Assessment of the Impact of Notification of Blood Donors Testing Positive for Microbiology Markers: What is the Psychological Impact of Notification and Does the Method of Notification Influence the Outcome?

The purpose of the study is to assess the impact of notification of blood donors testing positive for microbiology markers for blood-borne and (mostly) currently incurable infections (hepatitis B, hepatitis C, HIV, HTLV and vCJD). Specifically, the study will focus on donors' responses to being notified of an infection or possible infection, and their satisfaction with the notification process. The data collected will be used to examine predictors of satisfaction and thus help inform notification procedures in the future.

In the UK, all donations are unpaid and voluntary, which is considered to be the safest method of blood collection (WHO Global Database on Blood Safety (GDBS) and Blood Safety Indicators). Out of the 1.9 million UK blood donations in 2008, only 187 (>0.01%) tested positive. With such low incidence and focus on blood safety, the deferred donor management is largely informed by anecdotal evidence and historical developments. The notification process is standardised within each blood service (e.g. NHSBT Management of Donors with Confirmed Positive Microbiological Markers, MPD/MED/009/05), but has never been evaluated in a systematic study. Worldwide, only a handful of studies have approached the issue (Tynell et al, 2007; Kleinman et al, 2004), but have suggested that donors can experience confusion and anxiety as a result of notification. It is therefore possible that current notification procedures do not adequately address the donors' needs.

A recent in-depth qualitative study of the impact of notification of possible increased risk of variant Creutzfeldt-Jacob Disease (vCJD) for public health purposes (Elam et al, awaiting publication) found that notification was a shocking event in most subjects' lives, although it did not have a lasting emotional impact. Several factors influenced how well information given at notification was retained and implemented. As it is anticipated that all blood donations are to be screened for vCJD as soon as a test becomes available, the need for the development of optimal notification procedures was identified. The proposed study builds on those findings.

Blood donors comprise a unique population, usually characterised by high altruism, low risk-taking, conservatism and concern with health (Simmons et al., 1993; Burnett, 1981). For those reasons, notification of serious infection could cause them greater distress, experience of stigma and self-image damage than an average person (Jackson, 2005; Orsini, 2002; Schulte, 2002; Murray, 1990), and therefore should be handled with utmost care.

Currently, blood donations in the UK are routinely tested for syphilis, hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV) and human T-lymphotropic virus (HTLV). Additionally, if indicated by donor history, supplementary tests for malaria, T-cruzi, cytomegalovirus (CMV), and West Nile virus (WNV) are performed. For the purposes of the study, only donors notified of positive test results of routine screening will be surveyed. Those testing positive for syphilis will not be included because of the universally curable nature of the infection.