Donor Selection Process Research Articles

An exploratory study of perceptions and utilization of genetic information in the intended parent experience of oocyte donor selection.

Utilization of oocyte donation has become an increasingly common practice in assisted reproductive technology (ART). Since the introduction of larger carrier screening (CS) panels and extended family medical histories (EFMH), studies have not examined how this information factors into the oocyte donor selection process. This exploratory, qualitative study provides further insight into what role, if any, donors' available genetic information (e.g., larger CS panels and EFMH) plays in selecting an oocyte donor. An online screening survey was distributed to individuals who have undergone or are currently in the process of selecting an oocyte donor through the RESOLVE network and Mayo Clinic's Reproductive Endocrinology and Infertility clinic. From 13 survey respondents, six oocyte recipients subsequently participated in semi-structured telephone interviews and discussed their experiences as oocyte recipients including their perceptions of donors' available genetic information and process in choosing an oocyte donor. Genetic information was seen as valuable and reassuring for participants, particularly EFMH, but did not play a significant role in the selection process for these participants. Supplemental emergent themes provide context on the psychosocial complexities of the oocyte recipient experience and possible explanations for why genetic information is not a decisional priority. Participants indicated genetic information was not extensively discussed or fully explained by providers. Results demonstrate how genetic counselors can be more involved in the pre-selection process to discuss the utility and limitations of genetic information, as well as address psychosocial issues common to the oocyte recipient experience.

Performance of the New CKD-EPI Creatinine-and Cystatin C-based Glomerular Filtration Rate Estimation Equation in Living Kidney Donor Candidate.

Accurate preoperative evaluation of renal function in living kidney donor candidates (LKDCs) is crucial to prevent kidney failure after nephrectomy. We examined the performance of various estimated glomerular filtration rate (eGFR) equations, including the new chronic kidney disease epidemiology collaboration (CKD-EPI) equation in LKDCs. We analyzed 752 LKDCs who were assessed for measured GFR by inulin clearance as part of routine pretransplant examination from 2006 to 2020. CKD-EPI2012 from cystatin C (CKD-EPI12cys), CKD-EPI2021 from creatinine (CKD-EPI21cr), CKD-EPI21cr-cys, Japanese modified (JPN) eGFRcr, and JPN eGFRcys were compared in determining the suitability for LKDCs. CKD-EPI12cys had the lowest absolute and relative biases, with higher P30 and P10, followed by JPN eGFRcys, CKD-EPI21cr, and CKD-EPI21cr-cys. The root mean square error was least for CKD-EPI12cys, then JPN eGFRcys, CKD-EPI21cr-cys, CKD-EPI21cr, and JPN eGFRcr. CKD-EPI21cr, CKD-EPI12cys, and CKD-EPI21cr-cys estimated GFR higher, whereas JPN eGFRcr estimated GFR lower. At the threshold of 90 mL/min/1.73 m2, CKD-EPI21cr had the highest percentage of misclassification at 37.37%, whereas JPN eGFRcr had the lowest percentage of misclassification at 6.91%. Using the age-adapted approach, JPN eGFRcr had the lowest percentage of misclassification into overestimation at 7.31%. All eGFR had >5.0%, and CKD-EPI21cr had the highest percentage of misclassification at 21.94%. Conversely, CKD-EPI21cr-cys had the lowest percentage of misclassification into underestimation at 3.19%, both at the threshold of 90 mL/min/1.73 m2 and the age-adapted approach. JPN eGFRcr had the highest percentage at 33.38% and 40.69%, respectively. In evaluating the renal function of Japanese LKDCs, the new CKD-EPI equation had a lower rate of underestimation but a relatively high rate of overestimation. New GFR estimation formulas are needed to be tailored to each ethnic group to enhance the accuracy and reliability of donor selection processes.

