The healthy donor effect and survey participation,becoming a donor and donor career

Background

The healthy donor effect (HDE) is a selection bias caused by the health criteria blood donors must meet. It obscures investigations of beneficial/adverse health effects of blood donation and complicates the generalizability of findings from blood donor cohorts. To further characterize the HDE we investigated how self-reported health and lifestyle are associated with becoming a blood donor, lapsing, and donation intensity. Furthermore, we examined differences in mortality based on donor status.

Study Design and Methods

The Danish National Health Survey was linked to the Scandinavian Donations and Transfusions (SCANDAT) database and Danish register data. Logistic- and normal regression was used to compare baseline characteristics and participation. Poisson regression was used to investigate future donation choices. Donation intensity was explored by the Anderson-Gill model and Poisson regression. Mortality was investigated using Poisson regression.

Results

Blood donors were more likely to participate in the surveys, OR = 2.45 95% confidence interval (2.40–2.49) than non-donors. Among survey participants, better self-reported health and healthier lifestyle were associated with being or becoming a blood donor, donor retention, and to some extent donation intensity, for example, current smoking conveyed lower likelihood of becoming a donor, OR = 0.70 (0.66–0.75). We observed lower mortality for donors and survey participants, respectively, compared with non-participating non-donors.

Conclusion

We provide evidence that blood donation is associated with increased likelihood to participate in health surveys, possibly a manifestation of the HDE. Furthermore, becoming a blood donor, donor retention, and donation intensity was associated with better self-reported health and healthier lifestyles.     

Mechanism of altruism approach to blood donor recruitment and retention: a review and future directions

Why do people donate blood? Altruism is the common answer. However, altruism is a complex construct and to answer this question requires a systematic analysis of the insights from the biology, economics and psychology of altruism. I term this the mechanism of altruism (MOA) approach and apply it here for understanding blood donor motivation. The answer also has enormous implications for the type of interventions we choose to adopt as a society. A MOA approach so far shows that blood donors are a mixture of (i) warm‐glow givers (donation is emotionally rewarding) and (ii) reluctant altruists (cooperate rather than defect when free‐riding is high). Donors also show ‘saintly sinning’ with the extra ‘moral currency’ form blood donation allowing them to be less generous in other contexts. The MOA approach suggests why financial incentives, in terms of gifts/lottery tickets, are effective and suggests a number of novel interventions for donor recruitment: ‘voluntary reciprocal altruism’ and ‘charitable incentivisation’. The MOA approach also highlights the need for an intervention developed specifically for recipients to allow them to show their gratitude to donors and for society to celebrate blood donation. It is suggests a ‘Monument to Blood Donors’ will achieve this. The approach suggests a number of novel research questions into (i) donor self‐selection effects, (ii) conditional cooperation and (iii) construct overlap with Theory of Planned Behaviour (e.g. affective attitudes and warm‐glow). The MOA offers a powerful way to understand blood donor motivations around altruism and develop theoretically driven interventions.     

Iranian blood donors' motivations and their influencing factors

Aim: One of the challenges faced by blood transfusion services is the motivation of blood donors. The purpose of this study was to define the motivations of Iranian donors. Methodology: A total of 16 955 volunteers were studied to evaluate their motivation for blood donation in 2003 and 2004. A questionnaire was designed covering socio‐demographic characteristics, history of blood donation and a list of reasons for donating. The donor physician determined the donor's motivation after an interview. Motivation was classified as internal (altruistic and religious beliefs) and external motives. Results: The main motivations were 6629 (39·1%) altruistic, 6552 (38·6%) good for one's health and 1931 (11·4%) religious beliefs. It was shown that 8560 volunteers (50·5%) had internal motivations and 8395 (49·5%) had external motivations. Internal motivations were significantly higher in women, regular and educated donors. Conclusion: This study showed that internal motives are the main reason for blood donation in Iranian donors, especially in female, regular and high‐educated donors. Thus, altruistic and religious messages can be emphasized in recruiting and retaining donors, particularly in this group. Nearly half of the donors were motivated by external factors – mainly to improve their own health status, especially in older donors. This may be due to a psychological impact in which they feel improvement in their general health. As voluntary non‐remunerated blood donation is defined without considering the motivational factor, one might consider a new term such as ‘internal motivated voluntary blood donors' in accordance with their motivation and efforts could be centered about recruiting these specific donors.     

