Directed donation information for clinicians
This section describes the principles under which the Australian Red Cross Blood Service will participate in a directed donation programme and the rationale for our recommendations
Introduction
A directed donation is a donation collected for a specified patient from a selected donor who is known to the patient. This may occur when either the potential recipient has requested the donation from a specific donor or an individual requests making a donation for a specific recipient (e.g. parent to child).
Except in special circumstances (see below), the Australian Red Cross Blood Service strongly recommends against directed donations, as such donations have been shown to be less safe than blood collected from voluntary, non-remunerated donors. We recognise that some patients prefer to select a blood donor who is known to them. Where there is no viable alternative, this programme tries to accommodate this preference while maintaining a level of safety comparable to that of Australia’s community blood supply - one of the safest in the world.
A directed donor must meet the Australian Red Cross Blood Service’s usual donor selection criteria and all donations are subject to the same safety precautions and testing criteria as volunteer anonymous donations.
If a directed donation is unsuitable for any reason, the referring doctor will be notified. However, medical information concerning the donor cannot be released to the referring doctor or patient without the express permission of the donor.
In order to protect the safety of the homologous system, a directed donation which is not used for the intended recipient cannot be transferred to the community blood supply.
A request must be completed which includes a signed request from the patient and a referral from the treating clinician.
Requirements
1. Directed donations may sometimes be medically indicated in circumstances where the only practical means of accessing a suitable transfusion product for a particular patient is the use of a specific donor who is known to the patient. These include:
(a) Donor-specific immunomodulation
(b) Induction of graft-versus-tumour response following stem cell transplantation
(c) Provision of compatible red cells, platelets and/or leukocytes when anonymous donors are considered less able to provide the necessary transfusion product.
2. There is evidence that blood from directed donors is less safe than blood from anonymous volunteer donors. Pre-selection of a blood donor known to a patient could compromise the Australian Red Cross Blood Service’s usual strict donor selection and screening procedures.
There is further evidence to indicate that the overall risk of adverse outcomes following transfusion may be greater with directed donation.
However, despite the strong scientific evidence that directed donations are less safe than anonymous homologous donations, the Australian Red Cross Blood Service is prepared to provide this service under some circumstances.
3. The Australian Red Cross Blood Service will participate in a limited directed donation programme for indications other than the medical conditions listed above as long as there is unequivocal support by the patient’s treating clinician. The clinician is responsible for initiating the request, performing an initial ABO and Rh (D) compatibility check (and CMV screen, if required) on the proposed donor and recipient. Consent from the intended donor and recipient/parent/guardian must include an explicit acknowledgement of the absence of evidence of any safety benefit from directed donation.
4. Australian Red Cross Blood Service participation in directed donation for other than medical indications requires:
(a) That there is reasonable likelihood that the intended recipient will need transfusion with the blood product in the particular circumstance outlined in the request.
(b) That this circumstance is planned to occur within a single defined episode of care, with a reasonable expectation of a finite predicted requirement for blood products.
(c) That other alternatives to homologous transfusion from anonymous donors are either not appropriate or not available to the recipient.
(d) That the potential donor satisfies all Australian Red Cross Blood Service homologous donor selection criteria.
(e) That the potential donor is known to be ABO and Rh (D) compatible with the intended recipient.
(f) That the potential donor:
• is either the parent (or guardian) of a child up to the age of 18 years who is the intended recipient OR
• is an existing blood donor (donated in the last two years) who has donated at least twice.
5. If the directed donor is also related to the recipient the donation must be irradiated to prevent Graft Versus Host Disease (GVHD). This, however, does not prevent the formation of antibodies against the donor cells, which can occur even when the donor has the same major blood groups and is closely related to the patient. This could complicate future directed donations as well as transplants of bone marrow or organs.
Directed donation from a man to his wife or female de facto partner of child-bearing age is not recommended due to the possibility of the recipient forming antibodies which could seriously affect a future pregnancy.
For further information about Directed Donation, please call the Australian Red Cross Blood Service on 13 14 95 and ask to speak to a Medical Officer.
(added to website 23 March 2009)