Blood donor selection is a critical component of a safe and effective transfusion service. Over the past several decades, the transition from paid professional donors to voluntary, non-remunerated blood donors, particularly regular repeat donors, has contributed significantly to the safety and sustainability of the blood supply. [1,2] Blood donation is a voluntary process in which individuals come forward to donate blood without financial remuneration. However, not every individual presenting for donation is eligible to donate. Prospective donors undergo a structured selection process that includes a donor questionnaire, medical history, physical examination, and haemoglobin estimation to determine their suitability for blood donation.[3] Donor selection criteria are based on scientific evidence, medical expertise, and regulatory requirements and are intended to safeguard the health of both donors and recipients. They also play an important role in minimizing the risk of transfusion-transmitted infections and other adverse events. In India, the criteria for selection and deferral of blood donors are governed by the Drugs and Cosmetics Act, 1940, and the associated rules, along with applicable standards and technical guidelines for blood banks and transfusion services. [4,5] Thus, pre-donation donor screening remains an important, effective, and economical measure for ensuring blood safety. Blood donor deferral, although essential for protecting donors and recipients, can have an unintended impact on the donor pool. Temporary or potentially preventable deferrals may discourage individuals from returning for future donation and can adversely affect donor retention. [6,7] Consequently, blood centres need to balance stringent donor-selection criteria with appropriate counselling and follow-up strategies to ensure that eligible donors who have been temporarily deferred are encouraged to return when the cause of deferral has been resolved. The pattern of donor deferral varies across regions and populations because of differences in demographic, socioeconomic, cultural, and health-related factors. Previous studies from different parts of India have reported considerable variation in overall deferral rates and in the relative contribution of causes such as anaemia, hypertension, medical history, medication use, alcohol intake, and other temporary or permanent conditions.[8,9] Understanding the local pattern of donor deferral is therefore important for identifying potentially preventable causes and developing appropriate strategies for donor recruitment, counselling, retention, and re-entry into the donor pool. Despite its importance, donor deferral data are not always systematically evaluated at the institutional or regional level. Analysis of the reasons for deferral can provide useful information for targeted donor education, appropriate medical referral, and follow-up of temporarily deferred individuals. Such measures may help reduce avoidable temporary deferrals and encourage eligible donors to return for subsequent donations. The present study was undertaken to analyse the rate and pattern of blood donor deferral and to identify the various causes of temporary and permanent deferral among blood donors at a tertiary care hospital. The study also aimed to facilitate appropriate counselling, referral, and follow-up of temporarily deferred donors, with the objective of improving donor retention and encouraging their return for future blood donation. OBJECTIVES 1. To determine the rate and pattern of blood donor deferrals among individuals presenting for blood donation. 2. To identify and analyse the various causes of blood donor deferral, including temporary and permanent causes. 3. To facilitate appropriate counselling, referral, and follow-up of temporarily deferred donors, with the aim of addressing correctable causes and improving their eligibility for future blood donation.

A retrospective observational study was conducted in the Blood Centre, Raichur Institute of Medical Sciences Teaching Hospital, Raichur, over a period of two years, from October 2019 to September 2021. All individuals presenting for blood donation at both indoor and outdoor blood donation sites during the study period were included. Relevant information regarding donor eligibility and reasons for deferral was retrieved retrospectively from blood donor records and registers. Donor deferrals were categorized as temporary or permanent based on the underlying cause. The overall donor deferral rate and the distribution of various causes of deferral were analysed and expressed as frequencies and percentages. Temporary deferral causes were further assessed to identify potentially correctable factors and facilitate appropriate counselling, referral, and follow-up of deferred donors to encourage their return for future blood donation.

