February 14 is National Donor Day, recognized since 1998 to raise awareness of the critical importance of organ, eye, tissue, marrow, and blood product donation. The day also serves as a reminder of the nearly 120,000 individuals who are on the national organ transplant waiting list, and of the sobering reality that, on average, 22 people die per day while waiting for an organ transplant. No less critical is the need for blood products, as one in seven people entering a hospital require a blood transfusion. Local health departments (LHDs) across the U.S. help to support blood product, tissue, and organ donation in this country in a variety of roles.
The Role of Local Health Departments
Protecting the safety of the donation supply is the longest-standing role of LHDs, who often issue permits to qualified facilities, monitor errors and accidents at facilities, and ensure donation collection centers have the latest safety guidance available. Coordination between LHDs and donation centers is vital at all times, but becomes especially critical during outbreaks of emerging infectious diseases, such as Zika virus, when additional communication is required to prevent transmission through donated blood products, tissues, and organs.
During the recent emergence of Zika as a public health threat in the Americas, the Centers for Disease Control and Prevention (CDC) emphasized the need for LHDs and blood centers to collaborate in its Zika Response Plan for the Continental United States. The plan encouraged health departments to promptly and directly notify blood centers of any local transmission, and recommended blood centers establish plans to notify health departments in the event of a Zika-positive blood donor, to allow for epidemiologic follow up and investigation
In addition to ensuring the safety and responsiveness of the donation supply against emergent public health threats, LHDs also proactively work to increase the supply of blood products and the number of registered organ donors. The number of individuals on the national organ transplant waiting list continues to grow rapidly, yet the number of registered donors remains nearly the same as it was a decade ago. Since 2004, the number of individuals waiting for transplant has increased by more than 35,000, while the number of registered donors only increased by about 900. Recognizing that 95% of U.S. adults support organ donation, but only 48% are actually registered donors, LHDs are implementing outreach and education campaigns to recruit and register new donors and close that gap.
One example of these proactive efforts around donor recruitment takes place in Fairfax County (VA), where a local coalition called the Commission on Organ and Tissue Donation and Transplantation brings together representatives from healthcare, tissue banks, and local government to coordinate resources in the community; promote awareness of organ and tissue donation and transplantation; educate the community about the donation process; and, increase the number of registered Fairfax County organ and tissue donors. Developing or sharing campaign materials is another way LHDs can support donation, and many resources exist to help create new, locally-tailored materials. Donate Life America has developed a list of resources which includes state-level registry and transplant information, and the U.S. Department of Health and Human Services has a library of print and video resources. Finally, one way to promote donations is by linking potential donors to registry information through your webpage or by providing informational brochures in your facility.
Meeting Local Challenges
Unique local challenges can further complicate donation and exacerbate need. In 2016, the Food and Drug Administration (FDA) temporarily suspended the collection of blood donations in Miami-Dade and Broward Counties as the Florida Department of Health investigated possible cases of local transmission of Zika virus. While this was important in safeguarding the blood supply from possible contamination by Zika virus, it also imposed an additional challenge on collecting donor blood products in an already limited supply. Meeting this challenge required the blood bank to implement additional testing to resume donations, which the Florida Department of Health supported with $620,000 in funding.
The tragic shooting at the Pulse Nightclub in Orlando, Florida in June 2016 further exemplified localized donation challenges. Not only did this horrific event cause an acute need for donated blood products, which the Florida Department of Health in Orange County emphasized in a press release, it also illustrated a missed opportunity for increasing the availability of lifesaving blood products. Many individuals whose loved ones were injured in the shooting, and who desperately wanted to donate blood in response to the urgent need, identify as men who have sex with men (MSM) and were deferred from donating blood for a period of 12 months since their last sexual contact with another man, per FDA regulations.
This time-based deferral policy is a substantive shift from the FDA’s prior indefinite deferral period, but is still functionally indefinite for many MSM, as it bans individuals based on a generalized, identifying behavioral trait rather than specific risk factors. Soon after the Pulse Nightclub tragedy, the FDA opened this issue up for public comment, and NACCHO provided comments which advocated for a transition away from a deferral based on identifying traits and toward individual risk assessments and other options that better capture specific, measurable risk attributes and reduce potential stigmatization and discrimination of individuals.
NACCHO is proud to serve LHDs and commends LHD staff across the country who work on the frontlines protecting the health of communities. LHDs can serve critical roles in ensuring a safe and adequate blood product, tissue, and organ supply, and in increasing the number of blood donors and registered organ donors to help ensure this supply meets the needs of individuals and communities across the country.