Post donation confirmation, notification and counselling

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Donor Counselling

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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

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Outlines of the Presentation

• Need for counselling
• Predonation information
• Predonation counselling
• Post donation
• Confirmation of test results
• Donor notification
• Information and Counselling

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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

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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

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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
• donors rights and responsibilities
• donor safety
• the procedure of blood donation
• need for regular donations
• tests done on blood

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Pre-donation Information (2)

• TTI and how can they be avoided
• Donor confidentiality
• High risk behaviour
• Voluntary self-exclusion
• Confidential unit exclusion (CUE)
• Alternate testing sites
• Window period

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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?

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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?

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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?

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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?

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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?

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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

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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

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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

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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

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• Confirmation of Test Results

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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?

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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

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Confirmation

• Why - needs, benefits
• Where - specific competent laboratory
• How - methods, interpretation

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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

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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

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Benefits to Donor

• Clinical support for the donor
• Clinical support for infected contacts
• Preventive measures for uninfected close contacts
• Protection of community

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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

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Where

• Dependent upon size and level of
• development of the country
• National regulatory or public health laboratory
• Regional laboratory
• Accredited/reputed private laboratory

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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

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• Donor Notification and Counselling

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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

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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

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Positive Test Result

• Given in person, never on telephone
• Maintain confidentiality
• Opportunity to ask questions / discussion
• Fresh sample for additional confirmation
• Further appointment offered

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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

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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

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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

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Post-donation Counselling (3)

• Important in promoting health maintenance
• Negative results
• ensuring regular donations in donors with
  negative results
• helps them to stay uninfected

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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

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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?

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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

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Stages in Blood Donor Counselling
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Networking of Existing Facilities
University Teaching Institutions
Partner NGOs
Blood Transfusion Services
Medical and Nursing College Students Staff
HIV Counselling Centres
Sports Organisations
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WHO Learning Material on Counselling
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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

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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