(P-TS-43) Directed Donations</span><span>: </span><span>Utilization</span><span> and Cost Analysis for </span><span>a Large Pediatric Hospital</span>

Background/Case Studies: Directed blood donation for a specific patient, often by a family member or friend, is frequently performed for personal or social reasons, often lacking medical necessity. In such cases, directed donation is not recommended, as altruistic donation is generally safer, more cost efficient, readily available, and less labor intensive. Additionally, in our institution, providers do not request a specific volume of product, leading to multiple extraneous units being collected. Our aim was to evaluate the utilization and costs of directed donation in our primarily pediatric institution.

Study

Design/Methods: We performed a retrospective review of records from the blood bank laboratory information system for directed units received, transfused, released, and wasted from 2018-2024. Information regarding the ordering service was obtained from the electronic medical record. Administrative costs associated with directed donation and cost of units wasted were based on current facility contracts. Technical time was estimated based on direct observation. Calculations were performed using Microsoft Excel.

Results/Findings: A total of 2,121 directed units (RBC, plasma and platelets) were received for 650 patients over the study period (range: 1-63 units per patient). Of these patients, 220 (34%) did not receive transfusion, and 440 (68%) had unused units. Unit disposition and cost-analysis are shown in Table 1. Added administrative costs were $530,250.00 with $306,250.00 spent on units ultimately released to general inventory for potential use by other patients. Time spent on receipt, processing, inventory management, transport, irradiation, and release of directed units was estimated at one hour per patient resulting in 650 hours of additional technical time, which results in further institutional cost. The most common reasons for unit release were “patient discharge” (44%), “unit no longer needed” (34%), “incompatible unit” (8%), and “unit about to expire” (6%). Hospital services most commonly requesting units were Congenital Heart Surgery (55%), Neurosurgery (25%) and Orthopedics (7%).

Conclusions: Directed donations represent a significant, and often unnecessary, administrative and financial burden to the pediatric transfusion service, with greater than one-third of patients not receiving transfusion. A substantial proportion of units were ultimately not transfused and more than two-thirds of patients had unused units. Directed donor units increase direct and indirect costs for our service, and our findings highlight the need for more judicious use of directed donation. Targeted improvements such as physician education, addition of unit type and quantity requirements, and evidence-based guidelines can optimize and reduce the use of directed donation within our health system.