Blood Donation Policies and Transfusion Safety

Blood donation policies worldwide seek to reconcile two fundamental objectives: ensuring a sufficient blood supply and maintaining the highest possible level of transfusion safety. Historic approaches have relied on categorical deferral criteria based on donor group membership or time since potential exposure, but advances in testing technologies and growing awareness of equity issues have prompted a shift towards more nuanced frameworks. Contemporary strategies combine sensitive laboratory assays, notably nucleic acid testing, with detailed donor questionnaires that probe recent behaviours rather than solely demographic categories. This dual approach reduces the residual risk associated with the window period between infection and test detectability, while allowing for more inclusive donor eligibility. At the same time, plasma donation—critical for manufacturing life-saving fractionated products—has emerged as a focal point for policy innovation, with many jurisdictions exploring pilot programmes to broaden access. Ongoing challenges include harmonising deferral practices across regions, addressing perceptions of discrimination among marginalised communities, and ensuring that operational feasibility does not compromise either safety or donor experience. Research increasingly emphasises the integration of individual risk-based assessments, standardised screening tools, and targeted community engagement to support both donor retention and recipient safety on a global scale.

Research from Nature Portfolio

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Blood Donation Policies and Transfusion Safety publication trend

The graph below shows the total number of articles in blood donation policies and transfusion safety across all publications each year (not limited to Nature Index journals).

Technical terms

Deferral period: The prescribed interval during which a prospective donor is temporarily ineligible to give blood, intended to cover the window period of certain infections.

Transfusion‐transmissible infections (TTI): Pathogens such as HIV, hepatitis B and C, and others that can be transmitted through blood products if undetected.

Individual risk‐based screening: Assessment of donor eligibility based on personal behaviours and exposures rather than membership of a broad demographic group.

Window period: The time between acquisition of an infection and its detectability by laboratory tests, during which transmission risk persists.

Plasma donation: The collection of the liquid component of blood, used to manufacture a range of therapeutic products; often subject to distinct eligibility criteria from whole‐blood donation.

References

1. Improved access yet inequitable experience: gay, bisexual and other men who have sex with men’s views of more inclusive criteria for source plasma donation. BMC Public Health (2023).
2. The impact of blood donation deferral strategies on the eligibility of men who have sex with men and other sexual risk behavior in Australia. Transfusion (2024).
3. Acceptability of sexual history questions in a gender‐neutral risk assessment for blood donation. Transfusion (2024).