Oral Abstract
Transfusion Service - Transfusion Practices
Nabiha H. Saifee, MD, PhD (she/her/hers)
Transfusion Service Medical Director
Seattle Children's
Seattle, Washington
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.