Ease restrictions on U.S. blood donations

doi:10.1126/science.abc2322

GSTDTAP > 气候变化

DOI	10.1126/science.abc2322
	Ease restrictions on U.S. blood donations
	Chirag Vasavda; Byron K. Ho; Solomon H. Snyder
	2020-05-29
发表期刊	Science
出版年	2020
英文摘要	With a vaccine for coronavirus disease 2019 (COVID-19) likely more than a year away, we must identify effective therapies for patients now. One promising approach is the use of plasma from patients who have recovered from COVID-19 ([ 1 ][1], [ 2 ][2]). To facilitate this strategy, the U.S. Food and Drug Administration (FDA) recently revised some of the restrictions on blood donation, including a decrease in deferral time for men who have sex with men (MSM) to 3 months ([ 3 ][3]). This is a positive change to an outdated guideline, but it does not go far enough. In 1983, the FDA indefinitely barred all MSM from donating blood for fear of transmitting human immunodeficiency virus (HIV) and hepatitis B/C by transfusion. In 2015, the lifetime ban was changed to 12 months from last sexual contact ([ 4 ][4]). Today, the risk of contracting HIV or hepatitis B/C through transfusion is less than 1 in 2 million, and the incidence is substantially lower ([ 5 ][5]). This success is due to advances in screening, not to banning MSM from donating blood. The false-negative rates of modern HIV nucleic acid tests fall around 0.05%. The window between infection and detection has dropped to 9 days ([ 5 ][5], [ 6 ][6]). Despite this improvement, the FDA continues to exclude otherwise healthy MSM through arguably discriminatory policy. Although a step forward from the 12-month policy, a deferral period of 3 full months is not necessary to protect patients ([ 7 ][7], [ 8 ][8]). Moreover, this revised policy may not meaningfully increase the donor pool, given that waiting until 3 months after sexual contact amounts to a lifetime blood donation ban for many men. The demand for healthy blood and convalescent plasma will accelerate as COVID-19 infects more Americans. To address the acute shortage ([ 9 ][9]), the deferral period should be decreased to 2 weeks, after which we can reliably screen for HIV. More granular deferrals could also be introduced. Instead of a blanket discriminatory ban on MSM blood donations, we could evaluate donors based on concrete risky behaviors, such as having unprotected sex with multiple sexual partners or sharing needles. Alternatively, we could inactivate pathogenic DNA and RNA with intercalating molecules such as amotosalen, which European blood centers already do routinely ([ 10 ][10], [ 11 ][11]). Coupled with robust testing and screening, these approaches will exclude fewer healthy donors while still minimizing the risk of transfusion-transmitted HIV. The FDA's policies must be grounded in science. Safely lifting the restrictions on blood donations has the potential to save millions of lives in a normal year ([ 12 ][12]). Now, plasma may play a crucial role in treating patients suffering from COVID-19. We cannot afford to turn away HIV-negative blood with lifesaving antibodies just because the donor is gay or bisexual. 1. [↵][13]1. A. Casadevall, 2. L.-A. Pirofski , J. Clin. Invest. 