Abstracts of the XXIV Annual Scientific Meeting of the British Blood Transfusion Society. September 21-23, 2006. Bournemouth, United Kingdom

Introduction Hundreds of thousands of patients in Europe undergo therapeutic human allograft treatments. There have been three recent reports of possible transmission of vCJD or of abnormal prion by blood transfusion. There is no validated blood test for vCJD, but there are techniques using tissues, that have been used in vCJD epidemiological studies. The principle of testing tonsil, spleen or other reticulo‐endothelial or neurological tissues deserves discussion including issues of test validation, logistics of biopsy sampling, timeframes, potential implications for other human material procurement and ethical issues. Method The advantages and disadvantages of instituting vCJD tests on deceased donors was considered, legal advice sought and logistical issues considered. The advantages of undertaking vCJD testing of tonsil (i) Possibility of identifying potential vCJD deceased donors in the late latent phase of vCJD infection; and (ii) UK legal precedence suggests that the public is legitimately entitled to expect that blood, and presumably tissues, are 100% safe. Disadvantages to testing (i) Unknown time when in the pre‐clinical phase abnormal PrP may be detectable; (ii) The sensitivity of tests may be less than required; (iii) The impact of false positive and false negative results (iv) Logistical aspects of testing to GMP standards; (v) Impact of laboratory turnaround time for any PrP test on tissues/organs requiring rapid release; (vi) Possible pre‐disposition to vCJD disease impact on counselling donor families; (vii) Implications for lookback on recipients an infected tissue donor where previous donations may have been given, either of blood or tissues; (viii) Risk of contamination of tissues or processing laboratories from biopsies; (ix) Loss of categories of tissue donors due to unwillingness of donor families to consent to testing; and (x) Loss of tissue donors from living donor programmes where tonsil testing could not be undertaken. Results It was concluded that tonsil and splenic biopsies should be investigated logistically to provide analytes for vCJD testing. Conclusion Multidisciplinary work is underway to take forward vCJD testing of deceased donors.     

PL04Tissue Retrieval and Processing Initiatives to Reduce the Risk of vCJD Transmission

Risk reduction concerning potential tissue allograft vCJD transmission starts with effective donor selection and screening measures. Even as tests are developed and introduced, there are still risks regarding window period, which may result in potentially infective units being transplanted. Methodology can be implemented to reduce this risk by attempting to remove the infectious agents. NBS introduced blood leucodepletion as a risk reduction measure. For many highly processed tissue products, this is already achieved by washing blood and marrow from the graft. However the bone graft of preference for UK orthopaedic surgeons is fresh frozen femoral heads (containing blood/marrow) which have not been irradiated to 25 kGy. NBS have developed a bone washing protocol to achieve >99% marrow and blood depletion and are assessing whether the irradiation dose can be reduced as a result of bioreduction events included in the process. This is achieved without pooling tissues from multiple donors in turn reducing recipient exposure. Clinicians may find this a suitable alternative risk-reduced product. Other initiatives have been introduced to reduce the risk of abnormal PrP contamination of equipment, in turn cascading to subsequent grafts. Disposable equipment is now used wherever possible. Where not possible (e.g. bone saws, skin dermatomes etc.) the equipment is washed and sterilized to best practice (HTM2010 and HTM2030), is fully traced through subsequent graft exposures, and when a suitable screen test is performed, kit is quarantined until a negative result is received.     

