Vanderbilt Study Finds 15 Patients Sought Directed Blood Donations Based on COVID-19 Vaccine Status

A study at Vanderbilt University Medical Center found that requests for directed blood donations based on COVID-19 vaccination status delayed transfusions for severe anemia and postponed scheduled surgeries for 15 patients. Deva Sharma, assistant professor of hematology, oncology, and transfusion medicine at the center, co-authored the research published in March.

The review covered directed donations received from January 1, 2024, through December 31, 2025.

Thirteen of the 15 patients received at least one unit from a directed donor, and nine of the patients were pediatric. Sharma said directed donation requests related to vaccination concerns occur more frequently in pediatric populations. Sharma first learned of the requests through nursing staff and blood bank calls.

Families approached nurses and telephoned the blood bank directly to ask for blood from unvaccinated donors. Any modification or special request must be approved by an ordering physician, and regulatory bodies do not require blood products to be labeled by donor vaccination status. The study recorded delays in care when units from directed donors were not immediately available.

Patients waited for transfusion in cases of severe anemia and for surgery when the directed donation process extended beyond planned dates. Requests have continued after the study period ended. Directed donations carry documented risks that standard volunteer donations do not.

Sharma stated that potential donor dishonesty on screening questionnaires and the window period for infections raise the chance of transfusion-transmitted infections. Relatives share HLA proteins, increasing the risk of transfusion-associated graft-versus-host disease, a reaction that irradiation can prevent but that not all hospitals, particularly smaller facilities, can perform on site.

Patient concerns cited in the study included fears of infertility, transmission of genetic material, and loss of bodily autonomy.

Some individuals requesting unvaccinated units were themselves unvaccinated. At least two requests involved a person suspected to be unvaccinated making the request. Sharma said physicians have tried to discourage directed donations but often encounter resistance, with patients stating they will seek care elsewhere.

Most institutions lack standardized policies on directed donations, leaving decisions to individual clinicians who may have limited training on the risk-benefit ratio. The practice predates the COVID-19 pandemic and has been reported in the Northeast, Southeast, and Midwest.

Blood collection centers must monitor for transfusion-transmitted infections under FDA rules, yet other donor characteristics such as smoking status are not tracked, and publications have documented nicotine transmission to neonates after transfusion from smokers.

Sharma recalled being told upon entering transfusion medicine that blood is more regulated in the hospital than any other biological agent, drug, or device. She noted that an incompatibility can lead to fatality quickly and that transfusions enable chemotherapy and surgery without fatalities when performed safely.