Vasovagal reactions in blood donors: risks,prevention and management

This narrative review examines current research on risk factors, prevention methods and management strategies for vasovagal reactions (VVRs) that occur during or as a result of blood donation. VVRs are important to blood collection agencies (BCAs) as they negatively impact the number of completed collections, perceptions of the safety of blood donation and rates of donor return. There has been significant progress in understanding and preventing VVRs in blood donation in recent years, with a multitude of risk factors identified. This has resulted in many BCAs implementing evidence‐based strategies, such as donor age and weight restrictions. However, the profile of our most vulnerable donors and features of the donation setting that may protect these donors from experiencing a VVR have not been identified. Furthermore, an increased number of trials of physiological and psychological prevention interventions to reduce both immediate and delayed VVRs have been reported. However, a lack of methodological consistency in operationalising interventions to reduce or prevent VVRs means that the identification of effective VVR prevention strategies remains a challenge for practitioners. Furthermore, research is still required to determine how to successfully implement prevention and management strategies into standard operating procedures within collection centres. Finally, research in the management and mitigation of the effect of VVRs is currently only suggestive of what should be done to care for the donor who reacts and how to empower those donors to return. Collectively, research into these aspects of VVRs will provide support to donors and BCAs and improve the safety of blood donation.     

在广元市无偿献血者中开展丙氨酸氨基转移酶筛查的探讨

目的 探讨在献血者中开展丙氨酸氨基转移酶(ALT)筛查的可行性.方法 通过对2010年7月1日至9月30日5 376例无偿献血者进行ALT筛查,将其筛查结果与同时期3年内实验室无偿献血者ALT检测结果进行对比分析.结果 在无偿献血者中,再次献血不合格率(8.56%)较初次献血者(10.47%)偏低,复检不合格率(5.42%)较初筛(9.80%)偏低,差异有统计学意义(P＜0.05).通过开展献血前ALT筛查,2010年ALT不合格率较2008年和2009年低,差异有统计学意义(P＜0.01).ALT不合格主要与献血前饮酒(26.00%)、疲劳(29.60%)等相关.结论 在献血前开展ALT项目的 筛查,既保护了献血者的身体健康,也有效避免血液不必要的浪费,节约了血液资源.     

Improved safety for young whole blood donors with new selection criteria for total estimated blood volume

BACKGROUND: Young age, first‐time donation status, and estimated blood volume (EBV) are leading determinants of syncopal complications after whole blood donation. We evaluated a multifaceted safety initiative and more restrictive selection criteria for whole blood donation by individuals younger than 19 years. STUDY DESIGN AND METHODS: Measures introduced over 2 years addressed donor education, drive environment and supervision, and new eligibility criteria for EBV of 3.5 L or more based on height, weight, and sex for individuals younger than 19 years. Presyncopal and syncopal reactions after whole blood donation during the school year in the baseline, transitional (2008), and full implementation (2009) periods were evaluated. RESULTS: Young donors (16‐ to 18‐years‐olds) gave 754,402 and 710,922 whole blood donations in the 2008 and 2009 school years accounting for 16% of the total collections in both 9‐month study periods. The new selection criteria were associated with a significant reduction in the reaction rates among 16‐ to 18‐year‐olds. Sixteen‐year‐old donors had the greatest decrease in 2009 compared to baseline for presyncopal reactions (10.5% vs. 7.3%; odds ratio [OR], 0.67; 95% confidence interval [CI], 0.65‐0.69) and syncope (43.1 vs. 37.1 per 10,000 donations; OR, 0.86; 95% CI, 0.77‐0.96). Donor subgroup analysis by sex, age, and donation status demonstrated that age‐related differences in reaction rates were eliminated in 2009. CONCLUSION: The safety initiative with new selection criteria for EBV led to decreased complications among donors 16 to 18 years old, such that the risk for 16‐year‐olds was no longer different from that observed for 19‐year‐olds in the analysis stratified by age, sex, and donation status.     