A method for estimating incidence rate of infectious diseases among first-time blood donors

BACKGROUND: In certain circumstances, there is no method for estimating incidence based on testing results on a single blood sample from first‐time blood donors, severely limiting the ability to assess the residual risk of blood‐borne infections among this donor subpopulation. STUDY DESIGN AND METHODS: Incidence rates were estimated for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) among first‐time donors using the formula (P₂ ? P₁)/D, where P₁ is the prevalence among blood donations from first‐time donors of the minimum eligible ages for donation, P₂ is the prevalence among donations from first‐time donors of an older age group, and D is the age difference (in years) between the older and younger donor groups. RESULTS: Estimating incidence among first‐time donors using the proposed method based on a single test for anti‐HCV produced similar results to those based on HCV nucleic acid test (NAT) yield cases, by sex and in different periods. Comparison of the proposed method with HIV NAT yield also showed similar results although the small number of HIV NAT yield cases limits interpretation. CONCLUSIONS: The proposed method provides an alternative way for estimating incidence of certain blood‐borne infections among first‐time donors, provided that our assumptions are met. It helps residual risk assessment in donor populations where first‐time donors account for most of the donations and only one test result is available for each donor.     

The donor notification process from the donor's perspective

BACKGROUND: Despite large numbers of blood donors being notified of abnormal infectious disease screening results, there has been little scientific study of the effects of this process. STUDY DESIGN AND METHODS: With a 28-item questionnaire, an anonymous mail survey was conducted of 4141 blood donors notified of 15 distinct categories of abnormal infectious disease screening and confirmatory test results. RESULTS: The survey had a 42 percent response rate, and 10 percent of the respondents did not recall being notified of their results. Of the 1556 respondents who recalled being notified, 27 percent contacted the blood center for further information, 60 percent discussed their results with a health care provider, and 73 percent of permanently or indefinitely deferred donors correctly understood their deferral status. Confusion and emotional upset were reported in 81 and 75 percent of notified donors, respectively. CONCLUSIONS: The notification process appears to achieve most of its aims in the majority of donors. Nevertheless, some donors did not understand that they were ineligible for future donation, and many donors were confused and upset. These data indicate that the adverse impact of notifying donors about abnormal test results needs to be considered when new blood donor screening tests and confirmatory algorithms are being licensed and implemented. Further studies of the effectiveness of newer revised donor notification materials are needed.     

Autologous versus homologous donors. Evaluation of markers for infectious disease

Autologous blood donations may provide a new source of blood when components not used by the donors are deemed suitable for homologous use. However, the risk of transfusion-transmitted diseases form such donors has not been evaluated. We compared the prevalence of infectious markers and rate of abnormal responses to a confidential donor ballot in autologous donors from two blood collection programs, one blood center and one hospital-based, to corresponding homologous blood programs. The incidence of abnormal test results in autologous donors for HIV antibodies (either Western blot confirmed or repeatedly reactive, unconfirmed), HBsAg, ALT, and anti-HBc were not statistically different from homologous rates. The incidence of STS abnormalities in autologous donors was statistically significant, although all positive results were biologic false positives. The rate of abnormal responses to the confidential ballot was statistically significant only in autologous donors whose collections were already determined to be unsuitable for homologous use due to medical history problems. Although the data do not address infectious complications in transfusion recipients, this study offers no evidence that autologous blood components are less safe than their homologous equivalents.     

Risk of glucose intolerance and diabetes in hemipancreatectomized donors selected for normal preoperative glucose metabolism

