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# Surgery - Whole blood and components

## Essential information

Definition/s

  Recovery from surgery:

  Donors can be considered to be recovered if they:

  - Are well
  - Are back to activities of daily living (e.g. housework, employment, driving)
  - Have regained mobility

  Major surgery:

  For the purposes of donor selection, any surgical procedure where recovery is not achieved within 2 months.

Obligatory

  Must not donate if:

  1. For malignancy or other condition that would preclude donation.
  2. All wounds are not healed.
  3. There are signs or symptoms of any infection.
  4. Not recovered.
  5. Less than 4 months from major surgery.
  6. Less than 7 days from other surgery.
  7. Less than 4 months from any flexible endoscopic procedure.
  8. Requiring post-operative treatment or follow-up, except routine physiotherapy.
  9. Received a transfusion since 1 January 1980.
  10. Waiting for surgery that is:
      1. Expected to occur within 3 months, or
      2. Required due to possible malignancy.
  11. Less than 3 months from a surgical procedure performed outside of the UK and Republic of Ireland (ROI).
  12. Less than 7 days after completing postoperative prophylactic anticoagulant treatment.
Discretionary
  1. If all other criteria are met and the donor has received a metal-on-metal hip replacement even if being monitored for blood chromium or cobalt levels, accept.
  2. If the donor is waiting for surgery that is not required for possible malignancy, and:
     1. The procedure is not expected to take place within 3 months, or
     2. The procedure is minimally invasive and it is not expected to take place within 1 month, accept.
  3. If the donor has recovered from surgery within the UK and ROI, and:
     1. It is more than 4 months since major surgery, or
     2. It is more than 7 days since any other form of surgery, and
     3. It is more than 4 months since a flexible endoscopic procedure, and
     4. There was no malignancy and the reason for surgery does not otherwise preclude donation, and
     5. The donor did not receive a transfusion since 1 January 1980, and
     6. All wounds are healed, and
     7. There are no signs or symptoms of infection, and
     8. The donor has been discharged from postoperative follow-up, and
     9. The donor does not require ongoing postoperative treatment except routine physiotherapy, and
     10. It is more than 7 days from finishing any anticoagulant treatment given to prevent postoperative thrombosis (e.g. DVT), accept.
  4. If it is more than 3 months since a surgical procedure performed outside of the UK and ROI, and all other criteria for surgery performed within the UK and ROI are met (see 3 above), accept.

## Supporting information

See if relevant
  - Anaesthetic
  - Anticoagulant therapy
  - Cervical dysplasia
  - Disabled donor
  - Dental treatment
  - Endoscopy
  - Eye disease
  - Malignancy
  - Neurosurgery
  - Tissue and organ recipients
  - Transfusion
  - Wounds, mouth and skin ulcers
  - Xenotransplantation
Additional information

  Surgery may cause significant blood loss. It is important that donors waiting for an operation should not be put at risk of anaemia or poor iron stores by donating prior to planned surgery. Unless the type of surgery planned is unlikely to result in significant blood loss, the donor should be deferred until after their planned surgery. This will minimise their own chance of needing a transfusion, which would of course prevent them from continuing as a donor. It is also important not to hinder the recovery of the donor. This requires waiting until they are fully recovered before they donate again.

  This guidance presumes that a validated NAT test for hepatitis C is negative; if this test is stopped, the guidance will change.

  Surgery may place the donor at risk of infection, either from unhealed wounds, or due to infection risks from infected staff or equipment. Although these risks are very small, it is important to wait long enough for the risks to have gone or until the tests performed by the Blood Services can pick up any infection that they test for that may have been transmitted to the donor through their surgery. As there may be uncertainty about these risks for surgery performed outside of the UK and ROI, a deferral period of 3 months is required.

  Minimally invasive surgery includes superficial skin procedures and procedures performed under infiltration with local anaesthetic agents and/or sedation.

  This does not include procedures performed under regional anaesthesia (e.g. spinal, epidural) which may be used where joints and major body cavities may be accessed. The use of general anaesthesia may not indicate the invasiveness of a procedure and should not be used as a substitute to assessment of the donor regarding the procedure and their recovery. Donors can be accepted for donation once it is more than 7 days since a surgical procedure as long as they also fulfil all other criteria. Donors who have had minimally invasive surgical procedures are unlikely to have systemic effects from the surgery requiring recovery time. However, care should be taken to ensure that all wounds are dry and healing. An open wound is a risk for bacteria entering the blood. Bacteria can be a serious threat to anybody receiving blood or blood components. This is because bacteria can multiply to dangerous levels after collection.

  Donors being monitored for chromium or cobalt levels following a metal-on-metal hip replacement can be accepted for donation.

  Completion of postoperative monitoring, treatment and follow-up should be confirmed for every donor returning to donate. Thromboprophylaxis may be continued, usually for a few weeks only, after discharge from hospital. Donors who are recovered and are attending only physiotherapy appointments for ongoing rehabilitation can be accepted.

Regulatory information

  Part of this entry is a requirement of the Blood Safety and Quality Regulations 2005.

Reason for change:
  The entry has been revised to include a definition of recovery and amendment of the definition of major surgery. The deferral after major surgery has been shortened. Information regarding donor eligibility after non-major surgery has been added. Specific guidance for surgery overseas, donors awaiting surgery and postoperative thromboprophylaxis has been added.
Version details:

  WB-DSG Edition 203 Release 65 (30 August 2022)

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