A comparative analysis of screening technologies for transfusion-transmitted infectious diseases

Abstract: BACKGROUND AND OBJECTIVES: Ensuring the safety of blood supply relies on robust screening and donor selection processes. This study assessed the technical performance of automated enzyme-linked immunosorbent assay (ELISA) (EVOLIS, Bio-Rad, France) and electrochemiluminescence immunoassay (ECLIA) (COBAS 6000 e601 and COBAS e411, Roche Diagnostics, Germany) in detecting hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections. MATERIALS AND METHODS Retrospective data of transfusion transmissible infections (TTI) screening test results were collected from blood center records, encompassing two phases: January 2020 to May 2020 (phase 1) and March 2021 to April 2021 (phase 2). The sensitivity, specificity, positive predictive value, and negative predictive value of ELISA and ECLIA were calculated. Performance evaluation was conducted using the Youden’s index and the kappa coefficient. RESULTS: The study included a total of 824, 755, and 830 donor samples in phase 1 and 1237, 1238, and 1236 donor samples in phase 2 for HIV, HBV, and HCV testing, respectively. High agreement (kappa 0.88, 0.95) existed between ELISA and COBAS e601 for HIV and HBV, with substantial agreement (kappa 0.66) for HCV. Likewise, substantial agreement (kappa 0.66, 0.79, 0.79) was found between ELISA and COBAS e411 for all three parameters HIV, HBV and HCV, respectively. Notably, nearly all false-positive samples detected by ECLIA had low cutoff index values ranging from 1 to 6.5. CONCLUSION: The differences in sensitivity and specificity contribute to the discrepancy observed between various serological testing platforms, such as ELISA and ECLIA, for TTI testing. Specifically, low signal/cutoff ratios ≤6.5 obtained with ECLIA are highly indicative of false-positive results.

Molecular relapse monitoring reveals the domination of impaired NK cell education over impaired inhibition in missing KIR-ligand recognition in patients after unrelated hematopoietic stem cell transplantation for malignant diseases.

Transplantation of HLA and/or KIR mismatched allogeneic hematopoietic stem cells can lead NK cells to different states of activation/inhibition or education/resetting and change anti-tumor immunosurveillance. In this study, we used molecular relapse monitoring to investigate a correlation between either missing ligand recognition or variation of the cognate iKIR-HLA pairs with clinical outcomes in patients with hematological malignancies requiring allogeneic hematopoietic stem cell transplantation (allo-HSCT). Patients (N = 418) with acute myeloid leukemia (AML), chronic myeloid leukemia (CML), acute lymphoblastic leukemia (ALL), myelodysplastic syndrome (MDS), or lymphoma receiving T-cell repleted graft from HLA-matched or partly mismatched unrelated donors between 2012 and 2020 in our center were included in this study. Missing-ligand recognition was assessed through the presence or absence of recipients' HLA ligand for a particular inhibitory KIR (iKIR) exhibited by the donor. Inhibitory KIR-HLA pair number variation was defined by loss or gain of a new cognate pair of HLA-KIR within the new HLA environment of the recipient, compared with the donor's one. Considering the results of our research, we drew the following conclusions: (i) loss of iKIR-HLA cognate pair for C1, C2, and/or Bw4 groups led to significant deterioration of disease-free survival (DFS), molecular relapse, overall survival (OS) and non-relapse mortality (NRM) for patients undergoing allo-HSCT in the standard phase of the disease. This phenomenon was not observed in patients who underwent transplantation in advanced hematological cancer. (ii) The missing ligand recognition had no impact if the proportion of HLA mismatches was not considered; however, adjustments of HLA mismatch level in the compared groups highlighted the adverse effect of the missing ligand constellation. (iii) The adverse effect of adjusted missing ligand suggests a predominance of lost NK cell education over lost NK cell inhibition in posttransplant recipients' new HLA environment. Our results suggested that donors with the loss of an iKIR-HLA cognate pair after transplantation should be avoided, and donors who provided an additional iKIR-HLA cognate pair should be preferred in the allo-HSCT donor selection process.

A Single-Center Study on the Clinical Profiles and Ultrasonographic Assessments of Living Kidney Donors in the Marathwada Region of Maharashtra.

