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Policies on the management of heresay information received about otherwise qualified blood donors

A colleague in Brazil reports that his donor center has a donor management policy that requires them to follow up on each 'third party' hearsay statement that might disqualify a particular blood donation as unsafe for transfusion. According to their policy, each hearsay statement must be analyzed for its possible medical implications, and if the hearsay information suggests that the donor and/or the donated products might be unsafe, the donated products must be quarantined and the donor must be contacted and asked to be re-interviewed and retested. The 'look-back' of previous donations that have been made by donors whose eligibility is called into question by hearsay information is at the discretion of the blood center medical director. The inquiring colleague comments that when they follow up on the hearsay information and contact the donors, the donors became angry because of the intrusion into their private lives, and they want to know who provided the hearsay information. The blood center policy prohibits the disclosure of the source of the hearsay information to the donor. Not infrequently, the donors refuse to be re-interviewed, refuse to be retested, and/or refuse to confirm the hearsay information. The inquiring Brazilian wants to know what others do regarding hearsay information that is received about otherwise qualified blood donors.

The following responses have been received.

ADDENDA June 3, 2004

1. A colleague from Spain reports that their policy to manage third party information is exactly like that of the college in Brazil. Their experience with donors affected by third party information is similar - they usually get suspicious, angry and refuse to be interviewed or simply refuse to come to an interview.  If the donor cannot be 'cleared' of the third party allegations, all their donated blood products are discarded and the donor is deferred. If the donor ever returns, the interrogatory process has to be started from the beginning.

2. A blood center in Texas has the following policy on this issue:

"The medical staff reviews the information.  If the hearsay information would make the donor ineligible to donate, the unit is discarded. However, the donor is neither deferred from future donations nor contacted to clarify or verify the information". The responding Texan reports that their rationale for this is as follows: "The donor was already asked about his or her health history and answered all questions acceptably. Why should we believe a third party more than our own donor? We don't contact the donor because:

  • we have no way to verify the identity of a person we might call on the phone to our satisfaction, and we don't discuss donor eligibility issues on the phone as a rule anyway, and
  • since the donor may be in a situation when contacted at work or at home where they cannot speak freely, why should information obtained this way be held more truthfully than information gained in a private screening booth at the blood center or blood drive?"

3. A colleague in New Zealand reports that at their facility they employ the following policy for hearsay information about donors:

  • The medical staff review the hearsay information to determine if that information suggests that it might be unsafe to administer the donated product
  • If it is determined that the hearsay information does NOT suggest it might be unsafe to administer the donated product, neither the donor nor the donated product is disqualified
  • If it is determined that the hearsay information might suggest that the donated blood could be unsafe to administer, the product is discarded, even if the hearsay information cannot be substantiated. This is a precautionary strategy to minimize risk to the recipient.
  • If a donated product is discarded because of hearsay information, the donor of a discarded product may or may not be deferred, depending on whether the hearsay information can be substantiated.
  • In order to substantiate (or refute) the hearsay information, the blood center writes to the donor and indicates that hearsay information has raised questions about the answers that the donor provided on the donor questionnaire. The letter explains that the hearsay information may be unfounded, but that the donor center needs to follow this up as a part of their quality assurance process. They also send information about donor selection criteria and advise the donor that if there is nothing in their health history to affect their eligibility, they may continue to donate. This serves to highlight the selection criteria and to give the donor a chance to have a close look at these criteria again.

  • Depending on the donor's response they take the following actions:
    • If the donor confirms the hearsay information that bears on the safety of donated products, the donor is deferred.
    • If the donor refutes the hearsay information, the donor is eligible to return as a potential blood donor. If after refuting the hearsay information the donor wishes to make a future donation, he/she is assessed like any other donor whose eligibility is based on their predonation interview process.
    • If the donor makes no effort to refute the hearsay information or has no further contact with the donor center, the hearsay information goes unconfirmed, but no further donations are collected from that donor.

ADDENDA June 4, 2004

4. A colleague in Rhode Island reports that their policy is to ask the otherwise qualified donor whether the information is true.  If the donor denies the hearsay information, the donor is accepted.  If the donor confirms the hearsay information and if that information would have caused the donor to have been deferred, then the donor is deferred.  Depending on the significance of the hearsay information, the donated blood products may be quarantined until such time as the investigation of the hearsay information is concluded.

ADDENDA Aug. 3, 2006

5. A physician in South Africa wonders if colleagues might share their thoughts regarding the management of the complex ethical issue surrounding hearsay information alleging unacknowledged risk behavior on the part of a blood donor. Besides the present discussion and comments at "A complex ethical issue in a husband-to-wife directed donation" , are colleagues aware of any literature dealing with this issue?
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Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator

W. Tait Stevens, MD
CBBS e-Network Forum Assistant Editor & Moderator
Posted: May 30, 2004

Addenda: June 3 & 4, 2004; Aug. 3, 2006

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