<scp>AABB</scp> survey on directed blood donation practices

BACKGROUND: Standardized guidance regarding the processes for collecting directed blood donations (DBD) is lacking, leading to variable practices. This study assessed laboratory, clinical, and charging practices for DBD collection in the United States and Canada. STUDY DESIGN AND METHODS: An electronic survey was distributed to United States and Canadian blood collection centers and hospitals to evaluate institutional demographics, policies, indications, medical oversight, and financial responsibility for DBD collection. RESULTS: Survey respondents included 193 hospitals and 10 blood collection centers with a response rate of 34% (203/594). Red blood cells were the most commonly collected DBD product. Fifty percent (5/10) of blood center respondents did not include the rationale for the DBD request on requisitions. Non-medical requests were accommodated by 70% (7/10) of blood centers and 42% (81/193) of hospitals. Transfusion Medicine review was not required by 48% (98/203). Safety practices also varied: only 60% (53/88) verify donor-recipient ABO suitability prior to collection, and 57% (50/88) had no additional exclusion criteria for high-risk related donors. Forty-four percent of respondents reported additional charges, but many hospitals reported uncertainty about billing. Most hospitals (59%) reported wasting DBD units, with higher discard rates among those that do not return units to general inventory. CONCLUSION: Heterogeneous DBD practices reflect the absence of standard policies. Lack of oversight and safety checks may expose patients to unnecessary risks. The authors outline key considerations for DBD requests to standardize safeguards, including defined exclusion criteria for high-risk donor-recipient pairs and education on DBD risks.