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deferrals n Donor adverse reactions n Confidentiality, including facilities, procedures and documentation n Complaints n Blood screening results n Transfusion reactions in recipients of blood and blood products n Errors and untoward events n Staff competency assessment and training needs. Quantitative and qualitative data collection methods including focus group discussions could be considered to assess the effectiveness of blood donor selection. In order to maintain a balance between sufficiency, safety and emerging risks, donor selection criteria and the reasons for donor deferrals should be regularly evaluated to identify whether any criteria need to be removed, modified or extended to provide improved protection of donors and recipients, and to minimize the deferral of suitable donors. The application of the criteria should also be monitored to ensure they are being interpreted correctly and to identify any areas where additional staff training may be required. Epidemiological monitoring of infection rates in blood donors, including age and gender-specific prevalence rates in new and repeat donors, contributes to a better understanding of donor behaviour and assessment of risk. Knowing and understanding confirmed infection rates in blood donors helps to ensure that donor selection, donor deferral and blood screening strategies are up-to-date and effective. Post-donation counselling may reveal the probable exposure histories of infected donors and can help identify populations at risk of infection. This can provide information on the possible routes of infection and the effectiveness of the donor education and donor selection, including whether donor education materials give sufficient information about TTI risk and why the donor decided to donate. This kind of information aids in understanding patterns of infection in “asymptomatic” individuals and can be used to improve donor education, the donor selection criteria and donor selection process. 29 The following indicators may be used to monitor and evaluate the system of donor selection: n Total number of individuals presenting to donate blood n Number and percentage of deferrals from donation, by types of deferral: Permanent deferral Temporary deferral n Number and percentage of deferrals from donation, by reasons for deferral: — Low haemoglobin — Other medical conditions — High-risk behaviour — Travel — Other reasons n Number and percentage of deferrals from donation, by age and gender of donors n Percentage of donors who self-deferred following donor assessment and counselling n Percentage of incomplete donor questionnaires n Rate of adverse donor reactions, by types of reaction n Prevalence of markers of transfusion-transmissible infection in screened donations: — HIV — Hepatitis B (HBV) — Hepatitis C (HCV) — Syphilis — Others n Number and percentage of confirmed positive donors, by age, gender and types of donor. While the donor questionnaire and interview process is intended to elicit relevant information on which to assess donor suitability for blood donation, the process sometimes may not be effective (35) and operational research may be required to identify mechanisms for improving the process of donor selection and to address issues such as: n How to improve donor selection criteria n How to improve the effectiveness of donor education n How to assess the sensitivity and specificity of certain questions in the donor questionnaire n How to ask donors culturally-sensitive questions n Whether donors understand the donor questionnaire n How to increase donor adherence to selection criteria n How to reduce blood discard rates n How to improve donor retention. 30 3 Assessing donor suitability Donors should be in good health at the time of donation and free of infections transmissible by blood. The BTS should provide clear and unambiguous guidance for staff involved in donor selection. Rigorous donor selection should be consistently applied to all blood donors either donating whole blood or through apheresis, whether first-time or repeat donors. The process should be planned to make best use of staff and donor time, and make blood donation as convenient as possible for blood donors, without long waiting periods. Key principles of blood donor selection are as follows: n The health and safety of the donor as well as the recipient must be safeguarded n Only individuals in good health should be accepted as donors of whole blood and blood components n The selection of blood donors should be based on regularly reviewed selection criteria, without discrimination of any kind including gender, race, nationality or religion n A prospective donor’s health status and medical

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