Removal of UK-donor deferral for variant Creutzfeldt–Jakob disease: A large donation gain in Australia

In Australia, from December 2000 until discontinuation in July 2022, Lifeblood indefinitely deferred people who spent more than 6 months in the United Kingdom during the variant Creutzfeldt–Jakob disease (vCJD) risk period, 1980–1996 to mitigate the potential blood safety risk.

Regulatory approval to discontinue the deferral was supported by published mathematical modelling that concluded cessation of the deferral would still result in a negligible blood safety risk^[1].

The modelling also predicted that the increase in eligible donors associated with ceasing the deferral would result in an estimated increase of almost 58,000 donations annually.

Cessation of the UK deferral in Australia has resulted in gains over the first 6 months of almost 68,000 donations, substantially exceeding modelled predictions. The additional newly eligible, successful UK donors made a substantial contribution to supporting local blood sufficiency at a time when donations were below Lifeblood’s total internal targets due to multiple factors including COVID-19 pandemic impacts.

There are a number of possible reasons for the underestimation of the predicted number of newly eligible donors. An important model assumption was that the newly eligible population would donate at the same rate as the general population, but the data demonstrated a higher donation rate. This may be due to variety of reasons including;

• People who had in fact spent less than 6 months may have answered ‘yes’ if they were unsure of the time in the United Kingdom. 
• Blood donation^[2] is associated with higher socio-economic status and the UK donor cohort may represent a relatively high socio-economic group of targeted skilled migrants^[3]. 
• A higher level of initial donation commitment among the substantial proportion who had previously been regular donors and had been unexpectedly subject to a new indefinite deferral, which prematurely halted their eligibility to donate. 
• Other contributing factors likely include the efforts made to directly contact deferred donors and a robust media campaign^[4].

The removal of the UK deferral has had a substantial positive impact on the Lifeblood donor base and contributing significantly to our ability to maintain blood product supply during a challenging period. Furthermore, the additional plasma donations support plasma for fractionation targets aiming to improve self-sufficiency for plasma-derived blood products.

_{1. McManus H, Seed CR, Hoad VC, Kiely P, Kaldor JM, Styles CE, et al. Risk of variant Creutzfeldt-Jakob disease transmission by blood transfusion in Australia. Vox Sang. 2022;117:1016–26.}

_{2. Duboz P, Cunéo B. Impact of socioeconomic status on blood donation. Transfus Clin Biol. 2009;16:371–8.}

_{3. Sumption M. The Australian points-based system: what is it and what would its impact be in the UK? Oxford: The Migration Observatory, University of Oxford; 2019. Available from: https://migrationobservatory.ox.ac.uk/resources/reports/the-australian-points-based-system-what-is-it-and-what-would-its-impact-be-in-the-uk}

_{4. McManus H, Seed CR, Law M. People who lived in the UK in the ‘mad cow disease’ years may now be able to give blood. The risk ofvCJD is tiny. The Conversation. 2022. Available from: https://theconversation.com/people-who-lived-in-the-uk-in-the-mad-cowdisease-years-may-now-be-able-to-give-blood-the-risk-of-vcjd-is-tiny-183521}