Study Finds Vaccine-Related Directed Donations Associated With Care Delays, Clinical Risk

Requests for directed blood donations based on donor COVID-19 vaccination status were associated with care delays, clinical deterioration and resource waste, according to a recent single-center study published in Transfusion.

In a two-year review, investigators at Vanderbilt University Medical Center, led by Jeremy W. Jacobs, MD, MHS, identified 15 patients who pursued directed donations due to concerns about receiving blood from vaccinated donors. Thirteen patients received at least one directed unit, including eight pediatric patients. All directed donation requests during the study period were related to COVID-19 vaccination status.

Analysis of clinical outcomes found that these requests were associated with delayed care. Two patients experienced clinical deterioration while awaiting directed units, including one who developed hemorrhagic shock (hemoglobin nadir 3.6 g/dL) and another who developed symptomatic anemia (hemoglobin 5.9 g/dL). Two additional cases involved surgical delay or cancellation related to directed component availability.

Jacobs and colleagues also examined component utilization. Of 48 directed units collected, 31 units (65%) were transfused to their intended recipient while 17 (35%) were not; 12 (25%) were released to general inventory, three (6%) remained in frozen storage and two (4%) were discarded due to outdating.

The investigators noted that their findings contrast with reports from institutions that use structured pathways to address vaccine-related transfusion concerns, where many patients ultimately accept standard blood products following consultation with transfusion medicine and ethics teams. At Vanderbilt, requests were often initiated through clinical teams or perioperative workflows and routed directly to blood center collection processes without routine involvement of transfusion medicine specialists. An ethics consultation was documented in one of 15 cases, and transfusion medicine was notified prior to unit arrival in one of 15 cases.

Jacobs and colleagues also highlighted ethical considerations related to pediatric patients and surrogate decision-making in cases where standard blood products were refused. The authors noted that directed donations, particularly from first-time or family donors, may carry higher rates of infectious disease marker reactivity compared with repeat community donors. In addition, directed donations from biological relatives may require additional processing, such as irradiation, and could introduce immunologic risks.

Based on their findings, the authors recommended standardized institutional pathways that include mandatory transfusion medicine consultation before directed donation proceeds, integration of bloodless medicine or patient blood management expertise for shared decision-making, and explicit policies limiting directed donation to appropriate clinical indications. They also called for differentiated approaches for urgent, emergent, and pediatric cases, given the heightened clinical and ethical stakes.

“A clear institutional policy removes the burden of individual refusal and provides a framework for redirecting these conversations to transfusion medicine and ethics for shared decision-making with appropriate expertise,” the authors wrote.