Limited effectiveness of donor deferral registries for transfusion-transmitted disease markers

Donor deferral registries (DDRs) detect repeat donations by previously deferred donors and prevent their release. The utility of DDRs has not been objectively demonstrated.

A total of 10.2 million first-time donors to the American Red Cross from 1995 through 2002 were reviewed to identify donors deferred by screening tests for human immunodeficiency virus (HIV; 0.19% of donors), hepatitis C virus (HCV; 0.55%), and hepatitis B virus (HBV; 0.13%). All repeat-reactive (RR) donors were deferred despite confirmatory testing. Donors were notified and counseled about their test results and deferral. Their subsequent donation behavior was assessed.

A total of 414 HIV-deferred donors (2.1%), 471 HCV-deferred donors (0.8%, p < 0.001 vs. HIV and HBV), and 222 HBV-deferred donors (1.6%, p < 0.01 vs. HIV) returned to donate despite their deferred status. For all three tests, confirmed-positive donors were less likely to return. Of donors originally confirmed positive, only 7 returning donors were negative by screening (thus the repeat donation interdicted from distribution by the DDR): 0 HIV RR donors, 2 of 36,092 HCV RR donors, and 5 of 8,404 HBV RR donors. Review of the laboratory results for the HCV donors and one HBV donor was consistent with originally false-positive confirmation tests. The four other HBV confirmed-positive donors were anti-hepatitis B core antigen-positive on their subsequent donation, which was discarded despite the DDR.

Of 10.2 million donors, the DDR did not prevent the release of any potentially dangerous blood component due to inappropriate return of donors deferred for HIV, HCV, and HBV tests. The effectiveness of DDRs should be evaluated for other deferrals.