Directed blood donation in pediatric general surgery: Is it worth it?

Purpose: To date, there are no data to support the safety, efficacy, and cost-benefit ratio of donor-directed blood donation (DD). The objectives were to determine whether a DD program in pediatric general surgery practice is justified. Methods: A retrospective analysis was conducted of the transfusion practice and all DD requests received by transfusion services in a full calendar year (1997) at a tertiary care pediatric hospital. The authors examined the donations, utilization, and possible benefits for the recipients. Results: A total of 22,527 units of blood were transfused in 1997. General surgery used 471 (2%) of the total and 471 of 4,825 (10%) of all surgical transfusions. Total DD requests were 219 with only 11 of 219 (5%) originating from the general surgery department. After all the exclusions, 133 of 219 (61%) requests had DD blood available. DD blood had a higher true-positive rate for transmissible disease (1.1% v 0.10%), high-risk activity (2.5% v 1.2%), and malaria risk (3.1% v 0.31%). Total utilization of DD blood was 132 of 236 units (55.9%) and general surgery utilized 4 of 11 (36.4%) of their directed donations. Thirty-seven patients (27.8%) benefited from decreased donor exposure. No general surgery patient received more than 1 blood component to benefit from decreased donor exposure. Conclusions: DD deferral rates are higher than for volunteer donors for infectious disease markers, malaria, and high-risk activities. There is no evidence that DD is safer than volunteer donation. DD blood wastage of 63.6% is much higher than in volunteer donation (7%). Thirty-seven patients (28%) received multiple units from one donor suggesting a benefit from decreased donor exposure. Given the low frequency of transfusion and the poor utilization of DD in general surgical practice, a DD program is not justified.