Living donor kidney transplantation plays a vital role in renal replacement therapy, particularly in India, where a substantial increase in kidney transplants has been observed. Thorough assessments of living kidney donors are crucial, focusing on parameters such as kidney size and glomerular filtration rate (GFR). Despite the importance of GFR in donor assessments, there is a noticeable lack of data on normal GFR ranges in the Indian population. This study aims to address the gap in knowledge by establishing a reference range for GFR in healthy kidney donors from the Marathwada region of Maharashtra. The research also explores the clinical profiles and ultrasonographic features of living kidney donors. A retrospective analysis was conducted at the Mahatma Gandhi Mission (MGM) Medical College and Hospital in Aurangabad, involving 134 living kidney donors. Inclusion criteria encompassed healthy donors with a BMI of less than 30 kg/m², while donors with uncontrolled hypertension, diabetes, microalbuminuria, or a measured GFR below 70 mL/min/1.73 m² were excluded. Comprehensive medical histories, demographic parameters, and ultrasonographic assessments were conducted, with GFR measured using 99M technetium diethylenetriamine pentaacetate scans. The study reveals that the majority of donors were females (80.6%), and the highest number fell within the 41-50 age group. Parents constituted the primary donor category (68.7%), reflecting a familial inclination toward organ donation. Ultrasonographic assessments indicated larger kidney sizes compared to other studies, suggesting regional or population-specific differences. The mean GFR for the right and left kidneys, as well as the total GFR, was within the expected range. The negative correlation between age and GFR emphasizes the need to consider age in donor assessments. The findings emphasize the unique features of this population, including a higher average age, female preponderance, and larger kidney sizes. The study contributes to the understanding of living kidney donors' profiles in the region and highlights the importance of individualized assessments in the donor selection process.

Factors related to the development of high antibody titres against SARS-CoV-2 in convalescent plasma donors from the ConPlas-19 trial.

The efficacy of COVID-19 convalescent plasma (CP) associates with high titres of antibodies. ConPlas-19 clinical trial showed that CP reduces the risk of progression to severe COVID-19 at 28 days. Here, we aim to study ConPlas-19 donors and characteristics that associate with high anti-SARS-CoV-2 antibody levels. Four-hundred donors were enrolled in ConPlas-19. The presence and titres of anti-SARS-CoV-2 antibodies were evaluated by EUROIMMUN anti-SARS-CoV-2 S1 IgG ELISA. A majority of 80.3% of ConPlas-19 donor candidates had positive EUROIMMUN test results (ratio ≥1.1), and of these, 51.4% had high antibody titres (ratio ≥3.5). Antibody levels decline over time, but nevertheless, out of 37 donors tested for an intended second CP donation, over 90% were still EUROIMMUN positive, and nearly 75% of those with high titres maintained high titres in the second sample. Donors with a greater probability of developing high titres of anti-SARS-CoV-2 antibodies include those older than 40 years of age (RR 2.06; 95% CI 1.24-3.42), with more than 7 days of COVID-19 symptoms (RR 1.89; 95% CI 1.05-3.43) and collected within 4 months from infection (RR 2.61; 95% CI 1.16-5.90). Male donors had a trend towards higher titres compared with women (RR 1.67; 95% CI 0.91-3.06). SARS-CoV-2 CP candidate donors' age, duration of COVID-19 symptoms and time from infection to donation associate with the collection of CP with high antibody levels. Beyond COVID-19, these data are relevant to inform decisions to optimize the CP donor selection process in potential future outbreaks.

Abstract 13887: Longitudinal Trends in Donor and Recipient Risk Profile, and Clinical Outcomes, for Donation After Circulatory Death Heart Transplantation

Background: The US rate of Donation after Circulatory Death (DCD) Heart Transplant (HT) increased threefold from 2020 to 2022. While early analyses of DCD HT have suggested similar outcomes compared to donation after brain death HT, this may be the result of a restrictive DCD donor and recipient selection process, intended to minimize risk in the first US DCD HT cohorts. Hypothesis: We hypothesized that risk profiles for DCD HT donors and recipients have increased over time, as DCD HT has rapidly expanded. We sought to identify longitudinal changes in risk profiles for DCD donors and recipients from 2019-2023, and determine if such changes have impacted post-DCD HT clinical outcomes. Methods: We analyzed the UNOS thoracic organ database from December 2019 to March 2023. DCD HT donor and recipient risk characteristics were evaluated over time for significant trend. One-year recipient survival was compared over time. Results: During the study period, 716 DCD HT were performed. Recipients were mostly male (79%), Caucasian (68%), and had mean age of 54 years. Over time, several donor and recipient characteristics were significantly different (Table, Figure). Donors were older, and had increased BMI, creatinine, and agonal phase to cross-clamp time, although overall lower ischemic time. Recipients were more likely to be status 1 or 2, and had increased BMI, waitlist time, creatinine, and CPRA. Donor and recipient comorbidities and mechanical support use were unchanged. Post-HT survival over time was unchanged. Conclusions: Since the first US DCD HT, several donor and recipient risk-factors have increased. These increased risk profiles have not translated into reduced one-year survival.

