Deferral policies for prospective donors who have undergone laparoscopic surgery

A transfusion medicine physician in Africa reports that there is a concern locally over sterilization of endoscopes used to retrieve biopsies, although the exact risk has not been quantified. Consequently, they use a 12-month deferral period for individuals who wish to donate blood for their community supply, but who have undergone an endoscopic biopsy. They use a 3-month deferral period if a prospective donor underwent an endoscopic exam without a biopsy. In addition to a the above deferral periods following endoscopy procedures, they defer donors for at least 6 months after major surgery and at least 3 months after minor surgery. The above policies are now under review, and there is a local proposal that for laparoscopic surgery, that a 12-month deferral from blood donation should be implemented, irrespective of the nature of surgery, which could vary from tubal ligation to cholecystectomy. The rationale is over concern of contamination of instrumentation used during the laparoscopy. She adds that when a validated HCV & HIV NAT test is implemented, the blood donation deferral period following endoscopic biopsy or laparoscopic surgery might be reduced to 6 months. She realizes that this deferral strategy might vary from practices elsewhere and is particularly interested in how others are approaching donors who have undergone laparoscopic surgery . The underlying rationale will be appreciated.

The following responses have been received.

ADDENDA March 29, 2004

1. A colleague at the Banco de Sangre y Tejidos de Cantabria (Spain) reports that the 10th edition (January 2004) of the Guide to the Preparation, Use and Quality Assurance of Blood Components issued by the Council of Europe states: "Endoscopy with biopsy using 'flexible' instruments, inoculation injury, accupunture, tattooing, piercing, mucosal splash with blood, transfusion of blood components ... defer for 6 months or less provided a NAT test for hepatitis C is negative." He adds that the rationale for this guideline is not provided, but supposedly the reason is to avoid transmission of infectious diseases by endoscopy devices which somehow are incompletely sterilized. Since his institution has access to a validated NAT technique, they defer donors for 6 months if the instrument is flexible (laryngoscopy, gastro- or sigmoid/colonoscopy). If the instrument is rigid, (i.e. arthroscopy, histeroscopy) they allow donation if the donor has been discharged and is feeling healthy.

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