AABB24: Abstract Session Highlights Evolution and Impact of Blood Donor Screening Policies

Tuesday morning’s final abstract spotlight session at the 2024 Annual Meeting focused on the evolution of blood donor screening policies, featuring expert presentations on the latest data and trends. Program chair Mary Townsend, MD, vice president and corporate medical director at Vitalant, welcomed an international group of speakers to discuss the challenges and progress in donor eligibility screening, with a particular focus on data-driven policy changes and their broader implications for donor safety and inclusivity.

A Historical Perspective on Donor Screening

Townsend began with an overview of the history of blood donor eligibility screening, emphasizing major shifts in response to infectious disease outbreaks such as syphilis, HIV, and more recently, COVID-19. In the early years, donor screening was shaped more by convention and tradition than by evidence-based practice. The HIV crisis of the 1980s marked the first major shift, leading to the indefinite deferral of certain populations through the donor history questionnaire (DHQ).

By the early 2000s, the DHQ had expanded to include 75 health-related questions, prompting the formation of a Donor History Task Force to streamline the process. In 2004, the FDA approved a revised DHQ that simplified language and reorganized questions for clarity. Further adjustments followed: in 2015, FDA removed the indefinite deferral for men who have sex with men (MSM) to a 12-month deferral. Most recently, in 2023, FDA made a landmark change by eliminating gender-based deferral questions entirely, opting instead for individualized risk assessments (IDA) based on specific behaviors.

Examining Donor Deferral Rates
The abstracts began with a presentation by Ruchika Goel, MD, MPH, CABP, senior medical director, corporate medical affairs, at Vitalant. Goel discussed a study that analyzed deferral rates from 2015 to 2024 during three different MSM eligibility periods: the 12-month deferral, the three-month deferral and post-IDA implementation. Initially, male deferrals rates were higher than that of female donors. However, after IDA implementation, the rates became comparable between male and female donors. Goel noted that the data points need to be prospectively followed to see the ongoing impact of gender-neutral deferral criteria.

HIV Rates Among Blood Donors
Mindy Goldman, MD, FRCPC, medical director of Canadian Blood Services, presented data on HIV rates among blood donors before and after the introduction of IDA in Canada. Data from a national epidemiology database showed no change in HIV-positive donation rates during the 22 months before and after implementation. There with 5 HIV-positive donations identified in each period (out of 1.4 million donations each). Notably, four of the five HIV-positive donors identified post-implementation period were first-time donors, and the eligibility status for all five donors was unaffected by IDA. Goldman also discussed an anonymous compliance survey of nearly 40,000 participants (with a 28% response rate). The survey revealed that revealing that 0.57% of females and 0.92% of males were likely non-compliant.

Building and Maintaining Trust With the 2SLGBTQIA+ Community
Graham Sher, OC, CEO of Canadian Blood Services, shifted the focus with a presentation that explained the process behind the organization’s historic apology to the 2SLGBTQIA+ community in Canada following decades of deferral from blood donation. This apology, created in consultation with the community, acknowledged that the policy—while based in science—contributed to discrimination and stigma. The apology was a pivotal moment in rebuilding trust and led to positive responses from the 2SLGBTQIA+ community. Canadian Blood Services also affirmed its committed to ongoing engagement the with community to address remaining barriers to inclusion.

TTI Risk Among Urban and Rural Donors

In the session’s final presentation, Galen Conti, MPH, lead epidemiologist at the American Red Cross, shared a study that examined the prevalence of transfusion transmissible infections (TTIs) across urban and rural populations using data from the Transfusion Transmissible Infection Monitoring System. Unadjusted odds showed that urban donors had significantly higher likelihood of hepatitis B (HBV) consensus positive, HIV consensus positive, and syphilis infections (consensus positive and active infections) compared to rural donors. However, when adjusted for demographics, only the elevated HBV risk remained significant. In addition, the relationship between rurality and HCV consensus positive was significant in the adjusted model, showing a protective effect for rural donors.