Patient Blood Management and Its Role in Supporting Blood Supply.

Blood donors and voluntary blood donations are essential for ensuring the blood supply that can be maintained by good patient blood management (PBM) practices. This review article explores the role of blood donation in PBM and highlights the importance of donor screening and selection processes in different regions worldwide. The donor health questionnaires and the focused physical examination guidelines have changed in the last decade to increase donor and recipient safety. This article also discusses the status of transfusion practices, including the challenges of ensuring a safe blood supply. Significant among these are the effects of the COVID-19 pandemic on the blood supply chain and the impact of an aging donor population, especially. Promoting autologous donations and other blood conservation strategies are suggested to mitigate these issues. The role of replacement donors and the upper age limit for voluntary blood donation may be decided based on the demography and donor pool. The involvement of C-suite executives is also critical in implementing and running a successful PBM program. The review highlights how these different aspects of blood donation are integral to a successful PBM program and the safety of patients who receive blood transfusions.

The evolution of liver transplant program in Pakistan and the challenges ahead

Background and aimThe burden of Liver disease has significant implications on the healthcare infrastructure in Pakistan, with viral hepatitis being the leading etiology of end-stage liver disease. Liver transplant remains the only curative treatment option for end-stage liver disease. A decade ago, the liver transplant facility was almost non-existent for the Pakistani population, and the patients with end-stage liver disease had to travel overseas to receive liver transplantation. Gradually, during the last decade the country has progressed steeply and achieved various milestones in living donor liver transplantation. Various public and private sector hospitals are providing liver transplant services nationwide. The study aimed to describe the evolution and success of living donor liver transplant programs in Pakistan. We will also discuss the current practices involved in donor and recipient selection, factors related to non-existent deceased donor organ programs, and the introduction of innovative strategies to overcome the shortage of donor organ pools. MethodsWe retrospectively analyzed the data of the first 416 living donor liver transplants (LDLTs) performed at PKLI&RC from March 2019 to April 2023. The stepwise approach for the donor and recipient selection process is described in detail, along with the survival outcomes of LDLT at our center. ResultsAmong the 416 living donor liver transplants performed between March 2019 and April 2023. The Hepatitis C virus was the most common etiology (50.5 %) for chronic liver disease. Hepatocellular carcinoma (HCC) was present in 27.9 % of cases. Most donors were offspring of the recipients, with sons accounting for 23 % and daughters for 17.5 % of cases. Only a single (0.24 %) patient had a deceased donor transplant. The annual donor rejection rate was up to 68 % at our center. Nine SWAP transplants were performed to overcome the donor shortage. The Clavien Dindo classification system was used to grade the severity of complications after donor hepatectomy. No donor mortality (grade-5 complication) was observed in our cohort, whereas 1- and 3-year recipient survival rates were 89 % and 88 %, respectively. ConclusionHepatitis C virus remains the most common etiology of chronic liver disease requiring liver transplantation. The major pool of living donations was from first-degree relatives. There was no donor mortality with acceptable 1- and 3-year recipient's survival rates. Living donor liver transplantation is a feasible and safe strategy in regions where cadaveric liver transplant program is limited.

Analysis of blood donors’ characteristics during third-peak COVID-19 in Bojonegoro Regency, Indonesia

The third peak of Coronavirus disease 2019 (COVID-19) in Indonesia was recorded on February-March 2022 had an impact on voluntary blood donors at the Indonesian Red Cross (IRCS) Bojonegoro. The objective of this research was to analyze the blood donors’ characteristics during third-peak COVID-19 in Bojonegoro Regency. This research was descriptive analysis study using secondary blood donor data from February 22, 2022 to March 19, 2022 at IRCS Bojonegoro. The data was collected in donor selection process accordance the Indonesian and WHO blood donor selection guidelines. The average number per daily blood donors was tested using the Mann-Whitney-U test using IBM SPSS type 23 software with significancy p<0.05. The results showed there were 219 people (80.51%) on 22-28 February and 332 people (83.63%) on 1-19 March 2022 who approved to donate at IRCS Bojonegoro. There was a significant decrease in the average of daily male blood donors (p=0.01), average age group: 17-24 years (p=0.013), 35-44 years (p=0.002), and 45-54 years (p=0.030), hemoglobin (Hbl) levels on 16.1-17 g/dL (p=0.000), systolic blood pressure (SBP) <120 (p=0.03) and 130-139 (p= 0.02) and diastolic blood pressure (DBP) <80 (p=0.001), pulse rate (PR) 65-74 beats/minute (p=0.016), and blood type O+ (p=0.008). The characteristics of blood donors at the third peak of COVID-19 in Bojonegoro Regency decreased significantly in the number of male blood donors, age group, SBP, DBP, PR, and O+ blood type.

