Re-examining blood donor deferral criteria relating to injecting drug use

Brendan Quinn; Clive Seed; Anthony Keller; Lisa Maher; David Wilson; Michael Farrell; Sharon Caris; Jennifer Williams; Annie Madden; Alexander Thompson; Joanne Pink; Margaret E Hellard

doi:10.1016/j.drugpo.2017.05.058

Re-examining blood donor deferral criteria relating to injecting drug use

Int J Drug Policy. 2017 Oct:48:9-17. doi: 10.1016/j.drugpo.2017.05.058. Epub 2017 Jun 27.

Authors

Affiliations

¹ Burnet Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. Electronic address: brendan.quinn@burnet.edu.au.
² Australian Red Cross Blood Service, Australia.
³ Kirby Institute, University of New South Wales, Australia.
⁴ Burnet Institute, Melbourne, Australia; Kirby Institute, University of New South Wales, Australia.
⁵ National Drug & Alcohol Research Centre, University of New South Wales, Australia.
⁶ Haemophilia Foundation Australia, Australia.
⁷ Australian Injecting & Illicit Drug Users League, Australia.
⁸ St. Vincent's Hospital, Melbourne, Australia.
⁹ Burnet Institute, Melbourne, Australia.

PMID: 28666205
DOI: 10.1016/j.drugpo.2017.05.058

Abstract

Background and aims: Potential Australian blood donors are deferred indefinitely if they report a history of injecting drug use (IDU), or for 12 months if they report having engaged in sexual activity with someone who might have ever injected. Given incremental improvements in blood safety, this study sought to examine whether Australia's IDU-related eligibility criteria reflected current scientific evidence, were consistent with international best practice and, if current IDU-related policies were to be changed, how this should happen.

Methods: An expert committee was formed to review relevant literature with a focus on issues including: the epidemiology of IDU in Australia and key transfusion-transmissible infections (TTIs) among Australian people who inject drugs (PWID); and, 'non-compliance' among PWID regarding IDU-related blood donation guidelines. International policies relating to blood donation and IDU were also reviewed. Modelling with available data estimated the risk of TTIs remaining undetected if the Blood Service's IDU-related guidelines were changed.

Results: Very few (<1%) Australians engage in IDU, and IDU risk practices are reported by only a minority of PWID. However, the prevalence of HCV remains high among PWID, and IDU remains a key transmission route for various TTIs. Insufficient data were available to inform appropriate estimates of cessation and relapse among Australian PWID. Modelling findings indicated that the risk of not detecting HIV becomes greater than the reference group at a threshold of non-admission of being an active PWID of around 1.8% (0.5-5.1%). Excluding Japan, all Organisation for the Economic Co-operation and Development member countries permanently exclude individuals with a history of IDU from donating.

Conclusion: Numerous research gaps meant that the study's expert Review Committee was unable to recommend altering Australia's current IDU-related blood donation guidelines. However, having identified critical knowledge gaps and future areas of research, the review made important steps toward changing the criteria.

Keywords: Blood donation; Review; Risk modelling.

Publication types

Review

MeSH terms

Australia
Blood Donors*
Drug Users*
Guideline Adherence
Guidelines as Topic
Humans
Internationality
Prevalence
Risk-Taking
Sexual Behavior / statistics & numerical data
Substance Abuse, Intravenous / complications*
Substance Abuse, Intravenous / epidemiology