Safety and waste considerations in donated blood screening

Abstract

We study an important problem faced by Blood Centers, of selecting screening tests for donated blood to reduce the risk of “transfusion-transmitted infectious diseases” (TTIs), including the human immunodeficiency virus (HIV), hepatitis viruses, human T-cell lymphotropic virus, syphilis, West Nile Virus, and Chagas’ Disease. This decision has a significant impact on health care quality in both developed and developing countries. The budget-constrained decision-maker needs to construct a portfolio of screening tests, from a set of available tests, each with given efficacy (sensitivity and specificity) and cost, to administer to each unit of donated blood so as to minimize the “risk” of a TTI for blood classified as “infection-free.” While doing this, it is critical, for a viable blood system, that the decision-maker does not falsely (i.e., through screening error) discard too much of the infection-free blood (“waste”). We construct mathematical models of this decision problem, considering the various objective functions (minimization of the TTI risk or the weighted TTI risk) and various constraints (on budget and wasted blood) relevant in practice. Our work generates insights on the test selection problem. We show, for example, that a reduction in risk does not necessarily come at the expense of an increase in waste. This underscores the importance of considering these different metrics in decision-making through an optimization-based model. Our work also highlights the importance of generating region-specific testing schemes that explicitly take into account the regional prevalence and co-infection rates, along with the impacts of the infections on the society and individuals.