OBJECTIVE—Hemipancreatectomy (HPx) for the purpose of organ donation has been associated with a 25% risk of developing abnormal glucose tolerance or diabetes in the year after surgery. Since 1997, the University of Minnesota has imposed criteria to prevent potential donors with clinical features associated with an increased diabetes risk from undergoing HPx. We recently assessed glucose tolerance in hemipancreatectomized donors selected since the adoption of the new criteria to determine whether the risk of developing abnormal glucose tolerance was reduced below the 25% rate previously demonstrated.RESEARCH DESIGN AND METHODS—Individuals who underwent HPx for the purpose of pancreas donation between 1997 and 2003 were contacted and interviewed about their health status. Those not taking diabetes medications were invited to undergo an assessment of their glucose tolerance.RESULTS—Successful contact was made with 15 of 21 donors who underwent HPx during this period. Two donors reported use of oral diabetic medications and were not studied further. Of the remaining 13, 2 had impaired fasting glucose (fasting blood glucose 100–125 mg/dl), 1 had impaired glucose tolerance (2-h postglucose load blood glucose 140–199 mg/dl), and 3 displayed both. One donor met the diagnostic criteria for diabetes. Six donors had normal glucose values.CONCLUSIONS—Despite the use of stringent criteria to exclude those at risk for developing abnormalities in glucose metabolism, 43% of healthy humans who underwent HPx between 1997 and 2003 have impaired fasting glucose, impaired glucose tolerance, or diabetes on follow-up. The current preoperative criteria are insufficient to predict those who will develop abnormal glucose metabolism after HPx.Glycemic control has long been known to play a critical role in the development of the complications of diabetes. Since the results of the Diabetes Control and Complications Trial (DCCT) first demonstrated that intensive efforts to lower glycemia resulted in a reduction in the rate at which subjects with type 1 diabetes developed microvascular complications (1), clinicians and their patients have attempted to normalize glucose control through many different therapeutic modalities. Exogenous insulin has been used to achieve target glycemia almost universally in the treatment of patients with type 1 diabetes, but the risk of developing severe hypoglycemia has become a limiting factor for many (2). Pancreas transplantation offers an alternative for selected patients with diabetes who seek to achieve normal levels of glycemia without periodic hypoglycemia. During 2004, >1,400 pancreas transplants were performed in the U.S. (3). The vast majority of these transplants were done using deceased donor organs. However, some centers, including our own, have considered using living donors in situations in which improved outcomes over the use of a deceased donor organ might be expected. Such situations could include the presence of a nondiabetic HLA-identical sibling, a recipient with high panel-reactive antibody levels, or associated morbidities that predict a high risk of mortality while the recipient is on the waiting list.At the University of Minnesota, the use of living donors in pancreas transplantation dates back to 1977 (4). In this procedure, the distal half of the pancreas is removed from a living donor and placed within the pelvis of the diabetic recipient. Although outcomes for the recipient are at least equivalent to those achieved with a deceased donor organ and perhaps improved for those patients with high panel-reactive antibody levels that prevent an optimal tissue match (4), 25% of the donors were previously found to have glucose intolerance or frank diabetes (non–insulin-dependent) 1 year after hemipancreatectomy (HPx) (5). In addition, even donors with normal glucose tolerance were noted to experience a modest increase in blood glucose and a reduction in insulin and glucagon secretion ≥1 year after HPx (6). Because of these findings, the University of Minnesota changed the criteria used to select hemipancreas donors in 1997 to exclude those with clinical or metabolic features that may be associated with the future development of diabetes.In this report, we examine the metabolic outcomes in hemipancreatectomized donors selected because they appeared to be at low risk for developing diabetes. Our study was designed to test the hypothesis that the implementation of the revised University of Minnesota criteria would reduce risk of development of abnormal glucose tolerance to less than the rate of 25% reported using the previous criteria (5). We hoped that our observations would be of benefit to pancreas transplant programs considering the development of a living donor program. Further study of this unique population of healthy hemipancreatectomized humans also provides us with a rare opportunity to gain insight into the effect of β-cell mass reduction on the maintenance of normal glucose tolerance.     

Increased risk of a positive test for antibody to hepatitis B core antigen (anti-HBC) in autologous blood donors

Controversy exists about the suitability of blood from autologous donors for homologous use. We compared the infectious disease test results of 426 autologous donors, designated by donor history as suitable for homologous use, to those of 86,138 volunteer donations collected over the same 5 month period. Although donor characteristics differed, the relative risk of a positive test for anti-HBc in the autologous group was 2.09. When 413 autologous donors were compared to 413 volunteer donors matched for age, sex, and zip code, the relative risk of a positive test for anti-HBc in the autologous group was 3.2. If anti-HBc is a marker for non-A, non-B hepatitis transmissibility, then our autologous group is not as safe as our volunteer donors. We recommend that autologous blood, even when designated by donor history and laboratory screening results as suitable for homologous transfusion, not be used for other than the intended autologous recipient.     

