Frequently asked questions

Prior to giving blood, donors are required to complete a health check - the donation safety check. This health check consists of a comprehensive questionnaire about medical history and lifestyle and enables us to assess whether it is safe for the donor to give blood but also that the donation is safe for recipients to receive.

We screen blood and blood components for various infections. Some screening procedures are applied to all donations, some only to new donors and some are 'discretionary' and used only when indicated by risk factors identified when health screening the donor (for example lifestyle, country of birth or travel risks).

Donors are asked to read NHSBT's 'Donor Consent for Blood Donation' booklet, so they understand the importance of accurately answering the health check questionnaire.

A similar document exists for platelets and plasma donation. These consent booklets make it extremely clear when a donor must not or never give blood or platelets. For example, it makes clear that individuals must never give blood or platelets if they are HIV positive, have HBV, HCV, HTLV or syphilis (or ever been treated for syphilis), or where a donor has ever injected, or been injected with, drugs.

Donors are also encouraged to check whether they are eligible to donate blood using a tool on our website before they attend to donate.

Donors are selected according to guidelines set by JPAC - The Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee.

Donor selection criteria together with donation testing form the basis of blood safety.

Find out more about how we keep donors safe on the blood donation website.

All donations are routinely tested for hepatitis B, hepatitis C, hepatitis E, human immunodeficiency virus, syphilis and for first time donors, human T-lymphotropic virus, before they are released into the supply chain.

Find out more about the tests we carry out on donated blood on the blood donation website.

All donations are initially tested using a high throughput system, any donation that is repeat reactive in these tests is removed from the blood supply and additional testing carried out to confirm the results and confirm if a donor is positive for the marker of infection.

If a donor is found to be positive for a screened infection, we notify the donor and carry out a post-donation discussion where we explain the results, ask about any risk factors and advise regarding any further treatment or follow-up required. There will also be communication with the donor's GP if this is consented to. In most cases the donor will be suspended and a note made on their donor record so that they cannot donate - either permanently or within a set period of time, depending on the infection or other issue.

Most newly identified infections are in new donors. These are usually long-standing infections that the donor has not been tested for in the past.

If a regular donor tests newly positive for a test further investigations will be started to check that the donor was not in the early stage of infection at the time of their earlier donation. This may require additional, more sensitive tests, to be carried out.

NHSBT has obligations to make notifications of specific infectious diseases to the UK Health Security Agency (UKHSA) these are known as notifiable infections and include hepatitis B, C and E. Donors will notifiable infections will be reported to the local health protection team who will ensure that any public health actions for household and other contacts are carried out. We also have procedures for sharing information, where indicated, with other healthcare professionals such as GPs.

Compared to other everyday risks, the likelihood of getting an infection from a blood transfusion is very low. Blood donations are screened for several infections which can be transmitted through blood, but it is not practical or possible to screen for all infections, therefore, there will always be a small risk associated with having a blood transfusion.

When you have a transfusion, your team in hospital will explain the risks to you as part of their consent process. Please ask them if you have questions relating to your care.

As set out above, donor selection criteria together with testing form the basis of blood safety. All blood donors are unpaid volunteers and the risk of an infected unit entering the UK blood supply continues to decrease. The current risk of an infectious donation entering the UK blood supply due to a recently acquired infection is now less than 1 in 1.2 million donations for hepatitis B, less than 1 in 7 million for HIV and less than 1 in 28 million for hepatitis C.

More information on the risks of transfusion can be found on the SHOT website.

Since 1996 SHOT (the Serious Hazards of Transfusion committee) has been collecting and analysing anonymised information on adverse events and reactions in blood transfusion from all healthcare organisations that are involved in the transfusion of blood and blood components in the United Kingdom. Where risks and problems are identified, SHOT produces recommendations to improve patient safety. The recommendations are put into its annual report which is then circulated to all the relevant organisations including the four UK Blood Services, the Departments of Health in England, Wales, Scotland and Northern Ireland and all the relevant professional bodies as well as circulating it to all of the reporting hospitals.

In respect of transfusion-transmitted infections, SHOT is supported by the joint NHSBT/UKHSA Epidemiology Unit which acts as the national infections coordinator.

As seen with COVID, today scientists and doctors are much more aware of emerging infections and tests and vaccines are rapidly developed and implemented. Blood services collaborate internationally and learn from each other. In the UK we can rapidly develop and implement policy changes. Furthermore, NHSBT is managed and led across England, we are a national organisation with consistent policies and processes, we have good communications with hospitals and good education programmes.

