Oral Abstract
Transfusion Service
Emily Coberly, MD
Divisional Chief Medical Officer
American Red Cross
Maryland Heights,, Missouri
Disclosure information not submitted.
Directed blood donation (DBD) refers to collection of blood components for a specific recipient. DBD is medically-necessary for patients with difficult to match antibodies; however, patients may request DBD from personally chosen relatives/friends or individuals with certain characteristics (e.g., sexual orientation, vaccination status, or religion) despite a 2023 FDA statement regarding lack of scientific support. This study aimed to assess current DBD practice patterns and utilization in the United States (US) and Canada.
Study
Design/Methods:
A survey was distributed electronically to 592 AABB-accredited US facilities and 2 Canadian blood centers between October 2024 to January 2025.
Results/Findings:
A total of 203 unique institutions responded to the survey (34% response rate). Respondents included 167 (82%) hospital transfusion services without donor collections (TS), 26 (13%) hospital transfusion services with on-site donor collections (TSD), and 10 (5%) blood collection centers. DBD units for non-medical indications were collected or received by 7 (70%) blood collection centers, 14 (54%) TSDs, and 67 (40%) TSs. Among these, two (29%) blood collection centers, one (7%) TSD, and 13 (19%) TSs stopped accommodating DBD requests in the last 5 years. Clinical scenarios for DBD requests varied widely. Approximately 50% of blood collection center respondents did not know the rationale for individual DBD requests, 34% of respondents noted patient/guardian requests for DBD from family/friends and 14% noted DBD requests from donors who have not received a COVID vaccine. Transfusion medicine review of DBD requests was always required by 88 (43%) of responding institutions, whereas 73 (38%) hospitals and one collection center reported being unable to refuse DBD requests. Of 88 centers that accommodate DBD requests, only 53 (60%) confirm donor ABO compatibility with the intended recipient. Other exclusion criteria for DBD requests, if any, varied (Table 1). One-half of blood centers reported additional charges for DBD collections; more than 40% of TS and TSD respondent institutions also reported additional charges. The highest DBD collection/receipt was reported in 2022 by 7 blood centers and 51 TSs. In contrast, 10 TSDs reported peak collections/receipt in 2020. Most TSDs (9/13) and TSs (42/74) reported that some DBD units went un-transfused and discarded. Only 37% of TSs returned unused DBD units to general inventory compared to 54% of TSDs. Centers that do not return DBD units reported higher discard rates.
Conclusions:
DBD practice varies widely across the US and Canada. Several US blood centers and hospitals and both Canadian blood centers surveyed have recently ceased accommodating non-medical DBD requests. Centers accommodating DBD may benefit from adopting best practices such as confirming ABO compatibility and defining exclusion criteria to reduce recipient risk.