Comparison of the effectiveness of potential marrow donors recruited from apheresis donors or whole blood donors and through appeals to the general public

Marrow transplants with phenotypically HLA-matched, unrelated donors have been used effectively to treat a number of diseases. Many blood centers have recruited HLA-typed apheresis blood donors into marrow donor registries. However, to build larger registries so that more patients may be treated with unrelated donor marrow transplants, whole blood donors and people who do not donate blood have been added to the registries. The marrow donor program at our blood center had 2844 potential donors, of whom 1725 were also apheresis donors, 608 were whole blood donors, and 511 were recruited from the general public as a result of community appeals for marrow donors for a specific patient. Over a 9-month period, 297 potential donors were asked to donate blood samples for HLA-DR typing or mixed lymphocyte culture (MLC) testing or to participate in an informational session, undergo a medical evaluation, and sign a statement indicating an intention to donate marrow for a specific patient. Overall, these requests were successfully completed by 75.5 percent of apheresis donors, 87.2 percent of whole blood donors, and 78.1 percent of the potential donors recruited through community appeals. Furthermore, there was no difference among the three groups in the portion of people who donated blood samples for HLA-DR typing or MLC testing. Fifteen of 18 apheresis donors who were found to match a specific donor signed a statement of intent to donate marrow, 2 apheresis donors were deferred for medical reasons, and 1 decided not to donate.(ABSTRACT TRUNCATED AT 250 WORDS)     

Current status and future of clinical kidney transplantation in Japan

Kidney transplantation has been established to be the therapy for an end-stage renal disease. In Japan, living donor kidney transplantation is frequently performed (> 80%) because of a shortage of the deceased donors. The graft survival has been improved to 93.4% (5-year graft survival in living donor kidney transplantation after 2001). ABO-incompatible cases are increasing and more than 20% are ABO-incompatible in Japan (30% in our institution). In our institution, 225 kidney transplantations (182: living donors, 43: deceased donors) have been performed from 2004.4 to 2010.6. Although the graft survival is excellent, posttransplant infections including cytomegalovirus, EB virus and BK virus are problems which should be solved. For the safety of the recipients, we should use kidney grafts from brain-dead donors.     

Solid phase red cell adherence immunoassay for anti-HIV 1: a simple, rapid, and accurate method for donor screening

In technically developed countries in which acquired immunodeficiency syndrome is a risk to the recipients of blood or tissue, it is mandatory to screen the donor for evidence of HIV (human immunodeficiency virus) infection. Current tests, based on enzyme-linked immunoassay, are time-consuming and expensive and as such are unsuitable for developing countries. We describe a second generation test using anti-human IgG coupled to red cells as the indicator of antibody having reacted with test antigen (1). The test is complete within ten minutes, simple to perform and to read and has 100% sensitivity and 99% specificity compared with Western blot. It is ideal for the rapid screening of organ donors and for the screening of blood donors where cost is a major consideration.     

Mailing of a sickle cell disease educational packet increases blood donors within an African American community

BACKGROUND: Low blood donor rates among African American persons are recognized; however, few strategies exist to increase these numbers. STUDY DESIGN AND METHODS: A 1-year, prospective, ecologic study performed before and after an educational intervention designed to test the hypothesis that increased education about the importance of blood donation for children with sickle cell disease (SCD) would result in an increase in total blood donors among African American persons. RESULTS: Approximately 5000 videos were mailed to 50 percent of the households in a zip code where 98 percent of the residents are African American. In the first 6-month interval after mailing the video packet, there was a 75 percent (217 vs. 124; p = 0.05) increase in the total number of presenting donors and a 64 percent (126 vs. 77; p = 0.02) increase in the total number of first-time donors from the same 6-month period in the previous year. During the second 6-month interval, the total number of first-time donors declined. No significant increase in donor activity was noted during the two 6-month periods after the intervention in the surrounding zip codes. CONCLUSION: A mass mailing directed toward educating African American persons about the importance of blood donation for children with SCD may increase the number of total African American donors.     