We have guidelines and advice from expert committees and bodies, such as JPAC and SaBTO (the Department of Health’s Expert Advisory Committee on the Safety of Blood, Tissues and Organs), many of which have donor or patient representatives as members. These, in addition to the assurance mechanisms, such as audits, inspections and external reporting, check that processes are working as we think they are and provide us with external scrutiny. As a system, we have surveillance in place with both the UK Health Security Agency and SHOT, to horizon scan for emerging infections and to monitor infections in donors and patients. The governance of the system is therefore strong both within NHSBT and with external oversight.

Blood donations are taken by our transport team directly to one of our blood testing and manufacturing centres. The sorting, recording, testing and storage of blood all takes place in modern laboratories using the latest technology. Modern safety standards are very rigorous and follow strict guidelines.

Once all the testing is complete and passed, each pack of blood can be labelled and placed into controlled storage, ready to be sent to hospitals. Any blood donation that is reactive on testing for markers of infection is taken out of the supply chain and, if confirmed, the donor is contacted with advice and support.

The quality and efficiency of this service is very important to us, and we are regularly inspected by independent regulators to ensure we maintain our high standards. We are able to monitor stock levels of blood on a 'live' basis, enabling us to provide hospitals with automatic top up deliveries. This streamlined process means more patients safely receive the right blood, at the right time, with less wastage.

Data on the numbers of infected donations are compiled annually in the Safe Supplies joint NHSBT/UKHSA Epidemiology report.

In the case of actual transmissions, these are reported to SHOT, collated across the UK and detailed in the annual SHOT report.

NHSBT does not import blood products. We can provide all the red blood cells, fresh frozen plasma, and platelets required by the NHS, along with most other products. NHS England does import plasma derived medicines such as immunoglobulin. Plasma from UK donors was not used for immunoglobulin between the years 1998 and 2021 as a vCJD precaution. Since 2021, NHSBT has again started collecting plasma for these medicines, at the direction of the Government, following an MHRA review which decided supply could restart.

NHSBT is registered with the Care Quality Commission (CQC). The CQC monitors, inspects and regulates blood and plasma donation and the Therapeutic Apheresis Service to make sure they meet fundamental standards of quality and care.

The Medicines and Healthcare Products Regulation Agency ('MHRA') is responsible for the regulation of medical devices and medicines used in
healthcare and the regulation of blood establishments.

The Human Tissue Authority regulates the removal, storage and use of tissue and cells and organs for transplantation. We are also compliant with blood safety and quality regulations and compliant with recommendations from the Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO).

SHOT is the independent, professionally-led haemovigilance scheme. Since 1996 SHOT has been collecting and analysing anonymised information on adverse events and reactions in blood transfusion from all healthcare organisations that are involved in the transfusion of blood and blood components in the United Kingdom.

Where risks and problems are identified, SHOT produces recommendations to improve patient safety. The recommendations are put into its annual report which is then circulated to all the relevant organisations including the four UK Blood Services, the Departments of Health in England, Wales, Scotland and Northern Ireland and all the relevant professional bodies as well as circulating it to all of the reporting hospitals.

As haemovigilance is an ongoing exercise, SHOT can also monitor the effect of the implementation of its recommendations. The SHOT scheme is a UK wide body introduced in the 1990s. From 2005 it sat alongside the SABRE reporting scheme operated by MHRA in compliance with the BSQR. SHOT also provides recommendations to improve safety to the UK blood services.

The Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO) advises UK ministers and health departments on the most appropriate ways to ensure the safety of blood, cells, tissues and organs for transfusion or transplantation.

Find out more on the SaBTO website on gov.uk.

The Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee (JPAC) has two distinct remits (a) To prepare detailed service guidelines for the UK Blood Transfusion Services (b) To be an Advisory Committee to the UK Blood Transfusion Services, by reporting to the Medical Directors of the four individual Services, who are themselves
individually accountable to the Chief Executives of those Services.

Decisions on policy and implementation would be vested in the individual Chief Executives and their Service boards and, where appropriate, their respective Health Departments.

Find out more on the JPAC website.

We have in place a number of management and assurance steps. These include: a system of clinical governance, Quality Management System ('QMS'), an audit programme risk management system and a haemovigilance programme and SHOT. These assurance mechanisms are overseen by the Executive and Board members and committees including the Board subcommittee, the Audit, Risk and Governance Committee and the Clinical Governance Committee.

NHS Blood and Transplant has an Executive Director of Quality who holds the responsibility for regulatory compliance and a Chief Nurse who holds the responsibility for clinical governance in the organisation. NHSBT runs a 24-hour Consultant on call system across the country which can be accessed by any individuals in hospitals needing urgent (or other) clinical and/or laboratory advice relating to transfusion. Our Hospital Services departments are available to provide advice to hospital laboratories around the clock and will refer individuals or problems to the Consultants on call too, where appropriate.