FAQ: Delisting of directed donations at Canadian Blood Services

Date published: February 7, 2024
 

Background

Canadian Blood Services’ Directed Donations Program had historically allowed a parent or legal guardian to donate blood for transfusion to their minor child. No directed donations have been collected since 2019 to date in Canada. Directed donations carry heightened risks to both recipients and donors compared to allogeneic blood donation and are not recommended by current guidelines1,2

Canadian Blood Services has permanently discontinued its Directed Donations Program. This decision follows consultations, started in May 2022, with Canadian physicians who manage directed donation requests and other blood operators, in conjunction with analyses of the program's declining demand and clinical effectiveness.

1. What are the risks of directed donations to recipients?

Directed donations may present several risks to recipients:

  • Blood from a first-degree relative can be associated with an immune reaction called transfusion-associated graft versus host disease (Ta-GvHD), which can be a severe and potentially fatal reaction. To reduce the risk of this reaction, blood is irradiated which adversely impacts product quality and shortens shelf life.
     
  • During pregnancy, a mother may be alloimmunized to fetal blood cells. A subsequent directed donation from a mother to her child may result in an increased risk of transfusion-related acute lung injury (TRALI) to the child.3 TRALI is one of the leading causes of transfusion-associated morbidity and mortality today.
     
  • Directed donation donors tend to be first-time donors and are more likely to have detectable transfusion-transmissible diseases compared to allogeneic donors. A published retrospective study found that the mean rate of positive infectious disease testing for first-time parental donors was 8-times higher (8.6%) when compared to first-time non-parental donors (1.09%).4

Recipients of a directed donation may face future difficulties in finding family members who are compatible as stem cell or organ donors if needed. Stem cell donation is a lifesaving therapeutic option for life threatening blood cancers, and it is more challenging to find optimal suitable stem cell donors.

2. What are the risks of directed donations to donors? 

In a published review of directed donation practices at Canadian Blood Services from 2015-2019, 18% of all directed donation donors had a hemoglobin value lower than allogenic donor hemoglobin criteria.5

Directed donors may also experience undue and unwanted pressure to donate, leading donors to conceal risks or other conditions that may affect their donation eligibility. This may in turn adversely impact donor wellness, as well as the safety and quality of the product.

3. What about patients with rare blood needs? 

Patients with complex and rare blood needs can find a matching donor through Canadian Blood Services’ Rare Blood Program (for red cells) and HLA Apheresis Platelet Program (for platelets). When an individual is identified with a rare blood need, the individual and their family members may be recruited for further testing and to become allogeneic donors. This allows recruitment of suitable donors whenever patient need arises. Unlike the Directed Donations Program, blood donated to the Rare Blood Program and HLA Apheresis Platelet Program are available to all Canadians in need. Red cell units that have not been used may also be frozen for future recipients, including the donors themselves. Discontinuation of the Directed Donation Program does not impact Canadian Blood Services' ability to meet rare blood needs, and will allow the provision of safe, effective, and accessible blood products to all Canadians.

References

  1. National Advisory Committee on Blood and Blood Products. NAC Statement on perioperative autologous and matched donations.  (2023).
  2. Choosing Wisely Canada. Transfusion Medicine, Ten tests and treatments to question in transfusion medicine. Vol. 2023 (2023).
  3. Dunbar, N., Cooke, M., Diab, M., et al. Transfusion-related acute lung injury after transfusion of maternal blood: a case-control study. Spine (Phila Pa 1976) 35, E1322-1327 (2010).
  4. Jacquot, C., Seo, A., Miller, P.M., et al. Parental versus non-parental-directed donation: an 11-year experience of infectious disease testing at a pediatric tertiary care blood donor center. Transfusion 57, 2799-2803 (2017).
  5. Butler-Foster, T., Pambrun, C., Flahr, F., et al. Directed Donation Utilization and Donor Health Trends at Canadian Blood Services. Transfusion medicine reviews 35, 56-57 (2021).