Australian Red Cross Blood Service

These requirements describe the principles under which the Australian Red Cross Blood Service (Blood Service) will participate in a directed donation programme and the rationale for our recommendations.

Allocated and directed donations collected outside the Blood Service should follow appropriate guidelines and comply with legislation.

Blood Service requirements for directed donation

1. Directed donations may sometimes be indicated in circumstances where the only practical means of accessing a suitable transfusion product for a particular patient is the use of a specific donor who is known to the patient. These include:

   1. Donor-specific immunomodulation

   2. Induction of graft-versus-tumour response following stem cell transplantation

   3. Provision of compatible red cells, platelets and/or leukocytes when anonymous donors are considered less able to provide the necessary transfusion product.

2. There is evidence that blood from directed donors is less safe than blood from anonymous volunteer donors.

   • Preselection of a blood donor known to a patient could compromise the Blood Service’s strict donor selection and screening procedures.

   • There is evidence to indicate that the overall risk of adverse outcomes following transfusion may be greater with directed donation.

     • We are prepared to provide this service under some circumstances despite the strong scientific evidence that directed donations are less safe than anonymous homologous donations

3. The Blood Service will participate in a limited directed donation programme for indications other than the medical conditions listed above as long as there is unequivocal support by the patient’s treating clinician.

   • The clinician is responsible for initiating the request, performing an initial ABO and Rh(D) compatibility check (and CMV screen, if required) on the proposed donor and recipient.

   • Consent from the intended donor and recipient/parent/guardian must include an explicit acknowledgement of the absence of evidence of any safety benefit from directed donation.

4. Blood Service participation in directed donation for other than medical indications requires that:

   1. There is reasonable likelihood that the intended recipient will need transfusion with the blood product in the particular circumstance outlined in the request.

   2. This circumstance is planned to occur within a single defined episode of care, with a reasonable expectation of a finite predicted requirement for blood products.

   3. Other alternatives to homologous transfusion from anonymous donors are either not appropriate or not available to the recipient.

   4. The potential donor satisfies all Blood Service homologous donor selection criteria.

   5. The potential donor is known to be ABO and Rh(D) compatible with the intended recipient.

   6. The potential donor is:

      • either the parent (or guardian) of a child up to the age of 18 years who is the intended recipient

      • or an existing blood donor (donated in the last two years) who has donated at least twice.

5. If the directed donor is also related to the recipient the donation must be irradiated to prevent Transfusion graft-versus-host disease (TGVHD).

   • This, however, does not prevent the formation of antibodies against the donor cells, which can occur even when the donor has the same major blood groups and is closely related to the patient.

     • This could complicate future directed donations as well as transplants of bone marrow or organs.

   • Directed donation from a man to his wife or female de facto partner of child-bearing age is not recommended due to the possibility of the recipient forming antibodies which could seriously affect a future pregnancy.

For further information about directed donation, please call 13 14 95 and ask to speak to a Blood Service Medical Officer.