Recently the e-network discussed the question of donor deferral following receipt of a tattoo. Reviewing that discussion will help in following this related question, presented below.

As a follow-up of that discussion, an e-network member submitted the following question: "I understand the rationale for deferring a donor for a tattoo, but the tattoo procedure is only one of the many similar items stated in the donor questionnaire. Does the same "rationale" for deferral after receiving a tattoo apply to ear/skin piercing, acupuncture, and electrolysis? " To which the following replies were received:

1. The originator of this question did not state what his/her understanding is of the "rationale" for deferring tattoo recipients. Assuming this person's understanding of the rationale is that the deferral is made to prevent the transmission of blood-borne infectious diseases (e.g., HIV, HBV, HCV, etc.), the same rationale would apply to body piercing - with the exclusion of electrolysis. This latter procedure - electrolysis - has not been of great concern to the AABB Standards Program Unit. Also, acupuncture is not necessarily a criterion for deferral. If donors who come to our center can establish to our satisfaction (usually in the form of a note from the acupuncturist) that sterile one-time or dedicated use needles were utilized, we allow them to donate.

2.We defer all donors from donating for one year for tongue bolting, acupuncture and electrolysis, unless the donor presents a letter from the facility stating that sterile non-reusable equipment was used. Ear piecing is acceptable if the donor provides a letter. The rationale I think behind deferring tongue bolting and other body piercing is that the procedures are performed at tattoo parlors and in the absence of proof, sterility is a concern.

3.At the American Red Cross, we accept donors who've had ears, etc. pierced, if they can assure us that only single-use disposable needles were used, and that they saw the sterile package being opened.

4.The rationale that we use to determine donor eligibility following receipt of a tattoo or other body piercing is based on determining if the donor may have been exposed to hepatitis/HIV during the procedure. We defer donors who have received a tattoo unless the tattooing was performed by a physician. The theory is that if the tattoo was obtained at a physician's office the physician would need to be licensed to perform the procedure and would be in compliance with sterilizing any equipment that might transmit hepatitis/HIV from one person to another. For ear piercing/body piercing/acupuncture we accept or defer donors based on further questioning of the donor about the procedure and the equipment that was used. If the donor states that 'a sterile procedure was used to do the piercing' and (1) that the equipment was from a sealed package (one-time use only) or (2) the equipment can be ascertained to be sterile (the donor was informed that all equipment was sterilized and the equipment was only used on that donor after it was last sterilized) we would accept the donor. If the donor does not know if the equipment was (1) one time use only' or if the donor does not know that (2) the equipment was sterilized and only used on that donor' then we would defer the donor.

5.It was my understanding that tattoos are not allowed under any situation (whether or not a sterile needle was used) because the problem is with sharing the ink. I believe tattooing/tattoo parlors used to be licensed in some states, but not in others. Therefore, it is hard to know if uniform sterile procedures are used so that both the needle and the ink used are not shared among multiple individuals. Obviously you have a risk of disease transmission with tattoos unprofessionally made in jails or among individuals at home who share needles. Regarding the "rationale" applied to ear/skin piercing, tongue bolting, acupuncture, and electrolysis - I don't have the wording of the standards in front of me, but I thought the gist was sharing of blood and bodily fluids. Therefore, I have felt that if the above procedures are done using a single use, disposable, sterile needle, that donor is acceptable. (One could also argue that using a documented sterilized reusable needle is also acceptable, but this can be hard to verify. It depends on how your acceptability criteria is worded.) I would refer those asking the question both to past versions of the AABB standards and FDA memos.

6. If the piercing (wherever that might be) is done with a sterile, single use needle, we accept. Same goes with acupuncture and electrolysis.

7. The rationale for all of those issues is risk of exposure to hepatitis or other infectious diseases by exposure to another person's blood or body fluid. If there is no blood or body fluid exposure, then there is no risk. By using sterile needles for things like permanent make-up there is no risk.

8. If the procedure i.e. tattooing, body piercing guarantees single use of the equipment used the person should be allowed to donate. However we defer for tattoo, follow the AABB guideline for acupuncture/electrolysis and allow a donor to donate if the piercing method guaranteed single use of the equipment.

9. There is a one-year deferral for all of these unless it was done in a physician's office, using sterile (or disposable) equipment, or done (in the case of piercing ear or skin--) with a "gun." Licensed electrolysis or acupuncture establishments, with sterile equipment, will generate a shorter deferral (i.e., when free of infection).

10. We use the uniform donor screening question which asks "In the last 12 months, have you had a tattoo applied, ear or skin piercing, acupuncture, accidental needle stick, or come in contact we someone else's blood? We defer donors for a year if they have had any of the above, unless it was performed at a physician's office, or using a needle that is only for the donor. Single use needles or ear posts are also acceptable. Permanent make-up is a tattoo. We do not ask or defer for electrolysis.

ADDENDUM Oct 2, 2000

11. At our Blood Center we defer all donors from donating blood for one year for tattoo, skin piercing and acupuncture not performed by medical personnel. All these procedures are considered at risk because they are often performed in uncertified conditions and the possibility of using the same ink or the same needle for more individuals is high and impossible to verify. Ear piercing is considered acceptable when the donor declares that it was executed using disposable and sterile equipment. Usually we do not ask about electrolysis. Blood donors who admit to this practice will be accepted on condition they assure us that a single sterile needle was used.

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Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator