The ethics of wasting the donor’s gift of buffy coat

Dear Editor, Schrezenmeier and Seifried [1] observed that – albeit rare – donor reactions with plateletapheresis collections can be more frequent ⁄ severe compared with whole-blood collections. They then argued that – because all platelet transfusion needs of patients not alloimmunized to HLA antigens can be met by pooling (already-available) buffy coats from the whole-blood donations – donor reactions to any plateletapheresis collections represent an ‘additional’ (hence unnecessary and hard to justify) risk. As Table 1 shows for the US [2], any country with a North-American ⁄ Western-European health-care system requires several times more red-blood-cell (RBC) than platelet or fresh frozen plasma (FFP) doses to meet the needs of all its transfusion recipients. Modern apheresis technology permits blood operators to collect large-size units of plasma, as well as ‘double’ RBCs, in addition to single-donor platelets. Furthermore, it allows blood operators to collect RBCs along with platelets and ⁄ or plasma [3, 4]. Thus, modern apheresis technology could enable national blood services to provide for all of a country’s RBC, platelet, and plasma needs by subjecting a number of donors to the rare risks of donation, which would not exceed the number of donors bled today by the same blood services to produce components from whole-blood collections. Importantly, and in contrast to the historical literature on donor reactions reviewed by Schrezenmeier and Seifried [1], this modern approach to meeting all of a country’s needs should not be associated with any increase in donor reactions. In the largest reported multivariate analysis of moderate and severe donor reactions, Kamel et al. [5] observed no increase in donor reactions following each of three types of apheresis collections compared with wholeblood donation (Table 2). Even if donor reactions were higher with plateletapheresis (compared with whole-blood) collections in Germany today [1], the rights of transfusion recipients supersede any rights of donors who have given informed consent for the procedure and are aware of its risks [6]. The duty of national blood operators in countries with North-American ⁄ Western-European health-care systems is to maximize the safety and efficacy of all transfused blood components for the benefit of transfusion recipients. Although Schrezenmeier and Seifried [1] correctly assess that – based on the available data – the efficacy of buffy-coat PWBD vs. single-donor platelet concentrates does not differ, there is a ‡ 2-fold difference in the safety of the two components with regard to emerging transfusion-transmitted infections; and, in countries that use platelets from first-time wholeblood donors in buffy-coat pools, a ‡ 2-fold difference in the risk of human immunodeficiency virus, hepatitis C Table 1 Number of therapeutic doses of each blood component transfused in the US in 2006