A total of 9,184 blood donors registered for blood donation during the study period, comprising 8,940 (97.34%) males and 244 (2.66%) females (Table 1) were considered. Among the registered donors, 260 (2.83%) were deferred (Table 2), of whom 180 (69.2%) were temporarily deferred and 80 (30.8%) were permanently deferred. Although the absolute number of deferred donors was higher among males (194; 74.6% of all deferred donors) than females (66; 25.4%), the proportion of donors deferred within each sex was considerably higher among females (27.05%) than males (2.17%) (Table 3). Temporary deferral (180; 69.2%) was more frequent than permanent deferral (80; 30.8%). Among temporary deferrals, anaemia was the most common cause (Table 4), whereas hypertension was the predominant cause of permanent deferral (Table 5). TABLE 1:DEMOGRAPHICS OF THE DONOR GENDER REGISTERED BLOOD DONORS DEFERRED PERCENTAGE OF TOTAL REGISTERED DONORS DEFERRED MALE 8940 194 2.11% FEMALE 244 66 0.72% TOTAL 9184 260 2.83% TABLE 2: FREQUENCY OF TEMPORARY AND PERMANENT DEFERRALS TYPE OF DEFERRAL DEFERRALS PERCENTAGE DEFERRED PERCENTAGE OF TOTAL DONORS (9184) DEFERRED TEMPORARY 180 69.2% 1.95% PERMANANT 80 30.8% 0.88% TOTAL DEFERRED 260 100% 2.83% TABLE 3: FREQUENCY OF DEFERRAL AMONG MALE AND FEMALE DONORS GENDER NO OF BLOOD DONORS DEFERRED PERCENTAGE OF DEFERRED MALE 8940 194 2.17% FEMALE 244 66 27.04% TABLE 4: CAUSES OF TEMPORARY DEFERRAL CAUSES NUMBER OF DEFERRAL PERCENTAGE OF TEMPORARY DEFERRAL (%) PERCENTAGE OF TOTAL DEFERRAL (for 260) ANAEMIA 90 50% 34.6% LOW WEIGHT 25 13.9% 9.6% MEDICATION 15 8.3% 5.8% INFECTIONS 13 7.2% 5.0% ALCOHOL INTAKE 10 5.6% 3.8% RECENT DONATION 10 5.6% 3.8% FEVER 09 5.0% 3.5% TATOO 03 1.7% 1.2% MENSTRUATION 02 1.1% 0.8% RECENT SURGERY 02 1.1% 0.8% BREAST FEEDING 01 0.5% 0.3% TOTAL 180 100% 69.2% TABLE 5: CAUSES OF PERMANENT DEFERRAL CAUSES NUMBER OF DEFERRAL PERCENTAGE OF TEMPORARY DEFERRAL (%) PERCENTAGE OF TOTAL DEFERRAL (for 260) HYPERTENSION 40 50% 15.4% UNCONTROLLED DIABETES MELLITUS 15 18.7% 5.8% ASTHMA/COPD 10 12.5% 3.8% CARDIAC DISEASES 08 10% 3.1% LIVER DISORDER/HEPATITIS 05 6.3% 1.9% EPILEPSY 02 2.5% 0.8% TOTAL 80 100% 30.8%

The present study analysed the pattern and causes of blood donor deferral among 9,184 blood donors over a period of two years. A total of 260 donors (2.83%) were deferred, of whom 180 (69.2%) were temporarily deferred and 80 (30.8%) were permanently deferred. The overall deferral rate observed in the present study was relatively low compared with several previously published studies. Chenna et al. reported a donor deferral rate of 5.6% in a tertiary care hospital, while Sundar et al. reported a rate of 5.84% in a South Indian setting. [10,11]. Shrivastava et al. also demonstrated variation in donor deferral patterns in a tertiary care hospital and emphasized the importance of donor selection and deferral analysis as components of blood safety.[12] Agnihotri, in a study from Western India, reported an overall deferral rate of 11.6%.[13] Such variations may be attributed to differences in geographical location, demographic characteristics, donor recruitment strategies, socioeconomic factors, and institutional donor-selection practices. In the present study, temporary deferrals (69.2%) were considerably more common than permanent deferrals (30.8%). This observation is consistent with previous studies. Sundar et al. reported that temporary causes constituted the majority of donor deferrals in their South Indian study.[11] Chenna et al. also observed a predominance of temporary deferrals and highlighted their potential impact on the available donor pool.[10] Similar observations have been reported by Shrivastava et al., emphasizing that a substantial proportion of deferred donors may potentially return to the donor pool after resolution of the temporary cause.[12] The predominance of temporary deferral in our study is therefore important from the perspective of donor retention, as these donors should not necessarily be considered permanently lost. Anaemia was the leading cause of temporary deferral in this study, consistent with findings from other Indian studies. Sundar et al. identified low haemoglobin as a major cause of donor deferral in South India,[11] while Agnihotri reported it as the predominant cause in Western India.[13] Chenna et al. likewise found low haemoglobin to be the principal deferral criterion in a tertiary care hospital.[10] Its consistent prominence across Indian populations indicates that anaemia is an important, potentially preventable cause of donor loss. Nutritional education, appropriate medical evaluation, and follow-up after treatment may enable eligible donors to return for future donation. In the present study, males constituted most of the donor population and consequently accounted for a greater absolute number of deferred donors. However, the proportion of deferred donors among female donors was substantially higher than that among male donors. Similar sex-related differences have been reported by Sundar et al. and Agnihotri, with female donors showing higher deferral rates, particularly because of low haemoglobin and other eligibility-related factors.[11,13] Chenna et al. also reported a higher proportion of deferral among female donors.[10] In our study, females constituted only 2.66% of the total donor population, and therefore the sex-specific findings should be interpreted in the context of the markedly lower representation of female donors. Hypertension was the most common cause of permanent deferral in the present study. Hypertension has also been identified as an important cause of donor deferral in previous studies. Sundar et al. reported hypertension among the causes contributing to donor deferral, while Chenna et al. also identified hypertension as an important deferral criterion.[10,11] Shrivastava et al. emphasized the importance of identifying medical conditions during donor screening, as appropriate donor selection protects both the donor and recipient.[12] Detection of elevated blood pressure during donor screening may additionally provide an opportunity for the donor to undergo further medical evaluation and appropriate management. The findings of the present study demonstrate that donor deferral patterns vary between populations and geographical regions. Differences in demographic characteristics, nutritional status, prevalence of medical conditions, lifestyle factors, donor awareness, and recruitment practices may contribute to this variation. Chenna et al. emphasized the implications of deferral patterns for the donor pool and the need to develop strategies for donor retention.[10] Sundar et al. similarly highlighted the importance of understanding local patterns of donor deferral in order to improve blood donor recruitment and retention.[11] Shrivastava et al. emphasized that analysis of donor selection and deferral patterns is an important tool for maintaining blood safety.[12] Agnihotri's findings from Western India further support the observation that the causes and magnitude of donor deferral differ according to regional characteristics.[13] The study by Aneke et al. from South-East Nigeria provides an international perspective on donor deferral and demonstrates that donor deferral is a relevant issue across different healthcare settings.[14] Although direct comparison with the present study should be made cautiously because of differences in geographical, demographic, regulatory, and healthcare contexts, the study reinforces the importance of systematically evaluating prospective donor deferrals and their underlying causes. An important implication of the present study is that temporary donor deferral should not necessarily result in permanent loss of a potential donor. Appropriate counselling at the time of deferral, clear explanation of the reason for deferral, medical referral where necessary, and follow-up after the recommended deferral period may facilitate re-entry of eligible donors into the donor pool. This is particularly relevant in cases of anaemia and other potentially correctable causes

