Investigators in Canada have published a paper in Vox Sanguinis describing the importance of the donor notification process for transfusion-transmissible infections and reporting data on the experience of Canadian Blood Services (CBS) from 2006-2022. The researchers explained that, “all donors with positive confirmatory results for any infectious disease marker are notified by registered letter of their result. In addition, donors positive for human immunodeficiency virus (HIV) and West Nile virus are notified by telephone, and at the discretion of a CBS medical officer, donors with other infections may also be contacted by telephone. The notification letter and corresponding explanatory and supplementary information are specific to the test results. Generally, donors are informed that they are ‘very likely’ infected with the specific agent.”
The authors noted in their description of the CBS donor notification process that, “[f]rom 2005 to 2013, 12 weeks were allowed following a confirmed positive test donation before contacting donors, and thereafter eight weeks. Donors were invited by letter to participate in an interview about the risk factors. A trained interviewer from a research company (Decision Point Research) then contacted the donor by telephone to arrange a time. [The] first set of questions asked the donor whether they had been told after their last donation that they had a positive test for an infectious disease. If donors answered affirmatively, they were asked which one, what their initial reaction to this news was, whether they consulted a physician, and whether public health contacted them after they were informed. All questions were open ended. The donor’s age, sex, donation status, and region of residence were obtained from the CBS donor records to compare participants from non-participants.”
During the study period evaluating the donor notification process, 2,654 donors were notified of a positive hepatitis B virus (HBV), hepatitis C virus (HCV), human T-cell lymphotropic virus (HTLV), or syphilis test and invited to participate. The researchers noted that, “[o]f these, 876 (33 percent) donors participated in the interview [with] 786 (90 percent) [indicating] that they had been informed of their positive test result. However, about a quarter stated that either their infection was something other than what it was or they did not know which infection they had been notified of. Most donors went to a physician after being notified (80–90 percent by infection). About two-thirds of donors with HBV or HCV said they were contacted by public health, slightly fewer (58 percent) with syphilis and only 27 percent of those with HTLV.”
The study of the notification process of donors found that, “[w]hen all 876 donors with positive test results who participated, including those who said they did not have a positive infection result are considered, 678 (77 percent) said they had consulted a physician about their positive test. When donors were asked what their reaction had been to learning that they had a positive blood transmissible infection result, most were surprised and some were sad and disappointed.”
Additionally, the authors of the paper noted that, “[o]ver 17 years of surveying donors notified of positive test results for HBV, HCV, HTLV and syphilis, we report that after being notified by the blood service, most donors in the study were aware that they had tested positive for a blood transmissible infection, although not always able to correctly identify which one. About three-quarters followed the advice in the letter to consult a physician. Fewer said that they had been contacted by public health.”
The investigators of the donor notification process concluded that, “[o]ur results indicate that after notification most donors were aware that they had a positive test, but not all. As the letter was sent by registered mail to the donor’s home, and as we were able to contact the donor afterwards, the notification letter should have been received, although this could not be verified. That some donors denied knowing they had a positive test is perplexing. The letter may have been received by someone else in the household and never reached the donor. The donor may not have understood it or was in denial. It is possible that the donor was aware but did not want to admit to the interviewer because there is stigma associated with blood-borne infections. That some donors said they were notified but were unsure of which infection suggests imperfect communication. [Qualitative] interviews with donors post-notification may be helpful to identify specific actions that could be taken to improve the notification process and subsequent action. Although all donors are notified by registered letter (sometimes also by telephone) as per standard operating procedures, and public health is notified of all confirmed positive tests as required by law, the donor-centric clinical outcome is unknown. It appears that some donors — for a variety of reasons—do not follow the recommended advice to consult a physician. A potential area of further [i]nquiry arising from this analysis is to collaboratively explore with provincial public health authorities whether there are opportunities to increase the proportion of donor follow-up after public health notification of a confirmed positive test result for a reportable disease.”
Citation: O’Brien, S.F., Naicker, K., Osmond, L. et al. “Notification of blood donors who test positive for transfusion-transmissible infections.” Vox Sanguinis. 2025.