A WHO tool for risk‐based decision making on blood safety interventions

Abstract

Background Risk‐based decision making is increasingly recognized as key to support national blood policy makers and blood operators concerning the implementation of safety interventions, especially to address emerging infectious threats and new technology opportunities. There is an urgent need for practical decision support tools, especially for low‐ and middle‐income countries that may not have the financial or technical capability to develop risk models. WHO supported the development of such a tool for blood safety. The tool enables users to perform both a quantitative Multi‐Criteria Decision Assessment and a novel step‐by‐step qualitative assessment. Study Design and Methods This paper summarizes the content, functionalities, and added value of the new WHO tool. A fictitious case study of a safety intervention to reduce the risk of HIV transmission by transfusion was used to demonstrate the use and usefulness of the tool. Results Application of the tool highlighted strengths and weaknesses of both the quantitative and qualitative approaches. The quantitative approach facilitates assessment of the robustness of the decision but lacks nuances and interpretability especially when multiple constraints are taken into consideration. Conversely, while unable to provide an assessment of robustness, the step‐by‐step qualitative approach helps structuring the thought process and argumentation for a preferred intervention in a systematic manner. Conclusion The relative strengths and weaknesses of the quantitative and step‐by‐step qualitative approach to risk‐based decision making are complementary and mutually enhancing. A combination of the two approaches is therefore advisable to support the selection of appropriate blood safety interventions for a particular setting.

Viral Metagenomics for Identification of Emerging Viruses in Transfusion Medicine

“…This argues against the routine application of viral metagenomics as a tool for viral infectious surveillance in the Blood Banks worldwide. In that line, risk-based decision making for blood safety should be the most important tool combing health economics and operational assessments before introduction of any NGS procedure [57]. Although viral metagenomics could give us insights on the possible emerging transfusion threats, it is insufficient only by genomic characterization to reveal viruses that can impact transfusion medicine.…”

Validated transport conditions maintain the quality of washed red blood cells

“…Initiatives to control health care costs including the Affordable Care Act, Choosing Wisely, and a move towards risk-based decision making have highlighted the importance of reducing medical waste in an effort to improve patient care and access to services. 32,33 This trend has become increasingly important during recent blood shortages exacerbated by the Covid-19 pandemic. 34 Here we have verified that washed RBC units placed in transport coolers are similar to those stored in the refrigerator in terms of numerous metrics of quality.…”

“…In conclusion, storage of washed RBC units in transport coolers is associated with a strongly differing cooling rate that contributes to product wastage. Initiatives to control health care costs including the Affordable Care Act, Choosing Wisely, and a move towards risk‐based decision making have highlighted the importance of reducing medical waste in an effort to improve patient care and access to services 32,33 . This trend has become increasingly important during recent blood shortages exacerbated by the Covid‐19 pandemic 34 .…”