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Directed Blood Donations

Directed donations are units of blood directly solicited from family or friends by the intended recipient. Some patients anticipating elective surgery prefer to receive blood donated by relatives or friends, even though directed donations have not been proven to be safer than those from the community blood supply. Laws in many states have been established which protect the patient’s right to request directed donation.

Physicians initiate the order for directed donation of blood at a patient's request. The order must specify the number of units needed, transfusion date(s), and patient's ABO and Rh type. The patient should instruct his/her directed donors to donate a few days to a few weeks before the anticipated transfusion to allow adequate time for donor scheduling, blood collection, test completion, and shipping.

Directed donors must have a blood type that is compatible with the recipient and meet the same donor requirements as volunteer donors. The same tests are performed on directed units as volunteer units. Generally, donors give blood only once every 8 weeks. To reduce the number of donors a patient is exposed to, special arrangements can be made to have some designated donors give more frequently. These frequent donors must continue to meet all other donor requirements each time they donate.

Specific directed donor policies vary with institution. Only acceptable, ABO and Rh compatible directed donor units are reserved for a patient. Units that are ABO and Rh incompatible are either not drawn or released to general inventory. Most facilities reserve directed donor units only for a specified time, such as 5 days after the scheduled transfusion date or 1 week before the unit expires. After this time, they may be released to general stock and used on someone else to prevent unnecessary waste, although some institutions will not use them for other patients because of concerns that a directed donation may not be as safe as a volunteer non-directed donation. If the anticipated date of transfusion changes, the physician should notify the Blood Bank immediately so that the reservation time is extended. Directed donor units are not routinely frozen to extend storage. Instead, additional donors are recruited.

Because directed donor units require extra handling and tracking, they usually cost more than regular volunteer units. These charges are billed whether or not the unit is transfused. Directed donations, like autologous units, may not be covered by health insurance reimbursement. Patients seeking directed donation should be informed of this possibility.

Indications for Directed Donation include:

  1. Indications for autologous blood cited above.
  2. Bone marrow donor components after transplant.
  3. Family red blood cells for rare blood groups.

Directed donations may cause complications such as: maternal sensitization to paternal antigens, sensitization to HLA antigens, and the development of graft versus host disease. Men are advised against donating for their female sexual partners of child bearing age since this could increase the risk of hemolytic disease of the newborn in future pregnancies. Potential bone marrow donors should not donate blood pre-transplantation for the recipient because transfusion may lead to HLA sensitization and subsequent bone marrow graft rejection. Relatives should not donate plasma for a coagulation factor deficient patient if they have the same coagulation factor deficiency. Recipients receiving cellular blood components from first-degree relatives are at increased risk of developing graft versus host disease. Thus, all directed donor units of whole blood, red blood cells, platelets, and granulocytes must be irradiated.

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