Donor Counselling
Teaching Aims
You should learn to counsel the donor so as
to
– Enhance blood safety and donor care
– Minimise blood wastage
– Reduce HIV sero-prevalence in donated blood
– Promote the development of healthy donor pool
– Facilitate life styles changes and behaviour
modification in donors
– Result in a safe and adequate blood supply
Outlines of the Presentation
• Need for counselling
• Predonation information
• Predonation counselling
• Post donation
– Confirmation of test results
– Donor notification
– Information and Counselling
Need for Donor Counselling Programme
• Absence of a programme on counselling of
blood donors, deprives them
– of their right to know their health status and
plan behaviour modifications
– an opportunity to the donor to self-exclude
from donation
– to clarify myths and misconceptions
– to understand the consequences of Transfusion
Transmitted Infections
Objective of Pre-donation Information &
Counselling
• To increase donor awareness
• of TTI, route of transmission, prevention
• of the fact that their blood is tested for TTI
• of the implications and possible consequences of
that process
• To discourage blood donations
• by self-deferral of people coming only for testing
• among people who may have history of risk
behaviour
Pre-donation Information
(1)
• Written or oral information given to blood donors
before donation
• May be given by donor recruitment staff,
teachers, mass media
• Information on
– donor’s rights and responsibilities
– donor safety
– the procedure of blood donation
– need for regular donations
– tests done on blood
Pre-donation Information
• TTI and how can they be avoided
• Donor confidentiality
• High risk behaviour
• Voluntary self-exclusion
• Confidential unit exclusion (CUE)
• Alternate testing sites
• Window period
(2)
Pre-donation Queries
(1)
• Will I feel weak after donation?
• How much of my blood will be taken at time
of donation?
• Is there any risk to me?
• Will it be painful?
• What is a suitable age for blood donation?
• What should I eat and drink before and after
blood donation?
Pre-donation Queries
(2)
• I am very busy and have no time to go and
donate blood.
• I am very weak. Can I donate blood?
• What is a high-risk behaviour?
• Is blood donation totally safe?
• I am anaemic. Can I donate blood?
Pre-donation Queries
(3)
• If I am on long term treatment for epilepsy
/hypertension/diabetes/asthma/autoimmune
disorder, am I fit to donate blood?
• What is the benefit I get from donating blood?
• I am AB positive, do you really need blood of
this blood group?
Pre-donation Queries
(4)
• Nobody ever asked me to donate blood
earlier.
• Where do I go to donate blood?
• What if I feel faint after donating blood?
• What can I do after giving blood?
• Can I go back to work after blood
donation?
Pre-donation Queries
(5)
• Where does my blood go after blood
donation? Is it properly used?
• Why is voluntary regular blood
donation important?
• How often can I give blood?
Giving Pre-donation Information
• When
• Donor should not donate blood under pressure
• one-to-one or group talks
• By whom
• BTS- trained educator/social worker/counsellor
• volunteer recruiter
• approved mass media material
• Skills
• knowledge of blood needs and procedures
• communication
Pre-donation Counselling
(1)
• Counselling provided to potential donors in privacy
before blood donation
• Explanation of the tests done and the reasons for
testing
• Securing informed consent for donation and testing
• Possible consequences of learning negative/positive
test results
• Need to stay uninfected if negative results
• Availability of post donation counselling, testing care
and support agencies
Pre-donation Counselling (2)
•
•
•
•
•
Discourages donations from unsafe donors
Provides an opportunity to self-exclude from
blood donation
Clarifies myths and misconceptions
Increases existing knowledge of donor about
TTI and safe blood donation
Informs donors on testing for TTIs
Giving Pre-donation Counselling
• Activity
• review donors understanding of blood
donation and TTI
• assess personal risk history
• discuss possible results of TTI
• When
• just before donation
• By whom
• donor care staff
Confirmation of Test Results
The Screening of Blood
• Primary responsibility to the patient
– primary screening
– is the donation safe to issue?
• Secondary responsibility to the donor
– confirmatory testing
– is the donor truly infected?
Outcomes
• Primary testing
– negative screen results - suitable for issue
– repeatable reactive on screen - discard blood,
confirm status of donor
• Confirmatory testing
– negative - reinstate donor according to policy
– positive - permanently defer donor and counsel
– indeterminate - further investigation needed
Confirmation
• Why - needs, benefits
• Where - specific competent laboratory
• How - methods, interpretation
Why Confirm?