130, 1545 (2020). [OpenUrl][14][PubMed][15] 2. [↵][16]1. C. Shen et al ., JAMA 323, 1582 (2020). [OpenUrl][17] 3. [↵][18]1. P. Marks , “Coronavirus (COVID-19) update: FDA provides updated guidance to address the urgent need for blood during the pandemic” (FDA, 2020); [www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-provides-updated-guidance-address-urgent-need-blood-during-pandemic][19]. 4. [↵][20]FDA, “Revised recommendations for reducing the risk of Human Immunodeficiency Virus transmission by blood and blood products” (2020); [www.fda.gov/regulatory-information/search-fda-guidance-documents/revised-recommendations-reducing-risk-human-immunodeficiency-virus-transmission-blood-and-blood][21]. 5. [↵][22]1. S. Zou, 2. S. L. Stramer, 3. R. Y. Dodd , Transfus. Med. Rev. 26, 119 (2012). [OpenUrl][23][CrossRef][24][PubMed][25] 6. [↵][26]1. M. Busch, 2. K. Watanabe, 3. J. Smith, 4. S. Hermansen, 5. R. Thomson , Transfusion 40, 585 (2000). [OpenUrl][27] 7. [↵][28]1. E. DeBuck, 2. T. Dieltjens, 3. V. Compernolle, 4. P. Vandekerckhove , PLOS One 10, e0122523 (2015). [OpenUrl][29] 8. [↵][30]1. B. R. Sturrock, 2. S. Mucklow , Clin. Med. 18, 304 (2018). [OpenUrl][31][Abstract/FREE Full Text][32] 9. [↵][33]1. J. Stephenson , “Canceled blood drives, social distancing cause nationwide blood shortages,” JAMA Health Forum (2020). 10. [↵][34]1. L. Lin et al ., Transfusion 45, 580 (2005). [OpenUrl][35][CrossRef][36] 11. [↵][37]1. J. Irsch, 2. L. Lin , Transfus. Med. Hemother. 38, 19 (2011). [OpenUrl][38][CrossRef][39][PubMed][40] 12. [↵][41]1. A. J. Miyashita, 2. G. J. Gates , Effects of Lifting Blood Donation Bans on Men Who Have Sex with Men (Williams Institute, 2014). [1]: #ref-1 [2]: #ref-2 [3]: #ref-3 [4]: #ref-4 [5]: #ref-5 [6]: #ref-6 [7]: #ref-7 [8]: #ref-8 [9]: #ref-9 [10]: #ref-10 [11]: #ref-11 [12]: #ref-12 [13]: #xref-ref-1-1 "View reference 1 in text" [14]: {openurl}?query=rft.jtitle%253DJ.%2BClin.%2BInvest.%26rft.volume%253D130%26rft.spage%253D1545%26rft_id%253Dinfo%253Apmid%252Fhttp%253A%252F%252Fwww.n%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [15]: /lookup/external-ref?access_num=http://www.n&link_type=MED&atom=%2Fsci%2F368%2F6494%2F957.1.atom [16]: #xref-ref-2-1 "View reference 2 in text" [17]: {openurl}?query=rft.jtitle%253DJAMA%26rft.volume%253D323%26rft.spage%253D1582%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [18]: #xref-ref-3-1 "View reference 3 in text" [19]: http://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-provides-updated-guidance-address-urgent-need-blood-during-pandemic [20]: #xref-ref-4-1 "View reference 4 in text" [21]: http://www.fda.gov/regulatory-information/search-fda-guidance-documents/revised-recommendations-reducing-risk-human-immunodeficiency-virus-transmission-blood-and-blood [22]: #xref-ref-5-1 "View reference 5 in text" [23]: {openurl}?query=rft.jtitle%253DTransfusion%2Bmedicine%2Breviews%26rft.stitle%253DTransfus%2BMed%2BRev%26rft.aulast%253DZou%26rft.auinit1%253DS.%26rft.volume%253D26%26rft.issue%253D2%26rft.spage%253D119%26rft.epage%253D128%26rft.atitle%253DDonor%2Btesting%2Band%2Brisk%253A%2Bcurrent%2Bprevalence%252C%2Bincidence%252C%2Band%2Bresidual%2Brisk%2Bof%2Btransfusion-transmissible%2Bagents%2Bin%2BUS%2Ballogeneic%2Bdonations.