Can family or replacement blood donors become regular volunteer donors?

BACKGROUND: In sub-Saharan Africa (SSA) confirmed viral marker prevalence between family donors (FDs) and first-time volunteer nonremunerated donors (VNRDs) is similar. In a blood service collecting 10 units/1000 inhabitants, a questionnaire examined FD donation conditions and willingness of becoming repeat VNRDs. STUDY DESIGN AND METHODS: Four areas were explored: circumstances of visit to hospital, external pressure, experience of donating, and potential repeat donation. After donation and consent, research assistants administered 25 questions and, according to literacy, helped with translation and completion. RESULTS: Of 513 FDs, three-fourths were males (median age, 27 years). Only 1.3% were unemployed and more than 50% were students or teachers. Ties with hospitalized patient were family (76%), friends (13%), colleagues, or sharing place of worship (10%). Donating blood was the reason for visiting in 16.8% and 20.9% had previously donated blood probably as FDs. In one-third of FDs, the family asked for donation of which 10% was pressured by the unjustified reason that not donating was endangering the patient's life. For two-thirds of FDs, donation was given "because individuals were asked." Donation was a positive experience for 77% of donors, 62% being interested in predonation testing. Repeating donation was acceptable for 99% of 79% FDs answering. DISCUSSION: FDs are active in the population, are willing to donate blood if asked, are submitted to little pressure, do not receive incentives, and accept repeat donation. Except for circumstances of donation, FDs are not different from VNRDs and more directly motivated. They constitute a legitimate and important source to improve the blood supply in SSA.

Fourteen-year experience of a tertiary hospital transfusion committee in West Africa.

BACKGROUND: Hospital transfusion committees (HTCs) have been established in the United States to link producers and users as well as to ensure appropriate use of blood. The HTC has been little reported in sub-Saharan Africa (SSA), although it has been established in some hospitals. STUDY DESIGN AND METHODS: The minutes of three to four HTC meetings per year in a tertiary hospital hosting its own blood service have been reviewed to examine the HTC role over a period of 14 years. Minutes were broken down into themes and indexes, and incomplete data were reinforced by other information sources. Specific data on progress over time were reviewed. RESULTS: The HTC systematically scrutinized the blood supply, blood safety, donor care, clinical use of blood products, and costs. It operated more as a blood transfusion service supervisory board than the limited function allocated to western HTCs. Clinicians and hospital administration were directly involved in decision making and directing investigations to support potential changes and advances in the role and function of the blood transfusion service. The close relation with a UK major blood center and university laboratory provided the impetus and support for research and investigations preliminary to decision making. Data collected and analyzed were reported in the international literature and contributed to disseminate progress made. CONCLUSIONS: The HTC in a major SSA tertiary hospital inclusive of all sections of hospital organization was critically instrumental in decision making, funding, and implementing measures improving the amount and quality of blood products on the basis of evidence collected despite lack of resources. Steps are taken to ensure sustainability of the HTC.

Relative safety of first-time volunteer and replacement donors in West Africa.

BACKGROUND: A significantly higher level of safety between nonremunerated volunteer and replacement donor blood is assumed. This is supported by global data without stratifying between genuine replacement and paid donors, for first-time or repeat volunteer, or according to age. STUDY DESIGN AND METHODS: In 2008, first-time volunteer and replacement donors were identified, and confirmed human immunodeficiency virus antibody (anti-HIV), hepatitis B surface antigen (HBsAg), and hepatitis C virus antibody (anti-HCV)-positive screening results were collated. Data were analyzed according to age and sex between the two types of donors. RESULTS: In 6640 first-time volunteer and 4360 replacement donors, the prevalence of anti-HIV and HBsAg (1.03 and 13.8% vs. 1.1 and 14.9%, respectively) was not significantly different. Anti-HIV prevalence was higher in replacement donors less than age 20 than in first-time volunteers; the difference was not significant. HBsAg and anti-HIV confirmed-positive prevalence was significantly higher in first-time volunteer donors over age 20. CONCLUSION: In Kumasi, Ghana, viral safety of replacement and first-time volunteer donors was similar, constituting a single population of donors. Safety increment is provided by repeat donation applicable to either group, through different approaches. A blood unit from replacement donor costs half or less than that from a volunteer donor; similar studies conducted elsewhere in sub-Saharan Africa may lead to changes in current strategies.