To find out if the donor is truly infected
• Benefits to BTS
– minimise wastage of blood
– understanding of routes of transmission
• Benefits to donor and family
– clinical intervention
• Benefits to community
Benefits to BTS
• Minimise wastage of blood
– donors may be deferred unnecessarily and
subsequent donations lost
• Understanding of modes of transmission
• risk factors for donors
•
Understanding of donor comprehension and
perception
• why did an infected donor donate
• in improving donor selection procedures
Benefits to Donor
•
Clinical support for the donor
•
Clinical support for infected contacts
• Preventive measures for uninfected close
contacts
• Protection of community
Where
• ICTC/Independent competent laboratory
• Experienced and has expertise
• Reliable and consistent
• Acceptable turn-around times
• Provides clear and accurate reports
• Can provide clinical advice when required
Where
Dependent upon size and level of
development of the country
• National regulatory or public health laboratory
• Regional laboratory
• Accredited/reputed private laboratory
Confirmation
• Confirmation of screening results:
– minimises wastage of donors
– ensures clinical intervention when needed
– helps improve donor selection procedures
• Confirmation performed by ICTC for HIV
• Developing a suitable algorithm is vital
– start with alternative assays rather than blots
Donor Notification and Counselling
Donor Notification
Why should the donors be informed of test
results
• Results are significant to their health
• Results prevent use of blood, unethical to
hold information
How to Notify Donors
• Follow NACO/NBTC policy on how to notify
donors about positive TTI
• Tell the results on a face-to-face basis
• Counsellor - well-trained in counselling skills
• Refer the donor to other sources of advice and
support
Positive Test Result
• Given in person, never on telephone
• Maintain confidentiality
• Opportunity to ask questions / discussion
• Fresh sample for additional confirmation
• Further appointment offered
Post-donation Information & Counselling
• Post-donation information
• avoiding future transmission
• healthy living
• risk-reduction for others
• Counselling
• advice on location for family counselling and
testing
• advice on follow up and referral
Post-donation Counselling
(1)
• Interview to discuss results and their
significance
– identify risk
– understand why donor donated
– advice to partner
• Defer donor of acute HBV infection
permanently
Post-donation Counselling
(2)
•
Ethical duty of care towards the donors
•
Information on serological status
•
Support for donors in dealing with test results
•
Assistance in planning behaviour modifications
•
Referral for health care follow up
Post-donation Counselling
(3)
• Important in promoting health maintenance
• Negative results:
• ensuring regular donations in donors
with negative results
• helps them to stay uninfected
Why Counsel?
• Inform the donor
About HBV & HCV positivity and malaria & refer the
donor to physician/hepatoloigst who will explain the
pathology, secondary transmission, treatment and
management and other modes of infection.
Donors with positive test for syphilis may be referred
to STD clinic.
• Ensure no further donations
• General surveillance and epidemiology
• acute infection (WP), to improve test
Impact on Blood Donors
• What will the test result mean?
• Will I become ill?
• What about my partner / offspring?
• Am I infectious?
• How did I become infected?
• Is infection treatable?
Counselling for Positive Results
• Prepares the donors for changes in their health
condition and to help them to come to terms with
the disease
• May need help in deciding what to tell their family,
friends and colleagues
• In planning a different lifestyle
• Need to be informed about the dangers of
transmitting the infection to other people and how
to avoid this
Stages in Blood Donor Counselling
Networking of Existing Facilities
University
Teaching
Institutions
Partner
NGOs
Medical and
Nursing College
Students & Staff
Blood
Transfusion
Services
Sports
Organisations
HIV
Counselling
Centres
WHO Learning Material
on Counselling
Essential Features in Counselling
• Adequate time for counselling
• Provision of accurate and consistent
information to donors
• Maintenance of donor confidentiality
• Availability of facilities and trained
counsellors
• Donor acceptance
Learning Outcome
The counseled donors get aware of
 The need of enhanced Blood safety
 Of the importance of blood donation and they would
co-operate to avoid wastage of blood
 Of the importance of sero-prevalence of HIV/HBV & HCV and
therefore would take care to remain non-infected by these
infections
 They would help promote the development of healthy donor
pool
 They get inclined towards adaptation of healthy life style &
behavior to facilitate donation of safe blood in adequate
quantity