%26rft_id%253Dinfo%253Adoi%252F10.1016%252Fj.tmrv.2011.07.007%26rft_id%253Dinfo%253Apmid%252F21871776%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [24]: /lookup/external-ref?access_num=10.1016/j.tmrv.2011.07.007&link_type=DOI [25]: /lookup/external-ref?access_num=21871776&link_type=MED&atom=%2Fsci%2F368%2F6494%2F957.1.atom [26]: #xref-ref-6-1 "View reference 6 in text" [27]: {openurl}?query=rft.jtitle%253DTransfusion%26rft.volume%253D40%26rft.spage%253D585%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [28]: #xref-ref-7-1 "View reference 7 in text" [29]: {openurl}?query=rft.jtitle%253DPLOS%2BOne%26rft.volume%253D10%26rft.spage%253De0122523%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [30]: #xref-ref-8-1 "View reference 8 in text" [31]: {openurl}?query=rft.jtitle%253DClinical%2BMedicine%26rft.stitle%253DClin%2BMed%26rft.aulast%253DSturrock%26rft.auinit1%253DB.%2BR.%26rft.volume%253D18%26rft.issue%253D4%26rft.spage%253D304%26rft.epage%253D307%26rft.atitle%253DWhat%2Bis%2Bthe%2Bevidence%2Bfor%2Bthe%2Bchange%2Bin%2Bthe%2Bblood%2B%257B-%257Ddonation%2Bdeferral%2Bperiod%2Bfor%2Bhigh-risk%2Bgroups%2Band%2Bdoes%2Bit%2Bgo%2Bfar%2Benough%253F%26rft_id%253Dinfo%253Adoi%252F10.7861%252Fclinmedicine.18-4-304%26rft_id%253Dinfo%253Apmid%252F30072554%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [32]: /lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MTI6ImNsaW5tZWRpY2luZSI7czo1OiJyZXNpZCI7czo4OiIxOC80LzMwNCI7czo0OiJhdG9tIjtzOjI0OiIvc2NpLzM2OC82NDk0Lzk1Ny4xLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ== [33]: #xref-ref-9-1 "View reference 9 in text" [34]: #xref-ref-10-1 "View reference 10 in text" [35]: {openurl}?query=rft.jtitle%253DTransfusion%26rft.volume%253D45%26rft.spage%253D580%26rft_id%253Dinfo%253Adoi%252F10.1111%252Fj.0041-1132.2005.04316.x%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [36]: /lookup/external-ref?access_num=10.1111/j.0041-1132.2005.04316.x&link_type=DOI [37]: #xref-ref-11-1 "View reference 11 in text" [38]: {openurl}?query=rft.stitle%253DTransfus%2BMed%2BHemother%26rft.aulast%253DIrsch%26rft.auinit1%253DJ.%26rft.volume%253D38%26rft.issue%253D1%26rft.spage%253D19%26rft.epage%253D31%26rft.atitle%253DPathogen%2BInactivation%2Bof%2BPlatelet%2Band%2BPlasma%2BBlood%2BComponents%2Bfor%2BTransfusion%2BUsing%2Bthe%2BINTERCEPT%2BBlood%2BSystemTM%26rft_id%253Dinfo%253Adoi%252F10.1159%252F000323937%26rft_id%253Dinfo%253Apmid%252F21779203%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [39]: /lookup/external-ref?access_num=10.1159/000323937&link_type=DOI [40]: /lookup/external-ref?access_num=21779203&link_type=MED&atom=%2Fsci%2F368%2F6494%2F957.1.atom [41]: #xref-ref-12-1 "View reference 12 in text"
领域	气候变化 ; 资源环境
URL	查看原文
引用统计
文献类型	期刊论文
条目标识符	http://119.78.100.173/C666/handle/2XK7JSWQ/271735
专题	气候变化资源环境科学
推荐引用方式 GB/T 7714	Chirag Vasavda,Byron K. Ho,Solomon H. Snyder. Ease restrictions on U.S. blood donations[J]. Science,2020.
APA	Chirag Vasavda,Byron K. Ho,&Solomon H. Snyder.(2020).Ease restrictions on U.S. blood donations.Science.
MLA	Chirag Vasavda,et al."Ease restrictions on U.S. blood donations".Science (2020).