How understanding donor behavior should shape donor selection

Abstract

I N THE EPILOGUE of her wonderfully comprehens ive work detailing 10 years of research (1977 to 1987) into blood donor motivation, Piliavin states: Since we began the research on which this book is based, the necessity for convincing some donors NOT to give has become a far more critical concern than issues of recruitment and retention. 1 There is extensive literature on donor motivation but published material relating to the behavior of donors is sparse. This is not surprising, because the methods available for investigating such behavior have traditionally been limited to interview of donors subsequently found positive for microbiology mandatory test markers (eg, anti-human immunodeficiency virus [HIV], hepatitis B surface antigen [HBsAg], anti-hepatitis C [HCV]) and analysis of donor deferral/exclusion rates. The prevalence of confirmed positive test results for any one microbiology marker within a donor population falls within a year of the introduction of routine screening for that marker. For all tested markers, the prevalence is now very low in the United Kingdom and other developed countries. 2 To assess the impact of interventions in donor screening by looking for further decreases in prevalence will require many years. Changes in donor selection criteria are frequent, depending on perceived improvements and new regulatory factors. It is difficult to assess the effect of any single intervention. A further difficulty is that much work on donor perception and understanding has been performed for specific organizations by commercial research companies; such work is not published in peer-reviewed journals and therefore is not in the public domain. In addition, although a great deal of knowledge has accumulated from experience, this is often anecdotal rather than published, peer-reviewed work. The importance of donor behavior only started to come to light with the advent of acquired immune deficiency syndrome (AIDS) and more careful scrutiny of the donor population. Most work in this field therefore dates from 1985 onward, and this review considers the key works published since that time that highlight the importance of understanding the way blood donors behave. It is only by being aware of how donors behave that appropriate and effective guidelines and methods of communication can be developed. We have at our disposal three distinct approaches for safeguarding the blood supply: (1) selection of donors; (2) testing of donation samples; and (3) modification of the components and products. All of these methods complement each other, have limitations, and are continually improved in the light of increasing knowledge. The initial selection of the donor is of paramount importance, but the selection process must be effective. It is precisely this effectiveness that depends on an understanding of donor behavior. In 1991, Busch et al s estimated that the of donated units not detected by routine testing was 1:40,000 to 1:210,000. Such estimates usually apply to risks of HIV transmission. Donor selection is the chief means we have of trying to prevent transmission of the nontestable potential infections. This review is divided into three parts: 1. The setting of standards for donor selection by transfusion services. Where do these standards come from? How are they set? How does knowledge of donor behavior influence them? 2. How should donor selection criteria be applied to maximum effect? How does an understanding of donor behavior guide the transfusion services? 3. How to measure the effectiveness of the selection process; the assessment of residual risk We will consider published work and highlight gaps in knowledge. It must be stressed that, because of marked socioeconomic differences in the different countries in which transfusion services