How afraid are you of having blood drawn from your arm? A simple fear question predicts vasovagal reactions without causing them among high school donors

BACKGROUND: We previously demonstrated in a group of mostly experienced blood donors that fear of blood draws was a significant predictor of vasovagal reactions. Importantly, being asked about one's fear immediately before donation did not increase reaction rates. This study further evaluates the relationship between fear and reactions among high school blood donors, who are known to be at a relatively greater risk for vasovagal reactions. STUDY DESIGN AND METHODS: Immediately after completing the blood donor health screening, 17‐ and 18‐year‐old high school students were asked about their fear of having blood drawn. Based on a random selection, the fear question was administered in approximately half of the schools, resulting in a final sample of 1715 donors who did and 1692 donors who did not answer the fear question. RESULTS: Fear was a significant predictor of donor reactions and remained a significant independent predictor (along with estimated blood volume and donor sex) in a logistic regression analysis. There was no difference in the proportion of reactions observed between those who did and did not answer the predonation fear question. CONCLUSION: Consistent with previous evidence in older and more experienced blood donors, these findings indicate that assessing fear of blood draws may help to identify those who are most likely to experience vasovagal reactions among young donors without increasing the frequency of such reactions.     

Interventions to reduce vasovagal reactions in blood donors: a systematic review and meta‐analysis

Vasovagal reactions (VVRs) in blood donors have significant implications for the welfare of donors, donor retention and the management of donor sessions. We present a systematic review of interventions designed to prevent or reduce VVRs in blood donors. Electronic databases were searched for eligible randomised trials to March 2015. Data on study design and outcomes were extracted and pooled using random effects meta‐analyses. Sixteen trials met the inclusion criteria: five trials (12 042 participants) of pre‐donation water, eight trials (3500 participants) of applied muscle tension (AMT) and one trial each of AMT combined with water, caffeine, audio‐visual distraction and/or social support. In donors receiving pre‐donation water, the relative risk (RR) compared with controls for VVRs was 0·79 [95% confidence interval (CI) 0·70–0·89, P < 0·0001] and the mean difference (MD) in severity of VVRs measured with the Blood Donation Reactions Inventory (BDRI) score was ?0·32 (95% CI ?0·51 to ?0·12, P < 0·0001). Excluding trials with a high risk of selection bias, the RR for VVRs was 0·70 (95% CI 0·45–1·11, P = 0·13). In donors who received AMT, there was no difference in the risk of chair recline in response to donor distress from controls (RR 0·76, 95% CI 0·53–1·10, P = 0·15), although the MD in BDRI score was ?0·07 (95% CI ?0·11 to ?0·03, P = 0·0005). There was insufficient data to perform meta‐analysis for other interventions. Current evidence on interventions to prevent or reduce VVRs in blood donors is indeed limited and does not provide strong support for the administration of pre‐donation water or AMT during donation. Further large trials are required to reliably evaluate the effect of these and other interventions in the prevention of VVRs.     

Attitudes towards blood donation and transfusion in Bamenda, Republic of Cameroon

Objectives: This study was conducted in Bamenda, Cameroon. The objectives of the study were to develop a theoretical framework to better understand local attitudes towards blood donation and transfusion, to identify factors that motivate and deter blood donation and to identify interventions to improve the supply of blood for transfusion at Bamenda Regional Hospital. Background: The supply of blood for transfusion in sub‐Saharan Africa is insufficient. Cameroon has no national blood service and the collection and screening of blood is the responsibility of individual hospitals. At Bamenda Regional Hospital patient relatives recruit replacement blood donors, who may or may not be family members, and shortages of blood and delays in transfusion are frequent. Materials and Methods: Qualitative research methods were used: direct observation, in‐depth interviews, focus group discussions and a simulation exercise. Participants were clinical and laboratory staff, patient relatives, blood donors, secondary school students and community members. Results: Attitudes towards blood donation and transfusion fit a transanctionalist framework of health decision making. Deterrents to blood donation are multiple and varied. Some form of compensation is often expected, even by family members, although the blood donation is still considered ‘voluntary’ by the donor. Conclusion: This study confirms that interventions to improve the blood supply must take into account local attitudes and conditions. In Bamenda, a variety of pragmatic approaches are required including education around specific biological misperceptions identified in the study and the retention of replacement donors as repeat donors. Issues around compensation for blood donation require further work.     

