Jeffrey McCullough - Transfusion Medicine

30 30. Joseph BG, Hendry C, Walsh TS. Red blood cell use outside the operating theater: a prospective observational study with modeling of potential blood conservation during severe blood shortages. Transfusion 2009; 49:2060–2069.

31 31. Bowman R, Clay M, Therkelsen D, et al. Donor attitudes about exporting and importing blood. Transfusion. 1997; 37:913–930.

32 32. Cohn EJ, Oncley JL, Strong LE, et al. Chemical, clinical, and immunological studies on the products of human plasma fractionation. J Clin Invest 1944; 23:417–606.

33 33. Lamb M. Source plasma: future outlook. Transfusion 2009; 49:1520–1526.

34 34. Burnouf T. Modern fractionation. Transfus Med Rev 2007; 21:101–117.

35 35. Plasma Protein Therapeutics Association. Available from: https://www.pptaglobal.org/.

36 36. Code of Federal Regulations, Subchapter F, 640.60; 1992.

37 37. Plasma Protein Therapeutics Association. Plasma Collection. Available from: https://www.pptaglobal.org/plasma(accessed August 2020).

Thomas Watkins DO, PhD

The recruitment of donors has undergone several changes over the last few years. Regulatory agencies have allowed for a 1‐year deferral for males having sex with males (MSM), and societal acceptance toward nonbinary/gender fluid donors has had an effect on who presents to donate blood. Further research has raised awareness of iron depletion among donors, and emerging viral and parasitic infections have affected some travel deferrals and are likely to continue to evolve. As traditional print/radio/television media outlets are becoming somewhat less effective in reaching a more diverse donor population, blood providers have needed to become more adept at social media and targeted messaging to different groups. Patient blood management programs and aggressive cost control in hospital supply chain management have increased overall focus on cost savings, driving the process of donor recruitment toward maximum operational efficiency at blood centers from small to large. Health care reform has led hospitals to increasing their focus on cost savings, which has led to blood providers experiencing significant cost constraints. The commoditization of blood and decreasing contract prices for blood products have negatively affected operating margins for many blood centers. Blood collectors are having to do more specific recruiting with less financial resources. In the effort to decrease costs, there have been significant collaborations and mergers between formerly independent blood centers affecting the local identity and community relationships between blood collections and the donor base.

Although most Americans will require a blood transfusion at some time in their lives, it is said that less than 5% of the total population or less than 10% of those eligible to donate have ever done so, although there are no data to directly support this. A surprisingly limited portion of the US population is eligible [1–3]. Many donors give once or infrequently, and much of the nation’s blood supply comes from a small number of dedicated and frequent donors. Blood donors differ from the general population. The demographic characteristics or other factors related to the likelihood of an individual being a blood donor are age, marital status, gender, educational experience, occupation, peer pressure, humanitarianism, fear of the unknown, apathy, self‐esteem, race, social pressure, altruism, volunteerism, convenience, and community service [4–10]. These characteristics are described in more detail in the following subsections.

There is a preponderance of females among first‐time donors [4], but with subsequent donations the ratio shifts to a male preponderance of 60–80% [6, 9], with an overall average of 52% of donors being males [11]. Deferral has a more pronounced effect on first‐time compared with repeat blood donors, and because women are more likely to have a reaction during donation and reactions reduce the likelihood of a donor returning, the gender distribution shifts with advancing age to an increasing percentage of men compared with women. The greatest loss of female donors apparently occurs at about the fourth to eighth donation. In general, the larger the number of lifetime donations the greater is the male preponderance [9]. It seems likely that the shift from female to male donors with increasing numbers of donations is a result of deferral of women in the childbearing age who become iron deficient from menstrual blood loss.

As demographics have changed, there has been an increase in nonbinary gender donors, leading to changes in screening. Further complicating the process are programs of preexposure prophylaxis medication for individuals at risk for acquiring HIV.

Most donors are 30–50 years old, with an average age between 33 and 38 years [4, 9, 11]. The age range of donors shifted during the 1980s and 1990s from only about 2–3% of donors older than 60 years in the 1970s to 10% of donors older than 60 years and 4% older than 65 years in the 1990s [9]. This apparent “aging” of the donor population could reflect a shift in the population age in general; however, during the past few years, blood bank professionals have recognized that blood donation is safe for older individuals, and donor age limits have therefore been extended to attract older donors (see Chapter 4). During the past few years, recruitment of college and high school students has been emphasized, and they now account for about 8% of donations [12]. Younger donors are more likely than repeat donors to experience a reaction [12, 13]. Because donors who experience a reaction are less likely to return [12–15], strategies to minimize reactions in young and first‐time donors are being developed (see Chapter 4). Donors most likely to return are those aged 16 and 17 years and older than 50 years, males, blood group O donors (probably because they are sought by the blood centers), and those without any initial adverse reaction [15, 16].

There are differences in the rate of donation by different ethnic groups. In 1975, whites were 48% more likely to have donated blood during the previous year than non‐whites [17]. By 1989, this figure had increased to 56%. Minority and Latin America–born donors are younger and more likely first time compared with white US‐born donors, but the annual donation frequency of these minority donors is only slightly lower than white US‐born donors [17].

Blood donors tend to have more education and higher incomes than the general population, with incomes as much as 30% higher than those of nondonors. Donors with some college education are the most overrepresented group compared with nondonors. Lightman [18] found that 60% of blood donors in Toronto, Canada, had some post–high school education, compared with 20% for the entire city. Bowman et al. [11] found that 77% of their donors had some post–high school education, with a range of 60–80% in the different blood centers participating in the study. In a separate study, 69% of all donors and 79% of multigallon donors had more than a high school education.

In Bowman et al.’s study [11], 80% of donors were employed full time and another 9% part time. Seven percent were retired, which is consistent with the 10% of donors who were 60 years or older.

It is important to understand donors’ behavior that might increase their likelihood of transmitting disease. Compared with the general population, it appears that donors have fewer sex partners, less frequent sexual experiences, fewer homosexual experiences in males, and are less likely to engage in behavior that puts them at risk for transfusion‐transmissible diseases, although about 1.5% report some kind of risk behavior [19]. In one study, 8% of young “potential” donors tested positive for drugs of abuse [20], but because these were not actual donors, it is not clear whether this experience would apply to blood donors.