17

with respect and care in a confidential manner and should be given a clear explanation of the reason for deferral and an opportunity to ask questions. They should be informed whether the deferral is to safeguard their own health and/or that of the recipient. It is the responsibility of the BTS to ensure that donors who are deferred due to medical conditions are referred for further investigations and management, as appropriate. Studies have found that deferral has a negative impact on future donor return, particularly by first-time donors and those deferred for more than a year (37,44). 36 Temporarily deferred donors should be advised on when they could donate and encouraged to return. Donors are less likely to return to donate blood if unclear or unsatisfactory information is given about the reason for deferral. Many temporarily deferred donors do not spontaneously return to donate blood and may need to be recalled after the deferral period is over. Counselling of deferred blood donors could enhance the compliance of donors to seek follow-up medical care (45). A system should be in place for donor counselling and referral if any further investigations, treatment and care are indicated. Refer to Blood donor counselling: Implementation guidelines (6). 3.3 DONOR RECORDS The record of the donor’s general health, medical history and TTI risk assessment as part of the donor questionnaire should always be signed by the donor as being correct. The questionnaire becomes part of the donor’s records and documents the informed consent. Records should be kept of each activity associated with blood donation, ideally in an electronic database capable of generating reports. In addition to donor identification, assessment and selection, records should reflect donor deferrals, adverse reactions or unexpected events and any unsuccessful donations. Donor records should be confidential, easily retrievable and should allow traceability: from the donor to the patient receiving transfusion and vice versa. Records should be retained for a period of time defined by local or national legislation or guidelines. Donor records should be reviewed regularly and donor data (e.g. male: female ratio, donor deferrals, adverse donor events and reactions) should be analysed in order to monitor the effectiveness of donor selection so that remedial action can be taken, where necessary. Key records, including dates, times and signatures, to be maintained and retained during the donor selection process include: n Donor registration information n Completed donor questionnaires and informed consent n Outcomes of donor interview and assessment n Donor deferral records n Unique donation number for each donation n Donor counselling and follow-up records n Adverse donor events and reactions n Donor deferral registry. Data on donor deferrals should be collected and regularly reviewed to enable the BTS to assess the major causes of deferral, particularly those that result in the greatest numbers of donor deferrals and those presenting high risk to patients. These vary from country to country; hence there is a need to collect local data on which to base relevant decisions. The most common causes of donor deferral are of particular interest as these will indicate whether donor information and education may need to be improved or donor selection criteria should be reviewed. A deferral database will also indicate whether staff are interpreting the selection guidelines correctly and where further education and training should be focused. Donor deferral records also enable the previous deferral status of donors to be checked and decisions made on the re-entry of temporarily deferred donors. 37 A donor deferral registry (DDR) is a confidential list of donors who are positive for a transfusion-transmissible infection and who have been permanently deferred. A DDR is used to monitor the incidence and prevalence of such infections in the donor population and may also assist in identifying areas that require strengthening in the donor selection process. 3.4 CONFIDENTIAL UNIT EXCLUSION (CUE) The system of confidential unit exclusion (CUE) offers donors the opportunity to inform the BTS immediately after donation or subsequently if they consider that their blood may be unsafe for transfusion; this may be particularly useful if donors have been persuaded or coerced to donate. Where CUE is used, donors should be given information to enable them to contact the BTS and to communicate that their blood should not be used for transfusion. The CUE system is designed to add an additional level of safety to the donor selection and blood screening processes and has been found to be effective in some settings (46). However, there is some evidence that it may have limited effect on reducing the transmission of infections through window-

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25