Transfusion Medicine - Jeffrey McCullough

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to the general community blood supply. Sometimes donors are asked to donate blood for one or more specific patients. Newman et al. [46] found that these patient‐related blood drives were easier to organize, produced more blood, and left the donors and staff with a stronger sense of satisfaction because of the more personal nature of the experience.

      Little structured social science research has been directed to the issue of minority involvement in the blood donation process. Some success in increasing blood donation by minorities has been achieved by involving more minority staff in the recruitment and blood donation process (M. Wingard, quoted in O’Brien [47]). Compared with Hispanic nondonors, Hispanic donors were found to be better educated, to be more likely to speak English, to have higher job status, and to be more likely to have parents who were donors [48]. The study concluded that there is a need for improved education for Hispanic donors about the safety of blood donation. With the general aging of the population and the extending of age limits for blood donation, donation has been found to be safe for older persons. However, there are no unique recruitment strategies targeted to older donors. Because more blood is collected at colleges and high schools, the materials and publicity are designed to appeal to that age group, and thus could be considered to be targeted to this population segment.

      Another issue in donor recruitment is whether to devote more effort to recruitment of new donors or to maintaining existing donors. New donors add to the overall files and replace donors inevitably lost because of attrition or disqualification. Thus, it is essential to replenish the donor pool. However, once people are in the donation habit, strategies to encourage them to continue result in the collection of substantial amounts of blood for less effort than is required to recruit new donors. Therefore, the dilemma is not in choosing only one of these strategies, but in balancing the effort between them to maintain an adequate donor file and also to produce new donors with a reasonable amount of effort. In the interest of overall operational efficiency, there has also been a push to recruit donors to “right type, right technology”; for example, group O donors are guided toward whole blood or automated apheresis red blood cell (RBC) collections, because their RBCs are in highest demand, whereas group AB donors are guided toward platelets or plasma because their RBCs are often unused. Excess collections or outdated products are “red ink” to a blood collector.

      Some blood centers have taken steps to identify donors based on self‐reported ethnicity data. This has helped to provide certain ethnicity‐associated RBC phenotypes for difficult‐to‐match blood recipients. Several high‐profile national calls for “rare blood types” have recently been serviced by centers who could provide ethnically matched donors. This may over time increase the prevalence of blood donation in these ethnic groups.

      As cytapheresis became a widely used method of producing blood components and the procedures began to take a place in the more routine operation of blood centers and hospitals, attention was directed to structured donor recruitment programs. This has raised considerations in addition to those for whole blood donors. The cytapheresis procedure is longer and thus requires more of a time commitment. In addition, the side effects, the nature of adverse reactions to donation, and the donor medical assessment are different from whole blood donation. Thus, the types of people to be approached about donation, the information they would be given, and the strategy to be used to obtain the best decision from the donor and potentially the highest acceptance rate became topics of great interest.

      A key step in the development of cytapheresis donor programs was a conference that was held to address the scientific, legal, and ethical issues [49]. Issues such as the cost‐effectiveness of platelet transfusion, individual rights, informed consent, donor decision‐making mechanisms, and personal autonomy were discussed in the context of plateletpheresis donation. The results of this conference formed a sound basis for the development of cytapheresis donor programs. Because of the additional burden of cytapheresis donation, frequent whole blood donors were selected as possible cytapheresis donors. The provision of informational materials was often sufficient to attract them into cytapheresis donation [50]. Platelet donation was not only an altruistic act of giving, but it also filled some personal needs of the individual.

      Apheresis now is the major platelet production method (see Chapter 2) occurring thousands of times each day. Recruitment continues to focus on successful whole blood donors who are provided information about apheresis donation. Some blood centers position the apheresis collection area within the site of whole blood donors as a recruitment technique. Because apheresis donation can be done more frequently than whole blood, this is another incentive for some donors.

      Because this is a special pool of donors, there has been some work to find the special traits that distinguish apheresis donors from the existing pool of whole blood donors. Several firms can use consumer and demographic data to analyze a collector’s donors to see which ones are most amenable to recruitment as apheresis donors.

      With increasing use of bone marrow transplantation to treat a wider variety of diseases and with the success of the treatment improving, the lack of a suitable family donor for most patients became a major limitation in the availability of this treatment. The first successful transplant using marrow donated by a volunteer not related to the patient [51] opened the urgent need for large numbers of human leukocyte antigen (HLA)‐typed individuals who would be willing to donate marrow. A remarkable story unfolded, resulting in the establishment of the National Marrow Donor Program [52].

      Because of the extensive commitment required of donors, it was decided to approach multigallon blood donors and apheresis donors [54, 55]. This had the added benefit that most were already apheresis donors who had been HLA‐typed, and this avoided the cost of additional HLA typing. The “recruitment” involved providing an extensive description of marrow transplantation, the situations in which it was used, the results of transplantation, including actual survival statistics, the marrow donation process, and the steps that would lead up to marrow donation. The recruitment process drew heavily on the considerable experience of sociologic studies of families making the decision to donate an organ either to a relative or for cadaver transplantation [56, 57]. The informed consent process was given very heavy weight in the recruitment process [54]. Remarkably, about three‐fourths of the donors who were provided an extensive description of the marrow donor program elected to participate [54, 55]. Important factors in the donor’s decision whether to participate in the program were religion, experience with the medical system, and the spouse’s attitude regarding marrow donation [55].

      Donor recruitment efforts were expanded to the general public. Although there was concern that people who had never donated blood would not be sufficiently well informed or willing to make the necessary commitment, general community appeals for donors resulted in the recruitment of donors who became as committed

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