Public awareness and knowledge of blood donation eligibility and deferral criteria: Fostering a culture of donation and advancing equity

BACKGROUND: In Canada, blood operators permanently defer individuals with a history of malaria to prevent transfusion-transmitted malaria. While protective, this policy raises equity concerns, particularly for individuals requiring frequent transfusions, including those living with sickle cell disease. This study examined public awareness of donor screening criteria, perceived barriers to donation, willingness to donate, and views on potential changes to malaria deferral policies. STUDY DESIGN AND METHODS: A mixed-methods community based study was conducted using a national survey. The survey assessed awareness of donor screening criteria, perceived barriers, and willingness to donate before and after anticipated malaria policy changes. Quantitative results were stratified by malaria endemicity (high, moderate, and low region groups). Results are presented as proportions with 95% confidence intervals. Open text responses were analyzed using categorical thematic coding. RESULTS: Overall awareness of donor screening criteria was high at 67.5% (n = 385). Across endemicity groups, most participants reported no concerns regarding blood safety if a malaria test were implemented. A small subset of respondents (n = 113, 29.3%) expressed concerns, primarily related to testing reliability and blood handling processes. Willingness to donate remained unchanged for under half the respondents, with 38%-44% reporting willingness to donate pre-implementation and post-implementation. Notably, 13%-21% of those unwilling to donate before reported increased willingness to donate. DISCUSSION: Safety concerns were limited, and malaria screening was not perceived as a barrier to donation. These findings support implementation of malaria nucleic acid testing and removal of lifetime deferral policies, highlighting opportunities to expand donor eligibility while maintaining blood safety.