Vasovagal reactions in blood donors during or immediately after blood donation

The aim of the study was to estimate the type, incidence and causes of donor adverse reactions during and after blood donation in a Greek Blood Bank, where medical staff is responsible for donor selection. 12 173 blood donors were studied for adverse reactions. One-hundred and seven (0.87%) donors had a vasovagal reaction during or after blood donation. Donors who gave blood occasionally had a significant greater incidence of reactions compared with volunteer donors (1.15 versus 0.53%) (P < 0.001). There was no significant difference between men and women (0.85 versus 0.95%). First-time donors (1.7 versus 0.68%) and those under 30 years (1.15 versus 0.71%] had a significant greater possibility to have a reaction (P < 0.001). Twenty-two of 107 (20.5%) donors had a syncopal reaction. There was not a causative correlation of haematocrit, haemoglobin, systolic and diastolic blood pressure, pulse rate and weight in women (except weight in men) in developing a reaction. The stressing experience of phlebotomy was the reason for the higher frequency of a reaction. The incidence of reactions in our donors is lower than in other studies, and the possible reason for this is that only physicians are responsible for the selection of donors and trained personnel are careful of them during the donation process.     

湖北省武汉市居民无偿献血现状及思考

目的通过对湖北省武汉市无偿献血现况及影响因素的调查，为提出品牌营销策略提供基础。方法于2007年6～7月对武汉市部分地区1435名不同人群进行现场问卷调查。结果回收有效问卷1423份。在1423名被调查者中有372名参加过献血，占26．4％。愿意参加献血的1177人中，有539人（45．8％）认为参加无偿献血是帮助患者，是有益社会的高尚行为；而参加过献血的372人中，有180人（48．4％）认为捐献血液救助他人值得去做。结论无偿献血的宣教力度仍应增强，以吸引更多的人参加无偿献血；对再次献血者也应有更多鼓励，以提高他们对献血的忠诚度。     

Predicting a donor's likelihood of donating within a preselected time interval

The procurement of some advanced blood components, like quarantined plasma units, depends critically on retesting the donor within a fixed time frame. For health care systems, such as that in Germany, with mandatory retesting of donors before plasma release, the reliable identification of donors who are more likely to return in time has an immense practical implication, because their blood components could be preferably selected for quarantine purposes. The donation histories of about 760 000 donors with 4910 000 donation attempts were analysed. We developed a logistic regression model to calculate a probability of donation, p(Dts-te), within a preselected time frame (ts-te). The donation history was compounded in a score and shown to be very useful for determining p(Dts-te). A logistic regression model was developed with score and donor status as parameters; different regression coefficients applied to first-time-donors (ftd) and to repeat donors (intercept, int, and score factor, scf ). This model allowed us to determine the probability of donation, p(Dts-te), within a preselected time interval, e.g. 6-9 months after an index donation. The p(Dts-te) can be calculated for any donor of blood services. The p(D170-275 days) ranged from about 22% to 86% for any index donation in 1996/97. First-time donors had a p(D170-275 days) of 33% and were more likely to return within the time interval than certain subsets of repeat donors who can be defined by our model. We provided a technical procedure to increase the rate of plasma unit release after quarantine storage and showed the usefulness of our procedure for blood component management, if quarantine storage is required. By applying the model to our current plasma quarantine programme we could retrieve about 30% more units, which would represent about 30 000 units per year, without incurring additional costs. General implications for blood collection, like planning blood drives, were discussed. The whole demand of a health care system for single plasma units may be met by quarantine plasma and their cost-efficiency can be improved.     

Improving health profile of blood donors as a consequence of transfusion safety efforts

BACKGROUND: Transfusion safety rests heavily on the health of blood donors. Although they are perceived as being healthier than average, little is known about their long-term disease patterns and to which extent the blood banks' continuous efforts to optimize donor selection has resulted in improvements. Mortality and cancer incidence among blood donors in Sweden and Denmark was investigated. STUDY DESIGN AND METHODS: All computerized blood bank databases were compiled into one database, which was linked to national population and health data registers. With a retrospective cohort study design, 1,110,329 blood donors were followed for up to 35 years from first computer-registered blood donation to death, emigration, or December 31, 2002. Standardized mortality and incidence ratios expressed relative risk of death and cancer comparing blood donors to the general population. RESULTS: Blood donors had an overall mortality 30 percent lower (99% confidence interval [CI] 29%-31%) and cancer incidence 4 percent lower (99% CI 2%-5%) than the background population. Mortality rates and cancer incidence were lowest for outcomes that are recognized as being related to lifestyle factors such as smoking or to the selection criteria for blood donation. Blood donors recruited in more recent years exhibited a lower relative mortality than those who started earlier. CONCLUSION: Blood donors enjoy better than average health. Explicit and informal requirements for blood donation in Scandinavia, although mostly of a simple nature, have successfully refined the selection of a particularly healthy subpopulation.     

