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variant CreutzfeldtJakob disease (vCJD) Refer to Section 7.7.2 58, 86–87 Vitiligo Accept 57 Weight Refer to Section 4.4 41–42 West Nile virus Refer to Section 7.3.5 76–77, 87 Yersinia enterocolitica infection Defer for 28 days following full recovery if recent abdominal symptoms, particularly diarrhoea, suggestive of Y. enterocolitica infection 84–85 16 1 Introduction 1.1 BLOOD DONOR SELECTION The primary responsibility of a blood transfusion service is to provide a safe, sufficient and timely supply of blood and blood products. In fulfilling this responsibility, the BTS should ensure that the act of blood donation is safe and causes no harm to the donor (3,5,8). It should build and maintain a pool of safe, voluntary non-remunerated blood donors and take all necessary steps to ensure that the products derived from donated blood are efficacious for the recipient, with a minimal risk of any infection that could be transmitted through transfusion. All prospective blood donors should therefore be assessed for their suitability to donate blood, on each occasion of donation. The purpose of blood donor selection is to: n Protect donor health and safety by collecting blood only from healthy individuals n Ensure patient safety by collecting blood only from donors whose donations, when transfused, will be safe for the recipients n Identify any factors that might make an individual unsuitable as a donor, either temporarily or permanently n Reduce the unnecessary deferral of safe and healthy donors n Ensure the quality of blood products derived from whole blood and apheresis donations n Minimize the wastage of resources resulting from the collection of unsuitable donations. Information provided by 164 countries to the WHO Global Database on Blood Safety indicates that, worldwide, more than 92 million blood donations are collected annually. Of these, an estimated 1.6 million units are discarded due to the presence of infectious markers for TTI, including HIV, hepatitis B, hepatitis C and syphilis. In addition, at least 13 million prospective donors are deferred from donating blood due to anaemia, existing medical conditions or the risk of infections that could be transmitted through transfusion (9). The scale of these discards and deferrals highlights the need for effective blood donor selection to minimize the unnecessary deferral of suitable donors, and the donation of blood by unsuitable donors that subsequently has to be discarded; this will reduce the wastage of resources, including donor and staff time, consumables and screening tests, and also avoid needless discomfort to donors. Significant variations have been observed between countries in the extent to which national donor selection criteria are defined, prospective donors are assessed and the quality and effectiveness of the donor selection process are monitored. In some countries, national systems of blood donor selection are not well-developed and donor selection criteria are not clearly defined or applied uniformly. This may result in blood being collected from donors who have not been properly assessed for their suitability to donate; this may affect their health and pose a higher risk of transmission of infections through transfusion. In many countries, donor selection criteria are still based on tradition and customary practice rather than on evidence (10,11) and criteria from one country are often adopted in other countries without due consideration of the profiles 17 of the general and potential donor populations, the prevailing epidemiology of infections and diseases, local culture and available resources. Some countries take a highly precautionary approach to the selection of donors for the safety of blood products, donors and patients. Policies for donor selection should take into account the need for a balance between the safety and sufficiency of the blood supply and available resources (11,12,13). In 2005, World Health Assembly resolution WHA58.13 (14) urged Member States, inter alia, to establish or strengthen systems for the recruitment and retention of voluntary, non-remunerated blood donors and the implementation of stringent criteria for donor selection. World Health Assembly resolution WHA63.12 (15) in 2010 also urged Member States to take all necessary steps to update their national regulations on donor assessment and deferral. However, there are relatively few internationally-recognized guidelines on blood donor selection (Annex 1) and all of these have been developed to address the needs of specific regions or countries. There is therefore a need for global guidance on the development of systems and criteria for blood donor selection that could then be adapted at national level. 1.2 AIM AND OBJECTIVES Aim The aim of Blood donor selection: guidelines on assessing donor

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