Background/Case Studies: In the United States (US), the Food and Drug Administration and the Association for the Advancement of Blood and Biotherapies allow blood centers to screen and defer donors with a history of cancer based upon the discretion of their medical directors (MDs).
Study
Design/Methods: A working group of America’s Blood Centers’ (ABC) Scientific, Medical, and Technical Committee developed a survey composed of 31 questions to understand blood center policies for collecting blood from donors with a history of cancer. In June of 2022, the survey was distributed to representatives of 47 ABC blood centers in the US and Canada by email. Literature of a history of cancer, blood donation safety and transfusion-transmitted cancer was reviewed.
Results/Findings: Responses were received from 37 (79%) centers. There were no permanent deferrals for benign lesions and for donors with a history of carcinoma or sarcoma who had completed treatment. Donors with a history of leukemia or lymphoma were only accepted if the diagnosis occurred prior to age 18. Donors with a myelodysplastic or myeloproliferative syndrome were deferred permanently at 32 (86.5%) of centers with only 1 (2.7%) accepting with no deferral. Handling of donors with high white blood cell counts (WBC) varied from 8 (21.6%) not notifying the donor to 11 (29.7%) notifying donors at WBC counts of 12,000-16,000/uL. Donors with cancer who were not in active treatment (i.e. prostate cancer) were subject to a variety of deferrals. Blood center response to post-donation reports of cancer ranged from no action because the donor remains eligible 5 (13.5%) to donor deferral 20 (54.0%).(Table) Regarding the prevalence of donors deferred for cancer 17 (45.9%), respondents stated it was 1-5% of all donors and the remainder 20 (54.1%) did not know. Literature review yielded no evidence of transfusion-transmitted cancer. Conclusions: Cancer deferral policies vary widely among blood centers in the US and Canada and are not generally based on evidence, but on some aspects of the precautionary principle. There is no published proof that any of the wide range of deferral decisions that MDs make for individuals successfully treated for malignancy place those individuals at risk for morbidity. As the blood donor population ages and with increased risks of malignancy, this precautionary approach may cause further reductions in the available donor pool.
Importance of research: In the US and Canada blood center medical director’s discretion determines deferral for donors with a cancer history. Literature review and survey of approximately half of blood centers found that cancer deferral policies vary widely, are not evidence-based, do not affect donor or recipient safety, and rely on the precautionary principle. As the aging blood donor population has increased risks of malignancy, this may cause further reductions in the available donor pool.