Impact of Universal Donor History Questionnaire in Pre-Donation Deferrals a Tertiary Care Hospital Experience

Objective: The purpose of this research was to better understand the factors that lead to pre-donation deferral at a tertiary care hospital's Blood bank. Understanding the factors that lead donors to decline can inform more effective selection criteria. Study Design: Cross-sectional/Descriptive study Place and Duration: Diagnostic and research laboratory Liaquat university of Medical and Health Sciences Jamshoro Hyderabad. January 2022-December 2022 Methods: This study comprised of 2200 donors at blood bank of LUMHS. The UDHQ included 25 questions to assess donors' backgrounds in regards to things like injections, medicines, time since last donation, tattoos, general health, dental work, sexual relationships, malaria/T.B., surgery, jaundice, vaccination, positive viral markers, etc. Haemoglobin (Hemacue 50/Diaspect Hb with daily quality control), Heart rate/rhythm, Blood pressure, Body temperature, Weight/Height, and Jaundice were all part of the physical exam. Results: There were majority 1578 (71.7%) males and 622 (28.3%) female donors among all cases. Donors mean age was 26.12±9.88 years and mean weight was 61.3±8.49 kg. 1435 (65.2%) cases were from urban areas. Among all, 1650 (75%) donors were accepted and 550 (25%) donors were deferral. Most common cause of deferral was low hemoglobin followed by anemia, HCV, HBV, inappropriate pulse rate, low BP, jaundice, active infection, malaria, syphilis, allergy, aspirin intake, drugs, last donation, skin/eye colour and sexual relationship. There were 1870 (85%) cases of replacement donors among all cases. Conclusion: The selection of healthy blood and the reduction of donor injury will be made possible by a thorough pre-donation screening interview and physical examination. Our setup has a somewhat higher blood donor deferral rate because to stringent donor sector requirements and extra attention paid to donor selection processes. The increased replacement donor deferral rate is a result of refusals for past injection history and poor hemoglobin levels. Keywords: Donors, Deferrals, Hemoglobin, Infection, HCV

Review of blood donor deferral with emphasis on donor and patient safety.

Blood donor deferral is a part and parcel of the commitment of the blood transfusion services to assure the safety and health of the blood donor as well as the recipient. Periodic review of blood donor deferral is to incorporate or revoke deferral reasons based on the evidence generated in the process of review. Therefore, emphasis must be laid on preparing strategies to only judiciously defer blood donors, recruit and retain first time blood donors, which needs critical appraisal of the existing deferral policies, so that the evidence based changes can be done. A retrospective analysis of deferral in blood donors who presented at the blood donation centre of an institute of national importance over a span of nine years (2011-2019). Donors were screened as per the Drugs and Cosmetics Act 1940 and Rules 1945 given by the Ministry of Health and Family Welfare, Govt of India. There were 1,37,935 donors attempts, out of which 20,167 (14.6%) donors were deferred from donating blood. Most of the deferred donors were male (88.5%), first time (86.1%) and temporarily deferred (87.6%). Almost comparable number of donors (49.1 % & 48.5%) were deferred for donor safety and patient safety reasons respectively. Overall the three most common reasons for deferral were low hemoglobin (21.6%), hypertension (11.4%) and history of jaundice (9%). In donor safety reasons, low hemoglobin (43.4%), hypertension (22.9%) and low blood pressure (4.5%), and in patient safety, a history of jaundice (18.6%), common cold (15.8%), and high-risk behavior (8.8%) emerged as the three most common reasons for deferral respectively. Blood donor deferral is an essential quality indicator of the blood donor selection process. Initiatives like fortification of dietary ingredients with iron, optimizing protein in diet served in schools under mid-day meal program, screening for iron deficiency, hypertension and education about high-risk behavior in schools and colleges may have long term effects of promotion of better health.

