The Blood Service regularly reviews and updates as required the donor interview and selection process, taking into consideration local and overseas research studies, international best practice, literature reviews and analysis of surveillance data such as included in this report.

Conclusion 2 – Higher prevalence of transfusion-transmissible infections in first time donors.

The Blood Service focuses on education of all donors, particularly first time donors including providing a specific blood safety brochure highlighting the pivotal role of accuracy and honesty in answering the standard questionnaire.

In accordance with state/territory laws, there are penalties including fines and imprisonment for anyone providing false or misleading information.

While every effort is made to maximise donor retention, there is a fundamental requirement for continuing recruitment of new donors: firstly, to replace existing donors who can no longer donate (e.g., due to age and/or medical ineligibility) and, secondly, to meet the growing demand for some blood products.

The Blood Service considers the current proportion of first time donations (8% in 2013) to be acceptable, noting that this proportion is in the lower range among internationally comparable blood services (8–25%).

Conclusion 5&6 – Non-compliance

Non-compliance to screening questions remains an ongoing concern despite existing donor education initiatives targeting the importance of complete accuracy and honesty in answering the donor questionnaire. As noted, it is pleasing that the results of the national survey showed a comparatively low rate of non-compliance (in the range 0.05 to 0.29%) among TTI test-negative donors for several sexual activity-based donor deferrals. While it is reassuring that Australian rates are lower than comparable overseas rates, the Blood Service remains committed to seeking further improvement.

One potential strategy to improve compliance is optimising the communication of the rationale underpinning deferral policies. The Blood Service has established an expert advisory panel to make recommendations in this regard and several initiatives to improve communication have already been progressed. These include optimising the use of social media and developing new and refining current education resources. Furthermore, the study identified a correlation with non-compliance and concerns over ‘privacy’ of disclosure which might be partially alleviated by the use of a ‘computer-based’ donor questionnaire. The Blood Service has initiated a comprehensive project to improve the donor assessment process including investigating the feasibility of a ‘computer-based’ donor questionnaire. Its implementation though is dependent on a successful validation and risk assessment prior to implementation.

Conclusion 7 – Donation for the primary purpose of seeking TTI testing.

Test-seeking –that is donating for the purpose of being tested for TTIs, poses an avoidable risk to the blood supply given the availability of free sexually-transmissible infection (STI) testing in Australia. While the rate of test seeking identified in the Blood Service compliance study was low and at the lower end of international estimates, our goal is to further reduce this rate. The association of test-seeking with non-compliance among male donors suggests that test seeking could be reduced as a direct consequence of minimising non-compliance – so the strategies outlined above seeking to minimise non-compliance also address test seeking. Another focus is improving donor education materials to highlight the risk posed by test seeking, particularly by first time donors.

Conclusion 9 – Bacterial testing of platelets

Bacterial testing of platelets is one of a number of complementary strategies implemented by the Blood Service to reduce the risk of transfusion-associated sepsis. The decreasing rate of reported sepsis since 2008 (with only a single case in 2012) supports the conclusion that these strategies have incrementally reduced the risk to blood recipients.

Routine follow-up of culture-positive donors continues to identify undiagnosed infections with potentially serious health impact. This not only reinforces the operational importance of this process but also highlights the ‘public health’ contribution of donor screening.

Conclusion 10 – Surveillance for emerging infections

The Blood Service maintains surveillance for emerging infections through close liaison with Government communicable disease control units, CSL Behring, membership of international medical/infectious disease groups and active horizon scanning. Potential threats are regularly reviewed by the Blood Service Donor and Product Safety Advisory Committee and Clinical Governance Committee and risk assessment performed in the event that a threat is identified as a clear and present threat to the safety of the blood supply. Where appropriate, this will be performed in collaboration with CSL Behring (in their capacity as national plasma fractionator) and the Therapeutic Goods Administration (TGA).