SI30The Naughties–Recruiting Donors in the Decade of Donor Deferrals

Donor deferral rates continue to rise inexorably. Currently in Scotland more than a third of new donors are deferred, and nearly 20% of all donors attending. This reflects not only some major precautionary measures, e.g. the exclusion of donors with a history of transfusion since 1980, but also the increasing stringency and effectiveness of our selection procedures. The CSD SAC has been working to make the donor selection guidelines more evidence based, but often there is little or no evidence to guide decision making. Donors are frequently upset and angry at what they see as arbitrary decisions. While they are not always right, and cannot be considered to have a right to donate, their reaction may be triggered by the paternalistic nature of our approach to this issue. While accepting that we must do nothing to jeopardise recipient safety, an argument can be constructed for putting our relationship with potential donors on a more ‘modern’ footing, perhaps by defining a ‘contract’ which allows for a definition of, and acceptance of, the risks of donation on a ‘partnership’ basis. It is also fair to say that improvements in recipient safety due to the extreme sensitivity of donation testing have as yet had no impact on donor selection. This is not unreasonable but as and when pathogen inactivation becomes a reality it will perhaps provide an opportunity to review donor selection criteria for which we should be prepared. The threat that testing for vCJD might drastically reduce the available donor base should provide the stimulus for us to begin to contemplate a ‘paradigm shift’ in donor selection.