Subjective Donor Deferral As a Tool for Increased Blood Transfusion Safety

Background: In blood transfusion services (BTS), selection of appropriate donor populations via clinical and serological screening is necessary to prevent transfusion-transmitted infections (TTIs). One of the strategies adopted by some Brazilian BTS is known as Subjective Donor Deferral (SDD), i.e., the rejection of a donation by the clinical triage interviewer based on subjective factors. Therefore, we aimed to evaluate if SDD has potential for increasing blood transfusion safety. Methods: We did a cross-sectional study involving blood donors who passed clinical triage from January 1, 2013, to December 31, 2015, in the Hematology and Hemotherapy Center of Ceara (Fortaleza, Brazil). Donor information was collected via the Blood Bank System (SBS) Web ISBT 128 database. They were evaluated for age, gender, education level, donation type and history, presence of confidential unit exclusion and/or SDD, and results of the standard serological screening (HIV, syphilis, human T-lymphotropic virus, and hepatitis B and C). Findings: 105,005 donors were included for analysis. Individuals subjectively deferred were 2.80 times more likely to have at least one reagent serology in the standard laboratory screening. Also, they were, respectively, 4.47, 5.69, and 6.14 times more likely to have positive syphilis, hepatitis B, and HIV screening. Interpretation: If positive infectious diseases markers rates correlate with the incidence of window period infections, implementation of SDD in clinical triage of blood donors may be an effective additional way to avoid TTIs, highlighting the importance of interviewer experience, perspicacity and face-to-face contact with the donor for blood safety assurance. Funding Statement: None received. Declaration of Interests: The authors declare they have no financial, personal, or professional conflicts of interests to disclose. Ethics Approval Statement: The study protocol was approved on 09 April 2018 by the Ethics Committee of the Center of Hematology and Hemotherapy of Ceara (Centro de Hematologia e Hemoterapia do Ceara; HEMOCE), number 8152.