Paid platelet donors: Points to consider

Is there a case that are medically urgent, periodic platelet shortages, and will they increase in the future? Does overall demand exceed supply how is this managed? Should it be surprise shortages occur for 5-day dated blood component, most vulnerable to bacterial contamination resulting sepsis, which requires regular commitment on part of highly dedicated donors supply? Will platelets as our population ages, without new strategies, providers able keep up with demand? A recent article Transfusion1 suggests constrained argues paying younger would availability. Here, we discuss suggestion context unpublished data donor motivation hospital perceptions about paid donors. We also other options stabilizing availability platelets. suggest currently insufficient information support wide-scale implementation apheresis program many decades maintaining volunteer system. The American Red Cross (ARC) conducted six focus groups three unique markets (Tulsa OK-rural; Boston MA-urban; Portland OR-suburban), surveyed 8000 current potential understand their experience motivations donating during 5-month period 2018–2019. results indicate reasons fundamentally altruistic personal. total 91% respondents stated continue donate way give back community 71% because something special not everyone can do. Overall, do differ from those whole They share desire help or specific patient populations (e.g., cancer patients). However, was predictor donation frequency. And, only 21% indicated incentives were important very experience, 18% said lead them platelets, fewer than 15% lapsed (absence within prior 24 months) motivate again. Instead, prefer social forms recognition certificates, annual recognition, “wall fame”). Comfort convenience identified more drivers ongoing donation. Our studies retention frequency closely tied incentives. Donors supported enhancement including improved hours operations locations, professionalism staff increased appreciation donor. In short, survey findings determined motivated by altruism financial rewards. ARC sought opinions hospitals regarding use This May–July 2019 included 104 urban/suburban rural decision makers, 30 whom interviewed greater detail. participants did see need change practice, although recognized some instances exceeds supply. Approximately 40% routinely confront challenges; however, rarely involves delayed withdrawn care. Further, often struggle fulfillment state have trouble an adequate products. Only readily accept any conditions. One-quarter opposed citing safety reasons, impact donors, increases price 23% specifically stating products routine needs. Additionally, 24% believed clinical differences between majority (78%) require pathogen reduction before using platelets; 9% reduction. Paid used “last option” 53% respondents, while 32% benefits stable outweigh risks. Some suggested suppliers try resorting different recruitment efforts making aware used). Experience has shown grown independent Platelet transfusions 16% 2017 collectors pace.2 Blood adjusted adding collections sites, expanding operation collection devices existing centers, optimizing split rates, reducing outdates, dedicating marketing recruit base grew 14% December 2020. Importantly, 20–54 year–old age group constituted 60% that, under 35-year old segment approximately 39% base. As result, production since 2016; each month 4000 reactivating 800 (internal data); conclude yet its capacity. Furthermore, 6.4% over 3 years ending September 2019. result COVID-19 pandemic associated convalenscent plasma programs, seen influx strong, return 46% conversion first-time repeat 30%, further growth especially among Stubbs et al.1 acknowledge evidence lacking suggesting compensating may lower costs efficiencies collectors. safeguards inherent needed ensure both cannot underestimated. management standards qualifying applicant but limited ensuring community-based residency cross-donation substantial investment coordination. Ample evaluation feasibility required assessment given. addition, if implemented, particularly just portion donations, ethical legal considerations determine patients notified source informed consent process. consider fundamental challenge across country lack rather short shelf life, normally 5 days. problem exacerbated testing all pathogen-reduced shortening life 3.5 Extension dating 7 days dramatic considering much additional consumed process testing.3 noted al.,1 factors affecting could considered, such changes dose, random pathways resolution these issues unclear. payment donations consequences upon non-remunerated aspects collection. briefly address below. Given platelet's inevitable issue product outdates contributes shortages. Most want freshest available scheduled orders. expectation remains even periods low inventory, 1–1.5 being transfused. 2017, NCBUS reported 165,000 (7.1%) units outdated inventories, 179,000 (9.7%) outdated.2 Although outdate rate dropped due inventory management, remain significant contributor Managing challenging smaller, hospitals. mitigate expiration, again, benefit qualified additive solution platelets); thus, challenge.3 variability requirements major issue. Not needs vary daily, addition segmented ABO type attributes irradiation CMV seronegativity. With upcoming mitigations FDA's final guidance platelets,3 at least two types been tested large volume sampling reduced. Maintaining one outdates. set products, creating perceived should FDA-licensed system obviates seronegative irradiated thus facilitating management. Exacerbating difficulties changing intention when obtained. If derived indeed relegated mostly constraints, diminished. challenged terms planning, predicting managing discreet emergency complexity, wastage costs, limit improvement cold-stored (CSP) resolve problems areas, CSP might bleeding patients, prophylactically represents Thus, challenges attendant complexities centers. Compounding ambiguity fact 11.7 million red cells collected US 20172 via donations. Financially incentivizing negatively potentially cannibalize well possibly loss al. case1 based donors,4 applicable coexistence program. demographics subset incentive negative consequences. There question compatibility center World Health Organization ethos around donors; runs counter philosophy country. Indeed, recent, comprehensive review Chell clearly shows no consistent establish efficacy payment, cash payments, environment US.5 Nor effects payments long time. does, report compensation selflessness drives key recommendation controlled trials usefulness promote Notably, introducing Comprehensive validation extensive input resources into compromise attitudes of, willingness give, confidence Carefully designed surveys providers, academic operational studies, either self-funded appropriate contract grant support. al.,5 research examining broader variety define reward schedules encourage habit. contention, subsequent analysis, meaningful, Financial contribute loyal, repeating does nothing contributors (i.e., segmentation). For industry struggling achieve solvency, implementing necessary safeguards, recovered fees. summary, found act where importantly Over half viewed last option nearly quarter refusing them. Internal programs realistic number mechanisms, examine behavior enabling strong moving forward. unknown troubling donate, create concern supply, along analyses, optimization consideration PY serves medical advisory board Fresenius Kabi. Creative Testing Solutions. SLS Scientific Advisory Board Hema-Quebec RYD Research Committee Canadian Services.