Application of a Caprylate/Chromatography Purification Process for Production of a Hepatitis B Immune Globulin from Pooled Human Plasma

Background Hepatitis B (HB) is a worldwide public health problem affecting around 250 million people. Only about 10% of people with HB are aware that they are infected. Vaccination is crucial to prophylactically controlling HB and the combination of vaccination and HB immune globulin (HBIG) are essential in preventing disease after exposure to the HB virus. Objectives In this article, a caprylate-chromatography process has been used for the production of HBIG (HBIG-C). The previously used solvent-detergent process produced an HBIG (HBIG-S/D) with an excellent safety profile but allowed the retention of some procoagulant plasma proteins. The present studies were conducted to assess the character and purity of HBIG produced by the caprylate-chromatography process. Design and Methods Several analytical methods (eg, chromatography, immunoassays, and nephelometry) were used to assess the molecular characteristics, purity and HBIG potency and specific activity of HBIG-C. In addition, testing was conducted to assess the levels of several pro-coagulant factors. HBIG-C was compared with HBIG-S/D and other immunoglobulins manufactured by the S/D process. Results The analysis of HBIG-C showed that the product was almost entirely IgG (99.3 ± 0.2% by electrophoresis) and that the residual IgA was less than that found in S/D products. The IgG present in HBIG-C was 99.7 ± 0.6% monomers and dimers as measured by size exclusion chromatography. Aggregates and fragments constituted < 1%. The IgG subclass distribution in HBIG-C was in the normal reference range. Coagulation factor impurities and pro-coagulant activity were reduced in HBIG-C compared to IgG prepared by the S/D method. Conclusions HBIG-C takes advantage of long-established donor selection processes combined with recently improved manufacturing processes to produce a safe and effective HBIG-product. HBIG-C combines high purity with reduced pro-coagulant factors in a product used for post-exposure prophylaxis of HB.

Assessing Training Needs of Health Personnel on the Process of Selecting Blood Donors and Transfusion in the West Region of Cameroon.

Blood transfusion is a health care procedure that can expose the donor and receiver to risks. The knowledge and practices of healthcare personnel on blood transfusion are necessary to anticipate and/or prevent the occurrence of avoidable transfusion risks. The aim of this study was to assess the training needs of health personnel on blood donor selection procedure. We conducted a cross-sectional study targeting health personnel in health facilities that reported contributing in offering blood transfusion services in the West region of Cameroon between March and May 2022. A questionnaire administered face to face was used to collect data from the targeted health personnel exhaustively included from health facilities. Knowledge and practices were assessed by estimating the rate of correct answers. STATA software was used to analyze the data. Of the 41 health facilities that reported offering blood transfusion services, 35 (85.3%) were covered. Category 5 and 4 health facilities were respectively 23 (65.7%) and 9 (25.7%). Among the 325 health personnel involved in transfusion, 302 (92.9%) were reached among which, 201 (66.6%) were female and 127 (42.1%) were nurses. Two hundred and ten (69.5%) had already received training on blood transfusion and 268 (88.7%) expressed a need for training on blood transfusion of which 139 (51.8%) on blood donors' selection. Sixteen (5.3%) knew how to identify blood donor and 116 (38.4) knew the minimum required tests to be performed on the donors' blood before the transfusion. Six (2.0%) out of 302 health personnel were able to select blood donors and identify minimum tests to be performed on donors' blood. There is a real need for training of health personnel on the blood donor selection process. Health authorities should ensure that all health personnel involved in blood transfusion receive a minimum of training in blood donor selection and testing.

Genome-Wide Non-HLA Mismatches Improve Risk Stratification for Overall Survival and Cause Specific Mortality after Unrelated Donor Allogeneic HCT

