September, 1996

The Donor/Demand Dilemma

Joseph E. Kiss, M.D., Medical Director, Hemapheresis and Blood Services


Regular readers of the Update have come to expect that if the first sentence is about blood, the second sentence will be about testing or transfusion. In this issue, we will change our usual focus, addressing the critical human resource behind the transfusions that we use to treat patients: volunteer blood donors.

It is widely-recognized that area residents benefit from a highly-sophisticated medical delivery system which provides the latest advances in organ and bone marrow transplantation, cardiac surgery, as well as trauma care. The transfusion requirements generated by these procedures and other medical conditions creates an enormous demand for blood and blood components, periodically outstripping the available supply. In recent years, centers throughout the United States have reported blood shortages with greater frequency and urgency. Our regional supplies have not been spared, as we know from several public appeals for blood donors conducted by Central Blood Bank (CBB) over the past year. We have termed the constant need for blood, in the face of the supply short-fall, the "Donor/Demand Dilemma".


Blood Collections

In our region, approximately 160,000 units of red blood cells are distributed each year for transfusion. About 95,000 volunteer blood donors participate annually, many on more than one occasion. Over 300,000 components (red blood cells, platelets, apheresis platelets, fresh frozen plasma, etc.) are prepared and transfused to approximately 75,000 patients. Forty-six percent of the blood is collected at community donor centers; 38% at mobile blood drives; 6% using donor bloodmobile coaches; and 10% of the supply is imported from outside the region. Studies have shown that less than 5% of healthy Americans who are eligible to donate blood actually donate each year. Slightly more than this percentage donate in our region, however, in 1995 CBB’s blood donations posted a decline in comparison with the previous year.


Whither The Blood Donor?

Both external socioeconomic factors as well as internal factors have been cited as reasons for greater difficulty with blood donor participation. The external factors include: a lesser sense of community responsibility (decreased altruism), greater competition for the potential donor’s attention and time(both workplace and personal time), and workforce reductions leading to a greater sense of job insecurity. An aging area population is undoubtedly also a factor, despite data indicating that blood donation is a safe procedure for elderly individuals who are in general good health.

Perhaps just as important, however, is the increasing rigor of the donation process itself. Blood centers serve a dual mission, providing for both a safe and a sufficient supply of blood. The events surrounding the AIDS epidemic shifted the balance justifiably to safety concerns. Procedures have been strengthened or newly implemented which help to ensure a high degree of safety. Among these are: 1) A volunteer blood donor base, 2) Pre-donation educational materials which emphasize those individuals who are members of risk groups (potential exposure to HIV, hepatitis, etc.) who should not donate, 3) An increasingly rigorous medical screening interview and examination to cull out unsuitable donors, 4) Sensitive laboratory testing applied to all donations, 5) Confidential call-back procedures which provide a "safety-valve" to remove potentially unsuitable units from those who donated because of social pressure, and, 6) A computer database which tracks the completeness of current donation data and previous deferral status (Donor Deferral Registry) before the blood unit can be labeled and released. While achieving a remarkable level of blood safety, these policies have also resulted in the disqualification of many healthy, noninfected, longtime donors such as those with false-positive test results, or previous medical histories that have little relevance to current risk.

At CBB, more stringent donor criteria have increased the deferral rates for registered donors, from the 9-9.5% range five years ago to 13.2% in 1996. Even temporary deferral has been shown to result in permanent donor loss, because the psychological impact of deferral is interpreted by some donors as a form of rejection. This has predictable negative consequences in terms of donor attitudes and loyalties. When there’s a blood shortage, many former donors are forced to stay on the sidelines; others are less willing to risk "rejection" once again. It is evident from the cumulative effects of the deferral process, in the face of a continuing or increasing demand for blood, that innovative efforts to recruit and retain qualified donors are needed.


Donor Motivation

The decision to donate blood is motivated by a host of factors, including altruism, social pressure, replacement, and reward. Approximately 85% of blood donations are from repeat donors; new, first-time donors comprise the remainder. The motivational influences which lead to donation are somewhat different in the two subsets. Altruism or humanitarianism (providing emotional gratification and heightened self-esteem) continues to be the primary reason given for donations by the majority, whether repeat or "first-timers". Awareness of community need has been cited in a number of studies as a critical determinant of donor participation. Studies also suggest that some form of token donor recognition reward or incentive may assist in stimulating donation activity, particularly among new donors. Effective donor recruitment strategies are aimed at both groups: new donors are essential to replace those deferred or who stop giving for other reasons.

In surveys of non-donors, the chief reason given is simply not having been asked to donate, followed by fear (pain, needles, AIDS, etc.). While first-time donors are more concerned about discomfort, repeat donors complain more about procedural issues, especially delay and the length of the medical interview.


Current Recruitment Strategies

The foundation of CBB’s recruitment efforts continues to be public education regarding the daily need for blood, appealing to a strong sense of community responsibility. "Gift-of-life Donor" (G.O.L.D.) clubs have formed, aimed at creating awareness for specific needs, including apheresis platelets, plasma, etc. Community Care Clubs are being established to help increase the blood supply by allowing organizations with smaller facilities or those groups who are not available to participate in large mobile blood drives an opportunity to become involved in regular blood donation activities. The Community Care Clubs will align an organizations’ good will and capabilities with patients’ needs through the increased use of CBB’s Community Donor Centers.

A series of "Chance of a Life-Time" promotions have been instituted to provide recognition/"thank you’s" to area residents interested in blood donation. In this program, a drawing of chance is held for a special event or trip. To offset the concern that a few individuals might conceal a risk behavior in order to gain the reward, eligibility for the promotion is granted to anyone who merely presents at the collection location (i.e., an actual donation is not required), so that the reward does not have the potential for overriding safety-related self-deferral mechanisms. Deferral and viral marker trends have been closely monitored since the program began, with no evident changes in pattern or frequency noted to date.

Finally, area physicians and other health-care professionals are in a unique position to encourage and recommend blood donation to the families of patient’s that are under their care. Studies have shown that family members of patients who need blood are strongly influenced to become first-time donors and many return as committed donors. If needed, family members may become directed donors, providing components intended for their relative or friend. Others should be encouraged to donate simply because it is an easy way for them to help all those who are in need of the "gift-of-life".

For information on a conveniently located community donor center or to schedule a donation appointment,
please call Central Blood Bank at (412) 209-7000, or toll-free at 1-800-310-9551.


Copies of the Transfusion Medicine Update can be obtained by contacting
Deborah Small at (412) 209-7320