Antigen testing for human immunodeficiency virus (HIV) and the magnet effect: will the benefit of a new HIV test be offset by the numbers of higher risk,test-seeking donors attracted to blood centers? Retrovirus Epidemiology Donor Study

Background: There currently is debate on whether to include new assays for viral antigens and nucleic acids in the battery of screening tests applied to all blood donations. Proposals call for implementation of p24 antigen screening tests to help identify donors who are infected with human immunodeficiency virus type 1 (HIV-1) but have not yet seroconverted (window-period donors). There is concern, however, that people at higher risk for HIV infection will be attracted to blood centers in order to obtain the results of an HIV assay that is not routinely available elsewhere. Therefore, the benefit of antigen testing may be offset by an increase in the HIV incidence rate among blood donors. Study Design and Methods: Estimates were obtained from previous reports for the HIV incidence rate among blood donors, the percentage of donations from test-seeking donors, the duration of the HIV-infectious window period, and the performance of p24 antigen screening assays. Sensitivity analyses were performed by using various percentages of test-seeking donors following implementation of antigen testing and various HIV incidence rate ratios of test-seekers to nonseekers. Hypothetical residual HIV risks were calculated for multiple scenarios and compared to the current estimate of HIV risk without antigen screening of blood donations. Results: If antigen testing reduces the window period by 27 percent (e.g., from 22 days to 16 days), and the HIV incidence rate among test-seekers is 30 times that among nonseekers, then the benefit of antigen testing will be eliminated if the percentage of test-seekers (currently estimated at 3.2%) increases to 5.7 percent. If antigen testing reduces the window period by approximately 45 percent (e.g., from 22 days to 10 days or from 13 days to 6 days) and the HIV incidence rate ratio (test-seekers vs. nonseekers) is assumed to be equal to the HIV prevalence ratio (5.3), then the percentage of donations from test-seeking donors would have to increase to 25 percent of all donations to offset the benefit of antigen screening. Conclusion: This model helps identify the key measures for assessing the potential adverse effect of increased test seeking as a consequence of the addition of p24 antigen (or other direct virus) assays to blood donor screening programs. In most scenarios, the beneficial effect of antigen screening exceeded the potential detrimental effect of attracting higher-risk, test-seeking donors. The possibility cannot be ruled out, however, that a subgroup of high-risk, test-seeking donors attracted to the blood centers by a new HIV test will offset the reduction in the residual risk of HIV infection associated with antigen screening.     

Use of DNA amplification methods for clinical diagnosis in autoimmune diseases

Autoimmune disease is generally felt to result from the interaction of genetic and environmental factors. In recent years, significant advances have been made in using recombinant DNA methods to analyze specific genetic factors and infectious agents. However, new techniques are needed that are more rapid, inexpensive, and suitable for small tissue biopsies obtained early in the course of disease. New methods of DNA amplification based on polymerase chain reaction (PCR) and Q beta-replicase (Q beta R) have recently been reported. These methods are briefly reviewed, and their potential applications to patients with autoimmune disease are presented. Several types of applications can be considered, including detection of: a) specific HLA-D alleles in order to predict prognosis and better utilize existing medications; b) bacterial, fungal, and spirochete infections in joint aspirates or synovial biopsies; c) human immunodeficiency virus (HIV) and other viruses (e.g., EBV, CMV) that may be associated with immune dysregulation in certain patients; and d) neoplastic transformation in blood or tissues by determining monoclonal gene rearrangements, karyotypic alterations or oncogene activation. It is likely that routine clinical laboratories will soon begin implementing DNA amplification methods in order to screen blood products for infectious agents (especially HIV and hepatitis B virus). Because these techniques will be readily available, rheumatologists/clinical immunologists should begin developing strategies that will allow them to use these methods in a cost-effective manner for diagnosis and monitoring treatment.     