Understanding the sex disparity in living kidney donation

Living donors are the preferred source of organs for kidney transplantation, which is the treatment modality of choice for end‐stage kidney disease. Health care systems widely promote living kidney donation. However, women are consistently overrepresented among living donors. The reasons behind the sex‐based disparity in living kidney donation remain poorly understood. Compared to women, men possess a greater amount of kidney function, and the higher deceased donation rate among men reflects their higher overall kidney quality. A plausible medical explanation for the sex‐based disparity in living kidney donation includes an uncompromising emphasis on preserving donor health, with less emphasis placed on organ quality, which is the main criterion in deceased donor selection. On the other hand, consent to deceased donation is also greater in women, indicating their greater desire to donate even though fewer women actually become deceased donors. Therefore, nonmedical reasons for the sex disparity in living donation must be sought. Increased empathic distress or emotional memory; a greater sense of responsibility, urgency, and impulsiveness with increased reaction to empathy; a different body image; and a different social status may all contribute to greater living kidney donation in women. Economic inequity may be the singular explanation when personal worth links to economic worth. To better understand the sex disparity in living kidney donation, we need better data on the reasons behind both nondonation and donor rejection after evaluation in clinical practice. Nondirected living kidney donation provides unique opportunities to minimize factors such as emotional distress, empathy, and impulsiveness. More liberal acceptance criteria for donors with isolated medical abnormalities and testing legitimate donor reimbursement strategies based on actual income levels rather than a fixed amount can assist in both ascertaining the reasons behind the sex disparity in living kidney donation and increasing overall living kidney donation rates.     

Iron deficiency among blood donors: experience from the Danish Blood Donor Study and from the Copenhagen ferritin monitoring scheme

Blood components collected from blood donors are an invaluable part of modern‐day medicine. A healthy blood donor population is therefore of paramount importance. The results from the Danish Blood Donor Study (DBDS) indicate that gender, number of previous donations, time since last donation and menopausal status are the strongest predictors of iron deficiency. Only little information on the health effects of iron deficiency in blood donors exits. Possibly, after a standard full blood donation, a temporarily reduced physical performance for women is observed. However, iron deficiency among blood donors is not reflected in a reduced self‐perceived mental and physical health. In general, the high proportion of iron‐deficient donors can be alleviated either by extending the inter‐donation intervals or by guided iron supplementation. The experience from Copenhagen, the Capital Region of Denmark, is that routine ferritin measurements and iron supplementation are feasible and effective ways of reducing the proportion of donors with low haemoglobin levels.     

机采血小板对献血员血液流变学指标的影响

目的监测机采血小板献血者的血液流变学参数,评估多次机采血小板对献血者健康状况的影响。方法检测献血者献血前后血液流变学数值,并进行对比分析。结果献血前后全血黏度、血浆黏度、红细胞聚集指数、红细胞变形指数、红细胞压积和血沉等血液流变学指标的改变不明显。结论体检合格的血小板献血者,单采血小板对其血液流变学指标没有明显影响。     

SI31Serious Adverse Events of Blood Donation

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.     

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.     

Analysis and clinical significance of peripheral blood routine changes of platelet donors with ultra-high frequency donation

BackgroundIncreasing platelet donation frequency has become an important way to meet the growing clinical platelet need. Accordingly, the problem of whether the increase in platelet donation times will have an adverse effect on the health of donors has attracted more and more attention, and become an important factor affecting the donor enthusiasm and the safety of blood collection and supply.MethodsEleven ultra-high frequency platelet donors who donated more than or equal to 20 times in 2021 were selected, and the main peripheral blood routine indicators of hemoglobin, platelet and hematocrit were analyzed.ResultsThe above indicators of all donors fluctuated with the increase of donation times. Among them, older donors (≥50 years old) exhibited a significant downward trend in the above three indicators, and one young donor showed a downward trend in hemoglobin and hematocrit indicators. While the other donors showed the relatively stable performance of the above indicators.ConclusionThe effect of ultra-high frequency platelet donation on the main peripheral blood indexes of donors shows obvious age compliance, that is, the potential harm to ultra-high frequency donors older than 50 years is significantly greater than that of donors of other ages. Older platelet donors should be cautious about ultra-high frequency donations to avoid adverse health hazards. Meanwhile, the work will provide technical reference for the more scientific and efficient development of the platelet harvesting work and the establishment of the clinical blood supply system for related patients.