Introduction The number and location of human leukocyte antigen (HLA) mismatches associate with higher mortality after allogeneic hematopoietic cell transplantation (alloHCT). We sought to determine if prediction models using demographic and clinical data combined with genome-wide recipient-donor allele mismatching at non-HLA single nucleotide polymorphisms (SNPs) contributed independent information about patients’ cause-specific and overall mortality after alloHCT. Methods To develop and test our outcome prediction models, we use DISCOVeRY-BMT, a 2-cohort study of patients with acute leukemia (ALL and AML) and myelodysplastic syndromes (MDS) and their 8/8 HLA-matched unrelated donors reported to the Center for International Blood and Marrow Transplant Research. Donor-recipient pairs (DRP) were genotyped using the OmniExpress Chip. At each SNP, mismatch was defined as: 1) Host-versus-Graft (HvG) - where the recipient is homozygous at a SNP locus with the donor sharing one allele, 2) Graft-versus-Host (GvH) - where the donor is homozygous at a SNP locus, while the recipient shares one allele with the donor, and 3) Bidirectional - both alleles differ between DRP. Independent typed SNPs selected one representative SNP for each linkage disequilibrium region. For each DRP and for each type of mismatch, values were summed (1 = mismatch and 0 = match), multiplied by the weight based on expression quantitative trait (eQTL) loci in blood using Blood eqtlGEN (√-log10 (p) for an eQTL and 1 for a non-eQTL SNP), then divided by the number of total weighted SNPs to provide an estimated proportion of SNPs mismatched for HvG, GvH, and Bidirectional, respectively. Low, Medium, and High mismatch levels were assigned using a hierarchical method to determine the optimal cut points for the exponentiated β coefficients from the multivariate Cox regression. Risk groups were developed using DRPs in Cohort 1 and performance was validated in Cohort 2. Results The mean proportion and standard deviation of weighted mismatch SNPs for HvG, GvH and Bidirectional is 9.11 ± 0.14, 9.09 ± 0.11, and 3.0 ± 0.09, respectively, and do not differ across cohorts. A continuous mismatch score was constructed based on β coefficients trained using Cohort 1 DRPs (βHvG = -0.39, βGvH = -1.42, and βBidirectional = 0.74) and the score is normally distributed. The optimal cut-off values (x104) for the mismatch score for low/medium- and medium/high-risk groups were: 3.87 and 4.24, respectively. The mismatch risk score in testing data (Cohort 2) showed that the overall survival rate in the first year after transplant was 15.2% lower in the high mismatch risk group compared to the low mismatch risk group (log rank p = 0.0019) and did not significantly differ by disease. When further stratified by disease, the survival probability differed significantly in AML patients with high risk compared to low risk mismatch (p = 0.01). Analyses of Cohort 2 show patients in the medium mismatch risk group (HR = 1.47, 95% CI 1.08, 2.02, p = 0.02) and high mismatch risk group (HR = 1.58, 95% CI 1.17, 2.12, p = 0.003) have a significantly increased risk of overall mortality within 1-year after alloHCT compared to the low mismatch risk group when adjusted for disease, disease status, recipient age, donor age, and graft source (Figure 1). Cohort 2 analyses of cause specific death (transplant- vs. disease-related mortality, TRM vs. DRM) showed that models including genetic mismatch, disease, disease status, recipient age, donor age, and graft source, predicted patients in the medium mismatch risk group (HR = 2.19, 95% CI 1.36, 3.51, p = 0.0012) and high mismatch risk group (HR = 2.38, 95% CI 1.51, 3.74, p = 0.0002) have significantly increased risk of DRM within 1-year after alloHCT, compared to the patients in the low mismatch risk group, with no significant associations for TRM (Figure 2). Conclusions These data suggest that a reliable and reproducible genome-wide mismatch score can be used to assess risk of mortality after alloHCT. Recipients with a low mismatch genetic score showed significantly better survival irrespective of disease status; thus, this score is prognostic for patients in complete remission or with measurable disease. Understanding the contribution of non-HLA genetic mismatches between the recipient and their HLA-matched donor could provide better guidance for the donor selection process and improve the current donor-recipient matching algorithm. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

EVALUATING CURRENT CARRIER SCREENING PROTOCOLS FOR PATIENTS AND FAMILIES UTILIZING DONOR GAMETES

To better understand how individuals and families using donor gametes incorporate genetic carrier screening into the donor selection process and assess the utility of genetic counselors in navigating the donor carrier screening landscape.

COMPARISON OF LABORATORY OUTCOMES USING FROZEN DONOR EGGS OBTAINED FROM FROM DIFFERENT COMMERCIAL EGG BANKS

Use of frozen donor eggs for ART offers several advantages over fresh donor eggs. These advantages, coupled with an increase demand for donor oocytes, has given rise to numerous commercial egg banks. While many donor egg banks offer guarantees and most tout high outcomes, careful oversight and quality control during the donor selection, stimulation and oocyte vitrification process are paramount to ensure developmentally competent eggs. With the increasing number of frozen donor egg suppliers, comparison of quality/outcomes has become more important.

