Compensated-donor model ‘could be a long-term solution’ to blood, platelet shortages
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A year ago, American Red Cross declared the first-ever national blood crisis amid a surge in the omicron variant of COVID-19.
As 2023 begins, much of the country continues to experience blood and platelet shortages, according to Joseph Cho, MD, PhD, vice president of medical affairs at Secure Transfusion Solutions (STS).
“Platelet shortages are negatively impacting care,” Cho told Healio. “A national survey showed that around half of all high-volume transfusion hospitals experience supply challenges once or more a month. The consequence of these supply challenges includes delayed surgeries and outpatient transfusions.”
Although the effort to recruit volunteer blood donors is a key component of generating these much-needed blood components, Cho and his colleagues have been investigating an increasingly relevant model of platelet donation: compensation of donors.
“We’re here to help increase the supply of available blood components — we don’t want to take away from the great work that is happening with volunteer blood donation,” Cho said. “We’ve reimagined the blood donation experience, because we’re interested in capturing a new audience of people who aren’t donating today.”
Cho discussed data on the feasibility and safety of a compensated-donor model and emphasized the need to appeal to a new generation of potential blood donors.
Healio: Why did you decide to compensate donors?
Cho: We compensate our donors not necessarily for their platelets — it’s actually appreciation for their time. It takes anywhere between 2 and 3 hours to donate platelets. There is time spent getting to the donation center, making sure the individual passes the screening tests, completing questionnaires and a physical exam, donating the platelets and recovering after donation with some snacks and refreshments while sitting down and resting a bit before they leave.
Having the time to donate is actually a privilege — whether because of a job with flexible hours, you’re retired or you happen to have the luxury of leisure time. So, the question becomes whether platelet donation can be incentivized in a way that breaks down the frictional barriers of not having available time so that more people have the opportunity to participate. Our goal with compensating donors is to open up the donation experience to a wider audience and encourage repeat participation in this altruistic act.
Healio: How do you ensure that these paid donations are safe?
Cho: We have two main strategies that help ensure the platelets we collect and supply to hospitals are of the highest safety standard. The first is our rigorous donor selection process. We have a screening process that involves testing for infectious diseases on at least two occasions prior to qualifying someone as a donor. Typically, our donors are recruited through social media advertising, where they fill out a lead form that culminates in being invited to one of our centers for a prescreen visit. The prescreen visit entails all the qualification steps of a donation visit, except instead of platelets being collected, only a blood sample is drawn. If all testing comes back negative, that individual is invited back to our collection center a minimum of 21 days after the date of the prescreen visit to make their first donation. On the return visit, the individual will once again undergo all required donor screening and provide a blood sample for infectious disease marker testing. They will then be permitted to proceed with the donation process. Only if the infectious disease marker testing at that second visit comes back negative do we allow the platelets collected to be processed and distributed for transfusion.
The 21-day interval between the prescreen visit and the first donation is not arbitrary. It is based on the “window period” risk for hepatitis B, which is about 3 weeks with nucleic acid testing. The window period risk for hepatitis C and HIV are shorter than for hepatitis B. So, our process of becoming a donor is quite stringent. To date from our initial blood center, Trusting Heart Blood Center in Edina, Minnesota, we’ve had zero positive test results for infectious disease markers from our qualified donor pool.
Our second strategy involves the use of pathogen-reduction technology for all platelets we supply for transfusion. The technology we employ is FDA-approved and widely used in the industry, providing an additional layer of safety against both known and unknown blood-borne pathogens.
Healio: How might this compensated model help ease the platelet shortage in the long term?
Cho: When you look at the issues we face right now with the blood supply — chronic blood shortages and issues with platelet availability — you have to ask yourself, “Why is this happening?” The answer is we have a donor base that is not growing. In fact, the donor base is aging and the voluntary system is increasingly reliant upon older donors.
Blood utilization is no longer decreasing like it did over the past 15 years, and platelet utilization continues to increase. We’ve made some great progress with patient blood management and better adherence to transfusion guidelines. However, these measures have limits and don’t address the underlying problem, which is a lack of growth in the donor pool, especially with adding younger donors.
We’ve found that our model attracts younger donors — the average age for donors at our Edina, Minnesota, center is in the low 40s. In contrast, other blood collection organizations report the main cohort of platelet donors are in their mid-60s. Our compensated-donor model is attracting a new demographic that isn’t being engaged by the voluntary donor system, which is exciting because it demonstrates that our model potentially could be a long-term solution to the blood and platelet shortages we currently face.
Healio: Do compensated-donor models pose a threat to nonprofit blood collection?
Cho: The goal of our model is to augment the existing supply. We’re here to provide a solution to the blood crisis. Compensated donation is not about taking away from the great work that nonprofit blood collection organizations are doing. It’s about providing additional support for patients who need blood and platelets.
It’s estimated that the percentage of the U.S. population eligible to donate blood ranges between 30% to 60%, yet less than 3% donate. We are using a different approach to reach a demographic other than the 3% of people who currently donate under the voluntary system. By expanding the donor pool, we believe compensated-donor models like ours can provide solutions to the current challenges we face with blood and platelet shortages.
For more information:
Joseph Cho, MD, PhD, can be reached at Secure Transfusion Solutions, 111 Congress Ave., Suite 500, Austin, TX 78701; email: jcho@securetransfusion.com.
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Cho JH, et al. Initial experience of a for-profit blood center collecting apheresis platelets indicates feasibility and safety. Presented at: Association for the Advancement of Blood & Biotherapies Annual Meeting; Nov. 6-7, 2022 (virtual).
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