A growing number of patients in the United States are requesting blood from personally selected donors – often for reasons grounded in misinformation rather than medical need.
Between 2019 and 2021, transfusions from “directed donors” — those handpicked by the recipient — increased by 11.1%, according to recent data from the U.S. National Blood Collection and Utilisation Survey.
Now, some states, such as Iowa, Kentucky, and Wyoming, have sought to mandate requests for directed donation, including those demanding “nonvaccinated” blood.
This rising demand is drawing scrutiny from medical experts. In an article published in the Annals of Internal Medicine, a group of researchers has called for national policies to prohibit non–medically justified directed donations.
“Allowing non–medically justified directed blood donations—such as those based on vaccination status—carries substantive public health, ethical, and operational consequences,” says Dr Jeremy Jacobs, a transfusion medicine expert.
Direct blood donations aren’t safer
The paper says there is no evidence to support any safety benefits of directed donations, however, there is evidence that directed donations have greater safety risks.
“Direct donation presents important patient safety risks, including increased infectious disease transmission, immunologic complications, and logistic burdens,” the authors write.
For instance, first-time parental donors who seek to donate for their children have significantly higher rates of infectious disease marker positivity (8.6%) as compared with first-time community donors (1.09%).
Pandemic-era misinformation
Part of the rise in direct donation requests stems from misinformation around COVID-19 vaccines. Namely, one persistent myth: that vaccinated blood is “contaminated” and unsafe for transfusion.
The authors warn that allowing unfounded fears to influence blood donation policy could jeopardise public health.
“Accommodating such requests can also lend credibility to misinformation, set problematic precedents for discriminatory donor selection, and divert critical resources away from the community-based blood system that is already optimised for maximum safety and equity”, says Jacobs. “While respecting patient autonomy is important, it does not justify interventions that lack clinical benefit or may cause harm”.
Call for policy restrictions
The researchers argue that clearer national or regional guidelines are needed to prevent non-evidence-based transfusion practices.
“Policymakers should prioritise national or regional guidelines that restrict directed donations to clearly defined, medically necessary indications,” says Jacobs.
“We believe there is a role for regulatory clarity that prevents the codification of non–non-evidence-based transfusion practices. Clinicians and institutions must also be supported in declining requests that compromise safety or violate principles of equitable access. Unified messaging from health authorities, professional societies, and blood centres is essential to maintain public trust and depoliticise blood donation.”
As the disinformation epidemic grows around the world, other countries are likely to confront the same problem.
In Australia, directed blood donations are generally not permitted. The Australian Red Cross Lifeblood will only undertake directed donations in very specific circumstances, such as for patients with rare blood types where compatible donors are not available. It says directed donation will not be performed when suitable blood components can be provided from other Lifeblood donors.
A lot of blood is thrown away