Oocyte Donation: Three Perspectives

Background: A number of important problems remain unresolved in the field of assisted reproductive technologies (ART) using germ cells from a single donor. This study aimed to assess attitudes about the use of sex gamete donation in ART in different social groups including medical workers, oocyte recipients, and oocyte donors.
 Methods: To achieve this goal, we surveyed 286 participants from seven countries. Of them, 190 were medical workers from ART clinics (respondents from seven countries), 45 were oocyte recipients (Kazakhstan), and 51 were oocyte donors (Kazakhstan).
 Results: A survey of the three groups showed that issues related to donor health were most common in the donor selection process based on patient and doctor distrust of the health care system. The main motive for oocyte donation was financial compensation, which draws attention to the social disadvantage of the donor population. Medical workers with more than 5 years of work experience (79.7%) supported the use of programs tracking donor sex gametes and limiting the use of oocyte donors.
 Conclusions: The willingness and consent of the surveyed medical workers and oocyte recipients to use the donor material and create a unified registry of donor sex gametes demonstrates the importance of this issue.

Multistep screening and selection of COVID-19 convalescent plasma donors at the early stage of the SARS-CoV-2 pandemic: A retrospective analysis.

Background and AimsThe COVID‐19 pandemic reached Bavaria in February 2020. Almost simultaneously, Chinese physicians published reports on the first successful treatments with plasma from COVID‐19 convalescent donors. With these silver linings on the horizon, we decided to establish the manufacturing of anti‐severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) antibody‐containing plasma from COVID‐19 convalescent donors at our site. Here we describe our donor selection process, built from the ground up, which enabled us to cope with the immense resonance after our social media call for donors.MethodsAs a first step, we created a specific questionnaire for telephone interviews applied by trained students to filter the wave of callers interested in plasma donation. Afterward, the medical staff evaluated the hotline questionnaires and chose eligible donors to be invited for on‐site donor evaluation. Data documentation was performed with MS Excel, and statistical analyses were calculated with GraphPad Prism 8. A quantitative in‐house ELISA was used to detect anti‐SARS‐CoV‐2 antibodies and determine specific titers.ResultsOut of 1465 calls from potential plasma donors, we could register 420 persons with a completed questionnaire. Evaluation of questionnaires identified 222 of 420 persons as eligible for donation, and 55 were directly asked for on‐site donor qualification. Subsequently, as anti‐SARS‐CoV‐2 antibody titers ≥1:800 were required, we invited 89 of 222 potential donors for an antibody screening. This procedure resulted in another 28 potential donors for an on‐site evaluation. Finally, 12 donors qualified with a titer of 1:400 and 24 with ≥1:800.ConclusionIdentifying suitable COVID‐19 convalescent plasma donors was expected to be highly time‐consuming. Implementing a screening procedure with our hotline questionnaire helped us streamline the donor selection process and reduce the workload for the staff. We propose combining the described selection process with the later introduced on‐site antibody screening as an effective strategy.

Effectiveness of Combined Verbal Screening and Uniform Donor Questionnaire in Blood Donor Deferral; Evaluation at a Regional Blood Bank

Introduction: Blood transfusion is a potentially life-saving procedure that replaces the blood lost either during surgery or after injury. It also serves as a mean of replacing blood in the patients who cannot replenish enough blood for their own body. Donors come from all walks of life with established lifestyle. A detailed questionnaire along with verbal screening and general physical examination should be performed in all blood donors before labeling them unsuitable for donation. Objective: To evaluate the effectiveness of verbal screening in addition to uniform donor questionnaire as a routine pre-donation protocol for donor selection and deferral. Material and Methods: This cross-sectional study was conducted at a regional blood bank in Northern Pakistan over a period of six months from January 2021 to June 2021. The blood donors who were deferred after assessment by uniform donor questionnaire (UDQ), verbal screening and general physical examination were critically analyzed. The causes of deferral were noted. The data was analyzed by using SPSS Version 23. Results: A total of 400 blood donors were deferred during the study period. Their ages ranged from 25 to 40 years with a median age of 29 years. Majority of them were males (97.5%). Among these, 332 were deferred on uniform donor questionnaire, 48 on verbal screening and 20 on general physical examination. Conclusion: Assessment of blood donors by verbal interview as an adjunct to donor questionnaire is very effective in donor selection and deferral process and should be made a mandatory part of pre-donation blood donor selection protocol. Keywords: Transfusion, uniform donor questionnaire, verbal screening