International Forum 1616747 Vox Sang 1993;65:1-9 How Far Shall We Go in the Predonation Selection of Blood Donors to Safeguard Patients for Blood-Transfusion-Related Infections? Editorial (2) Are the selection criteria the same for all transfusion centres/blood banks in your country? In the respective countries of the experts written information is given to donors to in form them about sexual and other risk behav iour which may effect the safety of their dona tion. Donors have to sign, at every donation, a statement declaring the absence of such risk factors. In some countries in-depth question ing of the donor about possible risk factors is promoted, to assure that the questions are well understood. All transfusion centres in the respective countries are required to fol low minimal guide-lines for the selection of donors. In some countries like Australia local states may require more stringent selection criteria than others. (3) What is your opinion of a self-exclu sion form to select donors? The majority of the authors think that self-exclusion of donors after donation does not increase the safety of the blood supply. A self-exclusion system may even attract indi viduals at risk to the blood centre. Instead of nor population only a fraction of the preva lence rates of the above markers are observ ed as compared to those in the national pop ulation. Several authors suggest that ‘direct questioning' of donors will increase the effec tiveness of the selection. By introducing tests for HCV a high rate of the confirmed positive donors had risk factors [i.e. (past) intrave nous drug abuse] not mentioned by the do nor. To establish the CMV status of a donor, selection criteria are useless. Paid donors in the United States, exclusively used for plas mapheresis, have a definite increased risk for HIV, HBV and HCV, but paid donors in Ger many may not have such an increased risk. (5) Do you think a rewarding system for donors (e.g. providing money, meals or pre sents) has a negative influence on the selec tion of donors? All authors think that small give-aways and incentives do not influence the selection of donors and may promote donor motiva tion. However, most experts are against the financial compensation of lost time or the provision of meals. Some blood centres are against reimbursement of transportation costs, whereas other centres may provide these costs. Concern is expressed about the classifica tion of the blood centre as being a ‘testing agency’ attracting high-risk donors. In Germany a dual system of paid and unpaid donors exists. The German paid do nors are highly selected and, according to our expert, do not have an increased risk for blood-borne infections. H. W. Reesink The prevention of blood-transfusion-re- lated infections is based on (1) the careful selection of blood donors, (2) the testing of donor blood for infectious micro-organisms and (3) the proper handling and storage of blood products in blood centre and hospital before transfusion. The safety of practically all plasma derivatives, prepared from large pools of donor plasmas, is secured by addi tional virus-inactivating procedures. This fo rum deals with the importance of the selec tion of blood donors. It is well known that in most countries the blood donor population differs enormously from the general population with respect to the social-economic status, ethnic back ground and infectious disease markers. For example, the prevalence of HIV infection in blood donors of large métropoles is in various blood centres at least a 100-fold lower than in the general population, illustrating the pow er of selection of blood donors. The main object of donor selection is to avoid so-called ‘open-window’ infections not detected by current screening tests. The ex perts in this forum were asked to give their opinion on several questions regarding the efficacy or counter-productiveness of pred onation selection for blood donors. (1) What are the current predonation se lection criteria for blood donors in your coun try to avoid blood-transfusion-related infec tions in patients? going to alternative sites they use the blood centre for testing their infectious markers! In some countries a self-exclusion system is optional and may be used when the rate of first-time donors is high or when blood is given at the work site where groups of col leagues attend together. (4) How effective are your selection crite ria? All experts agree that selection of donors to avoid the risk of HIV, HBV or malaria infection are very effective. In the blood do ô 1993 S Karger AG, Basel 0042-9U07/93/0651-0001 $2 75/0