion efforts and build personalized integrated marketing communications.

Understanding the experiences of plasma donors in Canada's new source plasma collection centres during COVID-19: A qualitative study

BACKGROUND AND OBJECTIVES

To address a national concern over the sufficiency of plasma, Canadian Blood Services (CBS) initiated a proof-of-concept programme with three new source plasma collection centres, aiming to demonstrate a cost-effective template for future source plasma collection and to alleviate the concerns and risks associated with the dependence on the United States. This study uses social capital as a framework to assess the success of the proof-of-concept collection centres.

MATERIALS AND METHODS

One-hundred and one qualitative interviews with source plasma donors in three new source plasma centres in Canada were carried out.

RESULTS

CBS played a critical role in motivating whole-blood donors to switch to plasma donation by building on their identity as a donor and facilitating access. Community was central to ensuring that donors returned. The importance of the social network was apparent through relationships participants developed with staff and through the relationships that staff had with each other. Donors wanted to understand more about the uses of plasma so that they could promote donation through their social networks outside the centre.

CONCLUSION

Campaigns to convert existing blood donors to plasma donors should build on their identity as a donor and structure the centre as a safe and welcoming place. To retain donors, blood collection agencies should emphasize community by facilitating staff ability to work well together and connect with the donor. Blood operators have the potential to expand existing social networks and foster trust through the dissemination of knowledge about plasma more broadly in more diverse communities.

Motivators of and barriers to becoming a COVID-19 convalescent plasma donor: A survey study

OBJECTIVES

To determine the motivators and barriers to COVID-19 convalescent plasma donation by those in the United Kingdom who have been diagnosed with or who have had symptoms of SARS-CoV-2 (COVID-19) but who have not donated.

BACKGROUND

Convalescent plasma from people recovered from COVID-19 with sufficient antibody titres is a potential option for the treatment and prevention of COVID-19. However, to date, recruiting and retaining COVID-19 convalescent plasma donors has been challenging. Understanding why those eligible to donate COVID-19 convalescent plasma have not donated is critical to developing recruitment campaigns.

METHODS/MATERIALS

A total of 419 UK residents who indicated that they had been infected with COVID-19 and who lived within 50 km of sites collecting COVID-19 convalescent plasma completed an online survey between 25th June and 5th July 2020. Respondents completed items assessing their awareness of convalescent plasma, motivations and barriers to donation and intention to donate COVID-19 convalescent plasma.

RESULTS

Awareness of COVID-19 convalescent plasma was low. Exploratory factor analysis identified six motivations and seven barriers to donating. A stronger sense of altruism through adversity and moral and civic duty were positively related to intention to donate, whereas generic donation fears was negatively related.

CONCLUSIONS

Once potential donors are aware of convalescent plasma, interventions should focus on the gratitude and reciprocity that those eligible to donate feel, along with a focus on (potentially) helping family and norms of what people ought to do. Fears associated with donation should not be neglected, and strategies that have been successfully used tor recruit whole-blood donors should be adapted and deployed to recruit COVID-19 convalescent plasma donors.

Gone, but haven't forgotten: insights on plasmapheresis donation from lapsed donors

BACKGROUND AND OBJECTIVES

Blood Collection Agencies in several countries have implemented strategies to increase the number of plasmapheresis collections. Despite this, a sizable minority of plasma donors lapse from donation each year, with little research conducted on this topic. An understanding of the plasma donation experience from the perspective of lapsed donors, insights into why they stopped donating and their views on returning to donate may provide opportunities to intervene to increase the retention and reactivation of plasma donors.

MATERIALS AND METHODS

A qualitative approach was used in this study, with 17 lapsed plasma donors (no plasma donation for at least 13 months) interviewed. A purposive recruitment strategy was used to obtain a sample with diversity in gender (47% men), age (M = 36·2 years, SD = 13·6) and donation experience (M = 9·2 years, SD = 9·6). Semi-structured, narrative interviews were conducted, with participants describing their plasma donation careers chronologically from first donation to most recent.

RESULTS

The majority of participants described at least some aspect of the plasma donation procedure as unpleasant. However, adverse experiences were only attributed to lapsing in a minority of cases, with other participants reporting significant life events, perceived ineligibility and concerns about the safety of the procedure as the reason why they lapsed.

CONCLUSION

It is common for lapsed plasma donors to intend to donate again in the future. Recommendations are given for strategies to address barriers to returning, noting the potential role of tailored education and support.

Offering new and returned donors the option to give plasma: implications for donor retention and donor adverse events

BACKGROUND AND OBJECTIVES

In 2018, Australian Red Cross Lifeblood changed its plasmapheresis eligibility criteria to allow donors to donate plasma without the requirement of a prior successful whole blood donation. This study evaluated the impact of this policy change on donor retention and donor safety.

MATERIALS AND METHODS

All donors who had attempted to give their first plasma or whole blood donation from January to June 2018 were included in this retrospective cohort study. Donor characteristics and adverse events were analysed for this index donation, and the cohort was followed for 18 months to analyse time to return, subsequent donation frequency and predictors of return.