A survey of hepatitis B surface antigen-positive blood donors: degree of understanding and action taken after notification

All blood donors in the United States are tested for hepatitis B surface antigen (HBsAg) upon donation; if the test result is positive, the primary method of notification is by letter. To assess the effectiveness of this notification methods in stimulating HBsAg-positive donors to seek medical care and take preventive measures, 54 donors who tested HBsAg-positive on donation at the American Red Cross Blood Services. Atlanta Region, from January 1987 to July 1989 were interviewed. Thirty-nine donors (72%) had sought medical care after notification; the only motivating factor was that the letter told the donor to consult with his or her physician. Compared with donors who did not seek medical care, donors who did so were more likely to understand that the blood test was abnormal or that they were infected, and they were more likely to understand how hepatitis B virus is transmitted and that a vaccine is available. The differences were not significant, however. Of those donors who sought medical care, less than half received appropriate recommendations for protection of contacts, and of those who did, only one-third received prophylaxis. In-person and telephone interviews with donors, revision of the notification letter, and hepatitis B education programs targeted at medical care providers are suggested.     

The United States' potential blood donor pool: estimating the prevalence of donor-exclusion factors on the pool of potential donors

BACKGROUND: Efforts to ensure donor and recipient safety have reduced the population of eligible voluntary blood donors. The current method for determining eligible blood donors in a population using only age as the criterion for excluding donors poorly reflects the large constellation of factors known to cause donor deferrals. An epidemiologic model has been developed to determine the prevalence of donor exclusions and thus improve the estimate of total eligible blood donors in the nation. STUDY DESIGN AND METHODS: Epidemiologic databases were selected to enumerate the population prevalence of 31 donor exclusionary factors which correspond to the AABB standards. Prevalence data were adjusted for age, duration of exclusion, and comorbidities. This method yields the number of excluded individuals to calculate the number of eligible blood donors. RESULTS: The conventional method of calculating eligible donors indicates that there are approximately 177 million eligible blood donors in the US population. This study indicates that this method erroneously includes 66 million individuals who are ineligible due to known exclusionary factors. Only 111 million individuals in the US population are eligible to donate blood. CONCLUSION: The conventional method of determining eligible blood donors overestimates eligible donor prevalence by approximately 59 percent (111 million eligible individual blood donors rather than 177 million eligible individuals). It is recommended that a method similar to the one described in this study be utilized to additionally exclude potential donors not meeting AABB donation standards to improve accuracy of eligible blood donor estimations.     

Automated platelet collection using the latest apheresis devices in an Indian setting

In a developing nation like India where there is a scarcity of resources and voluntary donors, provision of safe and good quality blood and its components is a huge challenge. The demand for platelets is increasing constantly due to better management of various patient categories, specifically hemato-oncological cases, where there is an increased demand of platelet transfusion. The use of apheresis single donor platelets (SDPs) has been attributed to increased gap between demand and supply of whole blood derived random donor platelets (RDPs). Moreover, the other benefits of SDPs such as decreased donor exposure and simplification of inventory management cannot be overlooked.However, the increased costs and logistic problems, compounded by the lack of awareness, limit the donor recruitment and procedures for SDPs. In Indian scenario, there are no specific guidelines or standards available which can be followed, while simultaneously addressing the associated problems. In this review, we have tried to analyze the various problems of donor selection, donor safety and the quality issues regarding plateletpheresis. Based on this we have tried to give certain recommendations which might help the centers in resolving the problems related to plateletpheresis.     

Donor selection--securing a safe blood supply.

A survey of blood donors conducted at the Red Cross Blood Bank, Melbourne, Victoria in May 1989 identified deficits in the knowledge of some donor groups. As a result a new medical form for potential donors was designed and trialled. While there were few differences in responses to questions relating to interviewing, general health, medication or transfusion therapy, responses to questions regarding the eligibility of AIDS/high risk groups to donate showed several statistically significant differences. Although improvements in donor awareness have been demonstrated in some areas, further action is necessary to ensure that effective donor selection contributes to quality control and safety of transfusion products.     

