Safe blood comes from safe donors. In Malaysia, blood is procured from voluntary, non-remunerated blood donors.  Blood donor selection criteria is in place to ensure that only blood donors who meet the criteria are eligible to donate blood. An individual who does not meet the blood donor selection criteria will be deferred from blood donation. Blood donation deferral is a precautionary measure taken to protect the blood donor during the blood donation process as well as patient who received the transfusion. Globally, blood donor deferral rates vary from one blood centre to another, ranging from 5 to 25%.

What is blood donation deferral?

It basically means disqualification from donating blood and it can occur at registration, during pre-donation testing, pre-donation interview, during the donation itself or after blood donation.

How long is the deferral period ?

The period of deferral depends on the specific reason for disqualification. There are two types of deferral period : (i) temporary deferral and  (ii) permanent deferral.

A temporary deferral period can be as short as 1 day to as long as 2 years, whereas a permanent deferral means that the donor is disqualified from blood donation indefinitely.

What are the causes of temporary deferral?

Some of the common causes are low haemoglobin level, low or high blood pressure, underweight (less than 45 kg), taking medications (e.g. antibiotics, aspirin), immunization, certain medical conditions (common cold or upper respiratory tract infection etc ), minor or major surgical operation and procedures (e.g. dental procedures, tattoo, acupuncture).

Each year, about 15 to 20% of blood donors are deferred in Pusat Darah Negara as well as throughout the country, Majority of whom are temporarily deferred (90%.) The commonest reasons for temporary deferral are low haemoglobin level, followed by high blood pressure and low blood pressure.

What are the causes of permanent deferral?

Blood donors can be permanently deferred due to medical conditions or due to their life style which is considered as high risk groups. Blood donors with certain medical conditions such as cancer, bleeding disorders, heart diseases are not allowed to donate their blood as this process will potentially affect their well being and are permanently deferred. High risk groups (individuals with multiple sex partners, intravenous drug users, sex workers and exposure to sex workers, men who have sex with men) are permanently deferred because of the risk of transmitting transfusion transmitted diseases.

Individuals who have visited or resided in the United Kingdom (England, Northern Ireland, Wales, Scotland, the Isle of Man, Channel Island) for a period of 6 months or more from 1st January until 31st December 1996 required them to be permanently deferred. This deferral is necessary to reduce the risk of possible transmission of variant Cruetzfeldzt-Jacob Disease (vCJD) , the human form of “mad cow disease”. 

This also applies to individuals who have visited or resided in Western Europe (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Holland, Iceland, Republic of Ireland, Italy, Liechtenstein, Luxembourg, Norway, Portugal, Spain, Sweden, Switzerland) from 1980 until now for a period of more than 6 months.

About 10% of blood donor deferrals are permanent deferral. Majority of the permanent deferrals are due to high-risk behavior and a travelling history to United Kingdom or Europe. .

Can I self-defer?

Yes. Blood donor selection criteria is displayed at the registration counter of each blood donation drive organized by  Pusat Darah Negara or any collection centre as well as also available in the Pusat Darah Negara website.
Self-deferral is a process in which an individual who identifies him or herself as potentially carrying a higher risk of a transfusion transmissible disease and who chooses not to donate blood for some reasons. Individuals who belong to one of the high-risk groups above are encouraged to self-defer to ensure the safety of blood supply.

What if I still insist on donating blood despite not being eligible to donate blood?

An individual who does not meet the blood donor selection criteria (e.g. low haemoglobin level, low blood pressure) may end up with an adverse donor reaction such as headache, dizziness or fainting. An individual who has been temporarily deferred is advised and encouraged to return for blood donation after the deferral period.

An individual who engages in high-risk behavior may potentially transmit HIV, Hepatitis B, Hepatitis C or syphilis to a blood transfusion recipient if the individual donates during the window period.  This is because blood testing will not detect the infection during a window period donation, and the donated blood will be used for transfusion, infecting the recipient.

What if I choose not to disclose the truth or important information such as high-risk behavior so that I can continue to donate blood?

A blood donor who chooses not to disclose important information such as high-risk behavior is doing himself or herself and the safety of blood supply a disservice. Each blood donation can save up to three lives.  A blood donation during the window period can potentially infect up to three different patients following the blood transfusion.

A high-risk blood donor should understand the risks posed to recipients and that the donor has an ethical responsibility to the recipient. Any blood donor who is found to have made false declaration pertaining to his or her high-risk behavior can be prosecuted in court under the existing laws.

Finally, it should be emphasized that blood donation is a privilege, not a right and it is the right of every blood transfusion recipient to receive safe blood.

What is the implication of blood donor deferral on blood donors and on the blood supply?

Temporary deferral negatively affects blood donor return and subsequent blood donation.  Studies have shown that donors who have been temporarily deferred are less likely to return to donate blood compared to non-deferred donors.  It is important that temporarily deferred donors are properly counseled and given the appropriate advice so that they will return after the deferral period to donate blood.

Permanent deferral could affect a donor psychologically, sometimes leading to feelings of rejection, confusion, shock, disbelief, fear, anger, stigmatization or loss in a donor. It must be stressed again that the purpose of donor deferral is to protect the safety of the blood donor and the blood recipient.  Deferral of blood donors is carried out in the best interest of the blood donor as well as the blood recipient. Understanding this will make it easier for a blood donor to accept the deferral, either temporary or permanent.  Permanently deferred donors will be counseled appropriately and professionally by trained staff so that they understand the reason they are being permanently deferred and also so that they can accept the reason of deferral.

Blood donor selection criteria are also regularly reviewed to improve the selection criteria and to prevent unnecessary donor deferral.

Where to get more information?

Blood donor eligibility criteria is available in the Pusat Darah Negara website. Readers are advised to visit www.pdn.gov.my to find out more about the blood donor selection criteria.

The blood donation deferral can be found in the Transfusion Practice Guidelines For Clinical And Laboratory Personnel which is available at the Pusat Darah Negara  website.