The Impact of Donor Recruitment Strategy on Blood Safety: A Comparative Analysis of non-remunerated versus directed donors

Abstract

Background: Blood transfusion safety relies heavily on healthy donor selection. While voluntary non-remunerated donation is the gold standard, patient attendants in regions like Pakistan still frequently choose directed donors for immediate transfusion needs.

Objective: To compare the hematological and serological profiles of non-remunerated and directed donors.

Methodology: This cross-sectional study. Place and Duration of Study: Department of Hematology and Transfusion Medicine, The Children’s Hospital and UCHS Lahore, and the Sundas Foundation Lahore, from August 2024 to December 2024. Hematological parameters (hemoglobin and platelets) were analyzed via complete blood count (CBC) on an automated BECKMAN COULTER cell counter. Serological screening for Transfusion-Transmissible Infections (TTIs) was performed via chemiluminescence. Continuous data were analyzed using independent sample t-tests and Pearson’s correlation coefficient (r), while categorical variables were evaluated using the Chi-Square test via IBM SPSS 23 software.

Results: A total of 150 donors were recruited (75 non-remunerated, 75 directed) with a mean age of 29.47 ± 6.705 years. Non-remunerated donors exhibited a slightly higher mean hemoglobin level (14.5 ± 1.34 g/dL) than directed donors (14.2 ± 1.38 g/dL), though this difference was not statistically significant (p = 0.086$). However, non-remunerated donors had a significantly higher mean platelet count (287.1 ± 61.8 x 10?/L) compared to directed donors (245.8 ± 59.01 x 10?/L; p < 0.001). Pearson correlation showed a weak but statistically significant positive correlation between hemoglobin and platelet counts across the cohort (r = 0.175, p < 0.05). Directed donors demonstrated significantly higher positivity rates for Hepatitis C Virus (HCV: 9.33% vs. 1.33%, p = 0.029) and Malaria (13.33% vs. 2.67%, p = 0.016) compared to voluntary donors. Differences for HBV, HIV, and Syphilis were not statistically significant (p > 0.05).

Conclusion: Non-remunerated blood donors present with superior hematological indices and significantly lower viral/parasitic marker rates. Patient families must be actively counseled regarding the inherent clinical risks associated with directed donations.