A physician at a blood center in Indiana wonders how other sites would manage a prospective blood donor who years previously answered all screening questions appropriately, but who was deferred because they acknowledged that they were donating in order to be tested for HIV. Several years have passed and the individual wants to be reinstated a prospective donor. Would any center consider collecting blood from such an individual under any circumstances? The inquiring colleague's center's current policy is to enforce a permanent deferral for such an individual.

The following comments have been received.

ADDENDA Aug. 24, 2006

1. A Transfusion Medicine Specialist in Queensland, Australia acknowledges that it is reasonable for a blood center to defer people for having actually donated to secure an HIV test, out of concern for the donor’s less-than-altruistic motivation and potential dishonesty about risk factors. Nevertheless, extenuating circumstances might influence a decision to reinstate someone who once came to a blood center for HIV testing, but who did not actually donate. For instance, it might be appropriate to accept a donor if it can be determined that s/he did not have a deferrable risk factor at the time of the attempt, and that s/he was merely acting on 'medical' advice or conventional wisdom. He points out that even today, either because of miscommunication, misquotation, or misunderstanding, the lay public may believe that some physicians recommend blood donation as a way to be tested for WNV (ABC Newsletter, 18 August 2006); in the past, similar 'recommendations' may have occurred for HIV testing.

2. Two physicians associated with Transfusion Microbiology at the National Blood Service in the UK report that in their opinion all donors should be evaluated against the donor selection guidelines in force at the time of donation and that historical information, particularly with respect to HIV risk, may be no longer relevant, be superceded by new donor selection criteria, or simply inaccurate! They report having in the past accumulated information about donors believed to represent a "risk", sometimes because of something said, or because of appearance, or from third party information. However, they acknowledge that it is possible for staff to misinterpret, or misapply, donor selection criteria. Their approach now is that assessment against current donor selection criteria is the deciding factor. Very rarely they have approached a donor for a supplementary interview referring to the information from the past in order to clarify that information, but they now consider that so much of this historical information is either inaccurate or irrelevant that it is better to start afresh, and rely on the current donor interview. Thus, they say: "It may be that the 'test-seeking behavior' which led to the deferral some years ago was not reflecting a truly increased risk of HIV infection, but merely a responsible citizen who recognised that any sexually active individual is potentially at risk for infection and should have an interest in knowing about his/ her HIV status. Or it may be that there was one isolated incident, which is no longer a reason for deferral. Or there may be a number of other explanations. But if the current donor interview is effective, it should elicit any current reason for donor deferral without the need to refer to historical information." They conclude saying: "We do, after all, rely on the honesty of our blood donors right from the first question: name and date of birth! We should be able to rely on the current donor interview to elicit relevant information. We would argue that it is unlikely that the sort of historical information mentioned in this question will have any impact on the safety of the blood supply."

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