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reasons for any deferral and give advice about further medical care, if needed n Ensure that the donor is able to give informed consent to donate and recognizes that his/her signature is an affirmation that responses provided to the questionnaire are accurate. Donor health and risk assessment The assessment of the donor health and TTI risks requires privacy, a sensitive, non-judgemental approach and an assurance of confidentiality. The reason for questions aimed at eliciting any health and TTI risks should be explained and the donor should be offered an opportunity to self-defer. The assessment of donor suitability and deferral, where appropriate, aims to exclude donations from individuals at risk of TTI, particularly from those with recently acquired infection that cannot or may not be detected by routine screening tests or with infections for which no effective blood screening tests are available. An in-depth discussion may be needed, particularly with new donors who may not know about the “window period” or the signs and symptoms of an infection. Individuals who visit the BTS to obtain HIV testing pose a risk to the blood supply (42). The donor assessment not only enables the review of the donor’s medical history and medications, but also provides an opportunity for a basic health check to assess whether the donor is in general good health. Any signs of debility, under-nutrition, pallor, jaundice, cyanosis, dyspnoea or intoxication from alcohol or drugs should also be noted (also refer to Section 4.2 on donor appearance and inspection). Physical examination, weighing and/or measurement of vital signs (pulse, blood pressure) are part of the basic health check and are carried out at this stage. The venepuncture site should be examined to check that the donor’s veins are accessible and suitable to enable easy venepuncture. The basic health check also enables an assessment to be made of any physical disabilities that may impede the donation process, such as: n Mobility: the donor should be able to easily access the donor bed or couch n Sight or hearing impairment: assistance should be provided by a staff member. 35 Issues that require special attention during donor health and risk assessment include: n The prevalent culture and context of the environment for donation; in some situations, a donor may simply be overawed by the medical setting and procedures n The provision of sufficient privacy and assurance of confidentiality to make the donor comfortable when answering probing and sensitive questions n Identifying and overcoming language barriers or lack of understanding of questions in the donor questionnaire n Ensuring good communication by using simple jargon-free language and explaining any medical terms. Informed consent Informed consent is a voluntary agreement given by the prospective donor to the donation of blood, to the testing of a blood sample for TTI, for the transfusion of the donated blood to patients and if required, for the use of the blood for additional tests, quality assurance or research purposes. To obtain informed consent, the BTS should provide the following minimum information to the potential donor: n The donation process and potential adverse donor reactions n The tests that will be performed (TTI and others) on the samples taken from the donated blood and the reasons for these tests n Confidentiality of all personal information, including test results. The donor should sign and provide informed consent to the donation of blood or blood components on a voluntary basis. Informed consent signifies that the donor has understood the questionnaire, has provided accurate answers and is willing to donate blood (43). It also indicates that the donor understands the blood donation process, the possibility of adverse reactions to blood donation, the risks of the transmission of infections through donated blood and the implications of any abnormalities that may be detected during the donation process and blood screening, and is providing consent for post-donation notification and counselling, if detected to have a positive viral infection marker or any other abnormality. The donor’s understanding of the questionnaire and its implications is of particular importance in countries where donors may be held legally liable if they give incorrect information. In countries in which young people under the legal age of majority may be accepted as blood donors, written consent to donate blood may be obtained from a parent or guardian, prior to donation, in accordance with national requirements. 3.2 DONOR DEFERRAL Donors who do not to meet the selection criteria should be deferred on a temporary or permanent basis. All deferred donors should be treated

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