Donor Counselling

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

Outlines of the Presentation Need for counselling Predonation information Predonation counselling Post donation – Confirmation of test results – Donor notification – Information and Counselling

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

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

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 – donor’s rights and responsibilities – donor safety – the procedure of blood donation – need for regular donations – tests done on blood

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

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?

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?

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?

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?

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?

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

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

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

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

Confirmation of Test Results

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?

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

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

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

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

Benefits to Donor Clinical support for the donor Clinical support for infected contacts Preventive measures for uninfected close contacts Protection of community

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

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

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

Donor Notification and Counselling

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

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

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

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

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

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

Post-donation Counselling (3) Important in promoting health maintenance Negative results: ensuring regular donations in donors with negative results helps them to stay uninfected

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

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?

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

Stages in Blood Donor Counselling

Blood Transfusion Services Partner NGOs University Teaching Institutions Medical and Nursing College Students & Staff Sports Organisations HIV Counselling Centres Networking of Existing Facilities

WHO Learning Material on Counselling

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

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