Blood donor recruitment

Abstract

Safe blood donors are the cornerstone of a safe and adequate supply of blood and blood products. The safest blood donors are voluntary, non-remunerated blood donors from low-risk populations. Despite this, family/replacement and paid donors, who are associated with a significantly higher prevalence of transfusion-transmissible infections, including human immunodeficiency virus (HIV), hepatitis B virus, hepatitis C virus, and syphilis, still provide more than 50% of the blood collected in developing countries. World Health Organization advocates and recommends its member states to develop national blood transfusion services based on voluntary non-remunerated regular blood donation in accordance with World Health Assembly resolution 28·72, which was adopted in 1975. The definition of voluntary, non-remunerated donations passed by the VIIIth General Assembly of the International Federation of Red Cross and Red Crescent Societies and accepted by the International Society of Blood Transfusion and the Council of Europe states: ‘Voluntary non-remunerated blood donors are persons who give blood, plasma or other blood components of their own free will and receive no payment for it in the form of cash, or in kind which could be considered a substitute for money. This includes time off work, other than reasonably needed for the donation and travel. Small tokens, refreshments and reimbursement of direct travel costs are compatible with voluntary, non-remunerated donation.’ These donors donate for altruistic reasons, as an act of consideration and generosity to the community without thought of reward. Experience has shown that voluntary non-remunerated donations have the lowest incidence of disease markers. When combined with intensive donor screening, such as questionnaires, private interview and laboratory testing, very low incidences of infectious disease markers can be obtained. In many countries the payment of donors for blood donations is widely practiced. Unfortunately, in some cases it is the only way in which a blood supply can be secured. Some would argue that these are still volunteer donors; however, it is difficult to believe that financial reward leads to truly voluntary altruistic donation. The incidence of infectious disease markers in paid donors is very much higher than the non-remunerated volunteer group. Comparative studies have shown that there is an increased risk of post-transfusion hepatitis following the use of blood and blood products from commercial sources. The risk of HIV also appears significantly higher in the commercial system. A study of intravenous drug users in Baltimore showed that more than 20% had continued to donate blood. Of these 88·1% were donating in the commercial sector and 11·9% in the volunteer sector. Some would argue that this does not matter, provided all donations are screened. However, this argument is flawed. The primary risk to the blood supply is not those donors with detectable antibody but rather those infectious donors without antibody, that is, ‘window period’ donors. These latter donors are the ones whose donations will slip through and contaminate products. Many parts of the world widely practice the use of replacement donors. In this form of donation, the patient undergoing surgery, especially elective surgery, may be asked to find donors to replace the blood that they use at the time of their surgery. Surgery may not go ahead unless replacement donors are found. The essential problem with this type of system is that there is a degree of coercion involved on the part of the patient to find people to donate blood. Experience in some countries has shown that the majority of HIV-infected donors come from this replacement donor group. It is also likely that there is a continuing group of paid donors who donate within this frame work, particularly in smaller centres. The use of replacement donors in countries with insufficient volunteer donors must be a judicious balance. The aim of all countries must be progressively reducing their reliance on replacement donors with the only acceptable goal being an entirely volunteer system. Directed donations, also known as designated donations, involve persons donating blood for a specific recipient. In many cases the donor may be a friend or relative of the recipient who is to undergo elective surgery and in fact many replacement donors are giving directed donations. Directed donations are very controversial. On the surface, it would seem a particularly effective way of recruiting donors, with the patient selecting relatives and friends known to be ‘safe’ with a lower risk of TTI than the random donor population. Unfortunately, there is now good evidence that not only directed donors are no safer than random donors they are probably less. There must be some element of coercion, conscious or subconscious, when directed donors are recruited. A factor increasing the risk of this group is that the percentage of new donors among the directed donor group is much higher than among the random donor group and as already discussed new donors carry greater risk than pedigreed regular donors. The key to recruiting and retaining safe blood donors is good epidemiological data on the prevalence (and incidence, where possible) of infectious markers in the general population to identify low-risk donor populations coupled with an effective donor education, motivation and recruitment strategy to recruit new voluntary non-remunerated blood donors from these populations. A pleasant experience during blood donation, good donor care and effective communication between blood centre staff and blood donors are all important factors for the retention of safe blood donors. The objectives of this study are recruitment and retention of regular volunteer and non-remunerated donors. Blood donor recruitment remains an indispensable aspect of blood safety and a major cause for concern in many countries, where taboos and socio-cultural beliefs tend to inhibit spontaneous and benevolent blood donations. Voluntary blood donation from the low-risk population requires identification of such population and motivating them to donate blood regularly. Younger population is considered more impressionable and at low risk. Special strategies and programmes need to be developed to educate and motivate this population, so that they not only commence donating blood regularly, but also become motivators for other members of the community. Apart from conventional