Blood Banking - Directed Donations

A "directed" donation occurs when the potential recipient of blood or blood products designates certain persons to donate specifically for his or her use. In general, blood collected from directed donations is no safer than that of the general blood supply because of the stringent screening and testing of volunteer donors that ordinarily occurs.

Additional problems with directed donations include:

1. Confidentiality of the donor is difficult to maintain.
   
2. The donor may not want to answer the exclusionary questions of the blood safety form and health questionnaire properly.
   
3. This procedure is not cost-effective.
   
4. There are contraindications, such as an increased risk for transfusion-asscociated graft versus host disease (TAGVHD), alloimmunization of potential recipients of transplants, and increased risk for hemolytic disease of the newborn in mothers receiving blood from fathers.
   

There is a small but significant risk for TAGVHD in persons receiving blood from relatives, because of similar genetic makeup. TAGVHD is fatal, with no effective treatment. Thus, all units of blood collected by directed donation typically undergo gamma irradiation to destroy any white blood cells that could cause TAGVHD. This adds significantly to the cost of blood processing, and these units must be discarded if not used within 24 hours.

Patients who request directed donations from family and friends often do not realize the pressure such a request can place upon an individual who does not qualify to donate blood. That individual, if answering the questions in the interview properly, will be excluded from donating, which will result in family members asking questions about why the blood was not accepted. The alternative is answering the questions untruthfully and compromising the safety of the blood products collected.