Donor Deferral Decisions for a Directed Donor
A 38-year-old woman wants to donate directed RBCs for her sister, who is scheduled for elective surgery in 3 weeks. On the donor history questionnaire she reports: a tattoo obtained 5 months ago at a licensed facility in a state that regulates tattoo parlors; a body piercing 2 weeks ago at a mall kiosk; travel to a malaria-endemic region 13 months ago (no prophylaxis, no symptoms); and a cold sore (herpes labialis) currently healing. Her hemoglobin is 12.8 g/dL, BP 118/76, pulse 72, temperature 37.0°C. She takes no medications. The blood bank must decide eligibility and whether the directed donation can proceed in time for surgery.
1. Evaluate each donor history item against current AABB/FDA donor eligibility criteria and state whether she is eligible today.
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Evaluate each item:
- Tattoo 5 months ago at a state-regulated facility: Under current FDA guidance, a tattoo from a state-regulated establishment is not a deferral (the 12-month deferral applies to unregulated tattoo parlors). If the facility is verifiably regulated, she is eligible on this point. Many centers still apply a 12-month deferral if regulation cannot be documented - verify.
- Body piercing 2 weeks ago at a mall kiosk: Piercing with non-sterile equipment or at an unregulated facility requires a 12-month deferral from the date of piercing. A mall kiosk is unlikely to meet regulated standards; she is deferred for 12 months from the piercing date.
- Malaria-endemic travel 13 months ago: Travel to a malaria-endemic area without symptoms or prior malaria generally requires a 12-month deferral from departure from the endemic area (for travelers, not residents). At 13 months she is past the deferral window and eligible on this point.
- Active cold sore (herpes labialis): Active herpes lesions are a reason for temporary deferral until the lesion is healed (typically 1-2 weeks). She is deferred today.
Bottom line: She is not eligible today because of the recent piercing (12-month deferral) and the active cold sore. The malaria travel and regulated tattoo do not bar her.
2. Given the surgery is in 3 weeks, what options does the blood bank have, and what are the risks/benefits of directed donation in this setting?
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Options:
- Directed donation cannot proceed because the donor is deferred for 12 months (piercing) and temporarily for the cold sore. The 3-week timeline cannot accommodate a 12-month deferral.
- Alternative donors: Recruit other directed donors or rely on the general volunteer supply. The sister should be typed and screened; if she has no alloantibodies, standard inventory is appropriate.
- Autologous donation could be considered for the sister if she is a candidate and the surgery can accommodate it, but 3 weeks is tight and her clinical status matters.
Directed donation risks/benefits:
- Benefits: psychological reassurance; may be useful for rare phenotypes or IgA deficiency.
- Risks: directed donors are often first-time donors with higher rates of viral marker positivity; there is no proven safety advantage over volunteer donors; directed units are often discarded if not used, wasting resources; and they are not indicated for routine surgery.
Recommendation: Do not delay surgery for a deferred directed donor; use volunteer inventory and ensure the recipient has a current type and screen. Document the deferral and counsel the family.