methods of imparting education and creating awareness among the public, active cooperation of various media, both electronic and print versions, can boost the programme. Various communication strategies and methodologies are available and must be utilized effectively in educating the potential target population about the utility of voluntary blood donation. Sensitization of the media is also essential to prevent misreporting and sensationalization of some isolated mishaps or errors that may have occurred in some blood transfusion service. Cooperation of the media and their extensive outreach can be gainfully utilized for creating awareness on volunteer non-remunerated donor among various segments of populations. Training of staff who will be engaged in motivation, recruitment and retention of donors is a vital component of any blood donation programme. Training should be comprehensive and appropriate to the local needs. The blood donation programme must have an active feedback mechanism from the donors. A system for acknowledging errors, investigating and correcting these and making necessary correction to prevent their occurrence should be instituted. This augments credibility of the donor programme and assists in improvement in services. Quality must be integrated into all aspects of blood donor programme. An effective quality system in blood transfusion service should be extended to blood donor component too. Quality must be the responsibility of all staff members and should flow from the quality policy of the organization. Appropriate quality manual and Standard Operating Procedure should be developed, staff trained to use Standard Operating Procedure and their use made mandatory to assure quality. Similarly, documentation is an essential part of any quality system. Various documents that signify undertaking of activities, maintenance of records and traceability should be appropriately filled. Non-governmental organizations can play a vital role in galvanizing the community and motivating the donors. They can also provide considerable support in organizing mobile camps. Such organizations should be identified and encouraged to cooperate with blood transfusion services to contribute in donor-management programme. Similarly, big corporate and business houses can be approached to provide a variety of support in donor-management programme. World Health Organization has developed a set of simple guidelines designed to assist those responsible for blood donor recruitment in resource poor settings to develop and implement programmes to improve communication with blood donors. These guidelines provide approaches for setting up a communication programmes – organizing, collecting information and developing plans, as well as providing ideas that individual centres might consider for recruiting, educating and retaining safe donors. Elements and activities in promoting voluntary non-remunerated blood donation include: national blood donor programmes for the education, recruitment and retention of low-risk blood donors, including community-based voluntary blood donor organizations and youth programmes; appointment of an officer responsible for the national blood donor programmes to include donor education, motivation, recruitment and retention; training of donor recruitment and donor care staff in donor education, motivation, recruitment, selection and retention; development of partnerships with non-governmental organizations, such as national Red Cross and Red Crescent societies, voluntary blood donor organizations, national service organizations and the media; identification of donor populations at low risk for TTIs and development of strategies to promote positive attitudes towards voluntary blood donation; development of donor education and recruitment materials; educational and media campaigns in workplaces, communities and educational institutions; establishment and maintenance of a database/register of donor records; developing guidelines and protocols for donor selection and deferral, donor confidentiality and donor care; developing guidelines on the management of donor sessions and blood collection; monitoring of transfusion-transmissible infections in donor population; training of staff in pre- and post-donation counselling; donor notification and referral for counselling; and monitoring and evaluation of the blood donor recruitment programmes. Key points to a successful donor-recruitment programme: Successful programmes are multifaceted, drawing on expertise in customer relations, advertizing, public relation and marketing. Such programmes exhibit a culture of innovation and hard work. The most successful programmes have all staff members encouraging and thanking donors. Donor recognition is an important component of a successful programme Recognition does not mean providing incentives or gifts to donors. Recognition means acknowledging donors altruistic contribution at each donation, with special recognition at milestones of their donation career such as a public thank-you for multi-gallon donors at a celebration dinner. Successful advertizing campaigns are keyed to an emotional appeal. They put a human face on the transfusion recipient and the donor (Pictures of empty blood shelves do not work.). Advertizing increases awareness, but does not automatically result in more donors. To put a donor in the chair, the donor must be directly asked – preferably one-on-one. Corporate campaigns work when there is buy-in and support from top executives. Corporate campaigns can be expanded as corporate leaders challenge other executives to duplicate the programme. Tele-marketing is an effective recruitment tool when linked to a real-time donor database, that is, the telemarketers have ready access to the most current information about the potential donors. Donor education belongs in the school – as early as possible – as part of science and health curricula. Like the corporate campaigns, buy-in from the top (superintendents and principals) is critical. Recruitment and retention of regular volunteer non-remunerated donors from low-risk blood groups ensuring higher blood safety standards meanwhile boost blood collection. Both donor recruitment and retention is not an easy task to do. It requires dedicated and committed staff who are willing to understand the problem and explore every possible strategy. Beside, resources and researches should be invested in these areas to ensure blood safety.

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