Prospective blood donors turned away


In spite of a well publicised shortage
of blood, the Blood Donation Services Department is still turning away many
prospective donors.

Anyone who lived in the United
Kingdom or spent a cumulative time of three months or more there between 1
January, 1980, and 31 December, 1996, is ineligible to donate blood in the
Cayman Islands.

This exclusion affects not only
British citizens but also many Caymanians who might have attended school in the
UK during that time, or even made regular business visits.

The exclusion is in place due to
the possibility of the blood being tainted with variant Creutzfeldt-Jakob Disease.
The disease can be caused by the consumption of beef or beef products tainted
with Bovine Spongiform Encephalopathy, better known as Mad Cow Disease.

Many prospective donors are
questioning whether this ban, or permanent deferral as it is referred to in the
medical community, is really necessary.

According to prospective donor Sarah
Graham, the situation is very frustrating.

“My husband and I have been on
island for 6½ years. Prior to that we were in the UK and were regular blood
donors; a practice that we intended to continue here. We were first turned away
in 2003. Since then every time I have heard of a shortage I have contacted the
donor centre again in the hope that something might have changed,” she said.

The Cayman Islands Blood Bank uses
the standards of the American Association of Blood Banks as its guide for
accepting blood donors, while also including recommendations of the Pan
American Health Organisation.

The selection criteria when it
comes to prospective donors who may be at risk for vCJD seems to be more
relaxed than those of the American Association of Blood Banks, as the organisation
recommends “Individuals with diagnosis of TSE as well as those who received
extract derived from human pituitary gland, dura mater or corneal grafts; those
with family risk of human TSE; those with behavioural risk of vCJD; and those
who received transfusions in the UK from 1980 to 1996 should be deferred as
blood donors”.

However, according to Judith
Clarke, laboratory quality coordinator for the Cayman Islands Health Services
Authority pathology laboratory interprets the term “behavioural risk of vCJD”
to refer to the presence of the prospective donor in the UK or continental
Europe between 1980 and 1996.

According to Ms Clarke, the
deferral is likely to remain in place until the standards change.

“This change would be guided by
scientific evidence,” she said.

At present the incubation period of
vCJD is still unknown, which makes it impossible to predict when the deferral
could be lifted.

“There are people still incubating
the disease and showing no clinical manifestation,” said Ms Clarke.

Although vCJD was originally
thought to have an incubation period of 15 years, which would have made it
possible for the deferral on blood from the UK or Europe to be lifted soon,
research now suggests the incubation period can be up to 30 or even 50 years.

There is no test available to check
for the presence of vCJD in blood.

“We improve wherever we can, but in
terms of finding a test, it is bigger than us,” said Ms Clarke.

Although there have been a very
limited number of cases of vCJD in the United States linked to exposure to BSE,
all these cases are believed to have originated outside the US, with two traced
back to infection taking place in the UK with another believed to have taken
place in Saudi Arabia.

The deferral has had a devastating
impact on the ability of the blood bank to keep blood reserves at an acceptable

“The impact is great as some of our
most faithful donors are from Europe and we hope that one day very soon they
will perfect a test or be able to determine the incubation time,” said Ms

“This deferral is like any other
deferral rule in place to protect the recipients of blood or blood products.
Rules are in place to also protect the blood donor,” said Ms Clarke.

Although the deferral in place for
people who spent time in the UK during the indicated period has the biggest
impact on the local blood bank, there are numerous other deferrals in place.

In fact, the questionnaire that has
to be filled out by prospective donors every time they come in to donate blood
has close on 40 questions on it and answering yes to even one can lead to the
donor being at least temporarily deferred.

These include questions on
medication, travel, country of origin, current health and sexual practices.

In the UK there is concern that the
blood supply may contain some contamination caused by exposure to BSE.
According to a position statement on vCJD, found on the UK Blood Services
website, the UK Blood Services imports fresh frozen plasma from US volunteer
donors for the use in children born after 1 January, 1996.

“The rationale for this cut off
date is that children born since 1996 are considered to have received minimal
exposure to the BSE agent because of the effectiveness of the animal feed ban,
which was fully implemented from 1996 and the exclusion of animals above 30
months entering the food chain,” according to the statement.

Although the risk of a blood
recipient in Cayman contracting vCJD from a blood donor in Cayman would appear
to be remote, Ms Clarke is quite clear on the fact that it is not a change the
local blood bank is willing to take.

“Even that one life, that one
death, we wouldn’t want to risk it,” she said.

Ms Clarke urges any prospective
donors to contact the blood bank to find out whether they would be able to
donate, as the donor pool in Cayman is still woefully short of the number of
donors needed.

According to World Health
Organisation suggestions for a population of Cayman’s size, a pool of 2,600
active donors would be ideal. At present, Cayman has only around 750.

In spite of the shortage of donors,
Cayman is still one of the only countries in the region to have 100 per cent
voluntary donation.

For more information on donating
blood, contact the blood bank at George Town Hospital on 244-2669.


Blood donors are still needed at the Cayman Islands Blood Bank, but they must meet strict criteria to give.
Photo: File