Blood transfusion contributes to saving millions of lives each year and improving the life expectancy and quality of life of patients suffering from life-threatening conditions. The safety and availability of blood and blood products for transfusion requires the recruitment of voluntary non-remunerated blood donors, the selection and care of blood donors1, the quality-assured testing of donated blood for markers of transfusion-transmissible infections (TTI), blood processing, and the safe and rational use of transfusion.
Individuals who donate their blood provide a unique and precious gift in an act of human solidarity. In order to donate blood, prospective donors should be in good health and free from any infections that can be transmitted through transfusion. Most blood donors perceive themselves to be healthy, but some are unsuitable to donate blood due to the potential risk of compromising or worsening their own health or the risk of transmission of infections to patients.
Blood transfusion services (BTS) have a duty of care towards blood donors as well as to the recipients of transfusion. This duty of care extends to prospective donors who are deferred from donation, whether on a temporary or permanent basis, as well as those who donate blood and are subsequently found to have unusual or abnormal test results. BTS have a responsibility to confirm test results and provide information, counselling and support to enable these individuals to understand and respond to unexpected information about their health or risk status. Counselling is part of the spectrum of care that a BTS should be able to provide to blood donors, including referral to medical practitioners or specialist clinical services.
Historically, blood donor counselling was not widely practised until relatively recently. Some BTS provided information to donors on TTI test results that were indicative of infection, initially with syphilis and later, as tests became available, for the hepatitis B virus. It was not until the HIV/AIDS pandemic of the 1980s and the introduction of screening tests for HIV that BTS began to acknowledge the importance of donor counselling, particularly to ensure the safety of the blood supply.
Pre-donation counselling was recognized as one element of the strategy to reduce and, if possible, prevent the donation of blood by individuals who might be at risk for HIV and other TTI, including hepatitis B and C viruses, as well as to inform donors of the donation process and testing of blood for HIV. Post-donation counselling was acknowledged to be a necessary element of donor management as an adjunct to informing donors of unusual or abnormal test results.
Blood donor counselling by trained specialist staff is now considered to be a key component of the blood system in most countries with a well-developed blood transfusion service. It may be required at a number of stages in the blood donation process or following blood screening and should be available at any point at which the BTS has an interface with donors.
In many countries, however, blood donor counselling is not yet available in a structured way. The document Blood donor counselling: implementation guidelines, has therefore been developed to provide guidance to blood transfusion services that have not yet established donor counselling programmes.
These guidelines on blood donor counselling should be used in conjunction with other WHO resources, in particular Towards 100% voluntary blood donation: a global framework for action (1), The Melbourne Declaration on 100% voluntary non-remunerated donation of blood and blood components (2), Blood donor selection: recommendations on assessing donor suitability for blood donation (3) and Screening donated blood for transfusion-transmissible infections (4).
Dr Neelam Dhingra
Coordinator
Blood Transfusion Safety
World Health Organization
Dr Christie Reed
Medical Officer
HIV Prevention Branch
Division of Global HIV/AIDS
Centers for Disease Control and Prevention
Dr Lin Che Kit
Chief Executive & Medical Director
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The term “blood donors” includes donors of whole blood, red cells, platelets, plasma and other blood components, donated as whole blood and/or through apheresis.