Blood donor deferral is an essential component of the donor selection process and plays an important role in ensuring the safety of both donors and recipients. The present study highlights the importance of systematically analysing donor deferral patterns to identify the common causes and potentially preventable factors responsible for donor loss. Since a considerable proportion of deferrals are temporary, appropriate counselling, medical evaluation, referral, and follow-up can help address correctable causes and encourage eligible donors to return for future donation. Regular assessment of local deferral patterns can assist blood centres in developing effective donor recruitment, retention, and re-entry strategies, thereby contributing to a safe, adequate, and sustainable blood supply.

1. Davey RJ. Recruiting blood donors: Challenges and opportunities. Transfusion 2004; 44:597‑600. 2. 2. Domen RE. Paid‑versus‑volunteer blood donation in the United States: A historical review. Transfus Med Rev 1995; 9:53‑9. 3. James V. Blood donor selection and qualification: Selection and Testing. In: Barbara J, Regan F, Contreras M, editors. Transfusion Microbiology. Cambridge University Press; Cambridge, 2008;153‑7. 4. Drugs and Cosmetic Act. Available from: http://www.cdsco.nic. in/writereaddata/DrugsandCosmeticAct.pdf. 5. Standards For Blood Banks & Blood Transfusion Services, National AIDS Control Organisation, Ministry of Health and Family Welfare, Government of India, New Delhi; 2007. Available from: http://www.naco.gov.in/upload/Final%20Publications/Blood%20Safety/Standards%20for%20Blood%20Banks%20and%20Blood%20 Transfusion%20Services. 6. Brecher ME. AABB Technical Manual. 15th Edition. Bethedsa: AABBpress; 2005; 101. 7. Custer B, Chinn A, Hirschler NV, Busch MP, Murphy EL. Theconsequences of temporary deferral on future whole blood donation. Transfusion. 2007; 47(8):1514-23. 8. Bahadur S, Jain S, Goel RK, Pahuja S, Jain M. Analysis of blooddonor deferral characteristics in Delhi, India. Southeast Asian J Trop Med Public Health. 2009; 40(5):1087-91. 9. Chaudhary RK, Gupta D, Gupta RK. Analysis of donor-deferralpattern in a voluntary blood donor population. Transfusion Med 1995; 5(3): 209-12. 10. Chenna D, Shastry S, Murugesan M, Baliga PB. Implication of deferral pattern on the donor pool: Study at a Tertiary Care Hospital. Journal of Applied Hematology. 2015 Jul 1;6(3):111. 11. Sundar P, Sangeetha SK, Seema DM, Marimuthu P, Shivanna N. Pre-donation deferral of blood donors in South Indian set-up: An analysis. Asian journal of transfusion science. 2010 Jul;4(2):112. 12. Shrivastava M, Shah N, Navaid S, Agarwal K, Sharma G. Blood donor selection and deferral pattern as an important tool for blood safety in a tertiary care hospital. Asian journal of transfusion science. 2016 Jul;10(2):122. 13. Agnihotri N. Whole blood donor deferral analysis at a center in Western India. Asian journal of transfusion science. 2010 Jul;4(2):116. 14. Aneke CJ, Ezeh UT, Nwosu AG, Anumba EC. Retrospective evaluation of prospective blood donor deferral in a tertiary hospital-based blood bank in South-East Nigeria. Journal of Medicine in the Tropics. 2016 Jul 1;18(2):103