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Safe Donors1. Safe DonorsIntroductionTransfusion is blood and blood components is associated with an inherent risk of transmission of blood-borne infections. Therefore, it is very important for a blood transfusion service to ensure a safe blood supply to the patients. Assuring safe blood supply requires a multifaceted approach. All efforts should be undertaken to make blood transfusion as safe as possible. There are certain important strategies to prevent the transmission of infections through blood. Safe Donors Safe donors are the 1st line of defence for transfusion safety. Voluntary, non-paid, regular blood donors are the cornerstone for a safe blood supply. Strategies to prevent transmission of infections through blood: * Safe donors * Safe blood for transfusion * Safe blood products and viral inactivation procedures * Appropriate and rational use of blood * Effective quality assurance Strategies for developing a source of safe donors: 1. Establishment of a programme for voluntary blood donors The first and the foremost step in maintaining a safe blood supply is the recruitment of safe donors. Voluntary blood donors or self-motivated donors provide the best sources of safe blood. 2. Donor education and information * High risk behavior * Self-exclusion * Window period * Safe to donate blood * Confidential unit exclusion (CUE) * Alternate testing sites Donor education and information is very vital to recruit safe donors. This can be provide through verbal dialogue, leaflets or posters. Donors should be informed of various high risk behavior e.g. heterosexual or homosexual promiscuity, intravenous drug abuse, etc. The donors should be asked to self-exclude themselves from donation if they are practicing a high risk behavior. In addition, they must be educated about window period during which they may be the carriers of HIV infection but may not have developed the antibodies. Donors must be informed that it is absolutely safe to donate blood and each time a sterile, disposable lancet and collection set must be used for blood collection. It is very important to exclude donations from those at risk of infection with I-IIV or other blood borne diseases. However, if a donor with a high risk behavior is under pressure to donate, he can confidentially indicate to the physician after the donation to discard his collected blood unit and not use it for any patient. This approach is known as confidential unit exclusion (CUE). Donors must be informed of alternative HIV testing laboratories for voluntary I-lW testing and must be asked not to exploit the blood transfusion services to know their HIV status, as the donor may be practicing a high risk behavior and may donate an unsafe unit of blood. 3. Stringent criteria for donor selection * Exclusion of donors practicing to a high risk behavior e.g. homosexual or heterosexual promiscuous, promiscuity, intravenous drug abuse or STD patient * Exclusion of donors with signs and symptoms suggestive of AIDS d.g., progressive weight loss, prolonged fever, persistent diarrhea, recurrent infections. etc. Stringent and critical donor selection criteria is a good approach for proper donor screening. The criteria include a brief history taking, physical examination and preliminary laboratory testing (haemoglobin/haematocrit) based on which donors are deferred or selected. Any donor with history of practicing high risk behavior or with signs and symptoms suggestive of AIDS should be permanently debarred. 4. Development of voluntary donor registry It is extremely necessary to have trained donor recruiters or social workers who would develop a source of safe donors by creating a registry of voluntary blood donors. 5. Encouragement of replacement donors to become voluntary donors Donor recruiters can also help in encouraging the healthy family members to become voluntary, regular blood donors.
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