Ten-year follow-up of unrelated volunteer granulocyte donors who have received multiple cycles of granulocyte–colony-stimulating factor and dexamethasone

BACKGROUND: The combination of granulocyte–colony-stimulating factor (G-CSF) and dexamethasone is an effective granulocyte mobilization regimen. The short-term side effects of G-CSF are well studied, but the potential long-term effects of repeated G-CSF stimulation in unrelated volunteer granulocyte donors have not been reported.
STUDY DESIGN AND METHODS: Donors who had received G-CSF three or more times for granulocytapheresis between 1994 and 2002 were identified and attempts were made to contact them if they were no longer active donors. They were matched with control platelet (PLT) donors for sex, age, and approximate number of cytapheresis donations. A health history was obtained and complete blood counts (CBCs) and C-reactive protein (CRP) determined where feasible.
RESULTS: Ninety-two granulocyte donors were identified, and 83 of them were contacted. They contributed to 1120 granulocyte concentrates, or a mean of 13.5 granulocytapheresis procedures per donor (and a mean of 87.5 plateletpheresis procedures per donor). There was no difference in CBCs between the granulocyte donors and the control PLT donors. There was no difference in CRP between the two groups, and no difference in pre- and post–G-CSF CRP in a subset of 22 granulocyte donors. Predefined health events included malignancies, coronary artery disease, and thrombosis. At a median 10-year follow-up, there were seven such events in the granulocyte donors and five in the PLT donors.
CONCLUSION: Although the number of granulocyte donors studied is small and continued surveillance of healthy individuals after G-CSF is prudent, our data suggest that G-CSF/dexamethasone stimulation appears to be safe.     

Lapsed donors: an untapped resource

BACKGROUND: There is a clear need for methods to recruit and retain donors without compromising blood safety. Although prior studies report lower viral prevalence rates in repeat donors than those in first-time donors, it is unknown if this relationship holds after a lapse of several years between donations. STUDY DESIGN AND METHODS: A total of 6.4 million allogeneic donations collected at five US blood centers from 1991 through 1998 were classified by donation history (first-time vs. repeat) and by length of time between donations (lapsed interval length). The prevalence of HCV, HIV, and HBsAg was compared by donation history and lapsed interval length. The relationship between lapsed interval length and donor demographics was explored. RESULTS: Repeat donors who delayed their return for over 5 years were significantly less likely to test positive for a viral infection than were first-time donors. The likelihood of a positive test result appeared to increase steadily with lapsed interval length for HCV and HBsAg, but not for HIV. Younger, less educated, and nonwhite donors were less likely to return than others. CONCLUSIONS: Recruitment of donors who have not returned for several years could be an effective way to increase the blood supply while preserving blood safety. Understanding the relationship of donor demographics to return behavior is important for recruitment efforts.     

Organ and tissue donation from the emergency department

Despite mandatory request legislation, the lack of available donor organs and tissues continues to limit transplant efforts. The potential contribution from emergency department (ED) patients remains undefined. We reviewed the charts of patients dying in our ED for organs and tissues potentially suitable for transplantation, age, cause of death, and physician documentation of donation inquiry. Of 155 charts reviewed, potential donors were identified for corneas (99), bones (61), heart valves (42), and kidneys (3). Of the 155 charts, 130 (84%) made no mention of donation, and of 37 charts containing a donor request form, 34 (92%) were incorrectly filled out or left blank. Four charts (2.6%) mentioned donation in the narrative section, two (1.3%) documented discussion with family, and one patient was referred to our Organ Procurement Organization, with recovery of one kidney and heart valves. We conclude that physicians rarely document consideration of donation for patients dying in the ED; the number of potential donors far exceeds the number referred or recovered. Future efforts should focus on methods to increase recognition and referral of organ and tissue donors from the ED.