Medical, Societal, and Ethical Considerations for Directed Blood Donation in 2025

Jacobs, Jeremy W.; Booth, Garrett S.; Lewis-Newby, Mithya; Saifee, Nabiha H.; Ferguson, Eamonn; Cohn, Claudia S.; Delaney, Meghan; Morley, Sarah; Thomas, Stephen; Thorpe, Rachel; Raza, Sheharyar; Weaver, Meaghann S.; Woo, Jennifer S.; Sharma, Deva; So-Osman, Cynthia; Yurtsever, Nalan; Tormey, Christopher A.; Waters, Allison; Goldman, Mindy; Yan, Matthew T.S.; Fasano, Ross M.; Stephens, Laura D.; Allen, Elizabeth S.; Erikstrup, Christian; Infanti, Laura; Schlafer, Timothy D.; Warner, Matthew A.; Winters, Jeffrey L.; Tobian, Aaron A.R.; Bloch, Evan M.

Abstract

In the United States and other high-income countries, blood donation primarily relies on anonymous, voluntary donors. However, directed blood donation—where people donate for a specific recipient—has resurged, particularly due to misinformation surrounding COVID-19 vaccination. Requests for “nonvaccinated” blood, driven by misconceptions about vaccine safety, have led to legislative attempts to mandate compliance. Historically, directed donation was used to mitigate the risk for transfusion-related infections before modern screening techniques rendered it largely unnecessary. Today, it presents important patient safety risks, including increased infectious disease transmission, immunologic complications, and logistic burdens. Directed donations also introduce inefficiencies, diverting resources from the community blood supply and exacerbating shortages. Moreover, directed donation for nonmedical indications lacks scientific justification. Blood safety is ensured through rigorous donor screening, pathogen testing, and processing measures. There is no evidence that blood from vaccinated donors poses risk. Requests for nonvaccinated blood, as well as other directed donation preferences based on personal beliefs, introduce biases that are not grounded in medical necessity. Accommodating such requests undermines public trust in blood safety protocols and legitimizes unfounded fears. Ethical concerns arise as non–medically justified requests reinforce discriminatory practices, such as selecting donors based on race or gender. Allowing such preferences risks politicizing blood donation, spreading misinformation, and straining health care systems. Although autonomy is a core ethical principle in medicine, it does not justify non–evidence-based interventions. Given the potential harm and societal impact, directed blood donations should be limited to rare, medically necessary cases. Ongoing legislative efforts to mandate these requests require unified opposition from the medical and scientific community to uphold ethical, evidence-based, blood allocation practices.

Citation

Jacobs, J. W., Booth, G. S., Lewis-Newby, M., Saifee, N. H., Ferguson, E., Cohn, C. S., Delaney, M., Morley, S., Thomas, S., Thorpe, R., Raza, S., Weaver, M. S., Woo, J. S., Sharma, D., So-Osman, C., Yurtsever, N., Tormey, C. A., Waters, A., Goldman, M., Yan, M. T., …Bloch, E. M. (in press). Medical, Societal, and Ethical Considerations for Directed Blood Donation in 2025. Annals of Internal Medicine, https://doi.org/10.7326/annals-25-00815

• Journal Article Type: Article
• Acceptance Date: Mar 25, 2025
• Online Publication Date: May 13, 2025
• Deposit Date: May 13, 2025
• Publicly Available Date: Nov 14, 2025
• Journal: Annals of Internal Medicine
• Print ISSN: 0003-4819
• Electronic ISSN: 1539-3704
• Publisher: American College of Physicians
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.7326/annals-25-00815
• Public URL: https://nottingham-repository.worktribe.com/output/48984953
• Publisher URL: https://www.acpjournals.org/doi/10.7326/ANNALS-25-00815