RESULTS

Male and younger donors provided a significantly greater proportion of first donation plasma than females and older donors. New donors who gave plasma had the highest rate of donor adverse events, including vasovagal reactions and phlebotomy injuries. Nevertheless, donor retention was not affected, with more new donors returning and at a greater subsequent donation frequency after a plasma donation compared to new donors donating whole blood. First-time plasma donors who had previously donated whole blood, however, had greater and quicker rates of return, and more subsequent donations.

CONCLUSION

Offering new donors the option to give plasma had a positive effect on donor return and subsequent donation frequency. Removing the requirement of a prior whole blood donation is a viable way to increase plasma collections although the combined effect of new donor status and plasmapheresis procedure on adverse event risk needs to be considered.

Understanding donation frequency: insights from current plasma donors

BACKGROUND AND OBJECTIVES

Encouraging existing plasma donors to donate more frequently is a key objective for blood donation services committed to expanding yield through voluntary non-remunerated plasmapheresis donation. This requires an understanding of donors' perspectives on their current donation practice and how this relates to their knowledge and beliefs about the need for plasma. To explore this, Australian plasma donors were interviewed about how they arrived at the frequency at which they donate.

MATERIALS AND METHODS

Semi-structured telephone interviews were conducted with 105 Australian plasmapheresis donors.

RESULTS

Key themes identified were as follows: fitting donation into busy lives and how ideas about being an ongoing donor and the institutional context shaped their perspective on frequency; perceptions of the impact of donation on health; and wanting to make a greater contribution.

CONCLUSION

Experienced plasma donors work to maintain a donation practice in the context of busy lives often by adopting a flexible approach to donation frequency. Their knowledge of the contribution their donations make is key to their continued donation, yet most identified constraints to donating more frequently. Health concerns were a particular concern for some, and more research is needed to understand donors' perspectives on the impact of donating on their health.

How do people become plasma and platelet donors in a VNR context?

Background

The demand for therapeutic plasma‐derived products poses a challenge to blood collection agencies (BCAs). In 2014–2015, the volume of plasma sent for fractionation met 17.7% of Quebec's needs for immunoglobulins. This article aims to offer an exploration of the paths blood donors follow in order to become plasma and platelet donors (PPDs).

Study Design and Method

This analysis is based on semi‐structured interviews with 50 PPDs in Quebec, Canada. Our analysis focused on the occurrence of events and the presence of contextual elements identified through: (1) factual data on PPDs; and (2) what PPDs identified as being an influence on their donation experience. This information was synthesized using a typology of trajectories.

Results

Six typical trajectories have been distinguished, first by the presence (19/50 respondents) or absence (31/50) of blood donation as a family tradition. Of the latter 31 donors, some pointed instead to inherited family values as having a significant influence on their commitment (11/31). Donors' careers were then distinguished as having started early (34) or late (16). Sub‐types then appeared with the addition of other contextual elements, motivation profiles, and circumstances under which the conversion to apheresis donation occurred.

Conclusion

Our findings suggest the existence of diversified donor trajectories, and confirm the importance of conducting more in‐depth analyses of the sequence of events occurring along PPDs career. BCAs should develop strategies carefully tailored to different potential clienteles if they wish to convert whole blood donors to apheresis donation, and also focus on recruiting and retaining young PPDs.

Determinants of plasma donation: A review of the literature

The major contribution of Human Sciences in the understanding of the whole blood donation behavior has been through the study of individuals' motivations and deterrents to donate. However, if whole blood donation has been very widely studied in the last sixty years, we still know very little about plasma donation in voluntary non-remunerated environments. Yet, the need for plasma-derived products has been strongly increasing for some years, and blood collection agencies have to adapt if they want to meet this demand. This article aims to review the main motivations and deterrents to whole blood donation, and to compare them with those that we already know concerning plasma donation. Current evidence shows similarities between both behaviors, but also differences that indicate a need for further research regarding plasma donation.

[Commitment in plasmapheresis donation: A study of determinants among regular donors in plasmapheresis]

The purpose of this study, based on the Theory of planned behavior, is to identify and ultimately better understand what determines the fidelity and the regularity of donors committed in plasmapheresis donation. This qualitative study is a primary stage to establish a classification of donors in a French socio-cultural context. For this reason, we have carried out a survey among 16 regular plasmapheresis donors, by way of semi-structured individual interviews at the Établissement français du sang - Brittany. The level of commitment of these regular donors is considered as a level of appropriation. If subjective norms have initially influenced their decision to donate blood, no specific motivation has been highlighted for them to donate plasma except a generally favourable attitude towards the voluntary donation process. The perception of control over their environment is a variable which played a decisive role in the donor's intention to give, with little cost associated to plasmapheresis donation and recourse to internal causal explanations. A better comprehension of the plasmapheresis donors' determinants should lead us to a more efficient awareness of new potential donors, thereby enhancing recruitment and retention. Due to the increasing need for plasma-derived products, this study's ultimate issue is closely correlated both with ethical and socio-economic aspects. Following which, after analysing the results, a certain number of recommendations will be made.