New Eligibility Guidelines for Blood Donors with Previous Cancer Diagnoses

@angieklima
Hello,
Thank you for wanting to donate blood it’s a very rewarding thing to do. I can’t answer about Mayo Clinics restrictions however according to the American Red Cross which is where I donate since I'm in Californiasinceand being a skin cancer their requirement is that it must be 12 months from the last treatment. since that type of cancer can reoccur if that should happen it again is 12 months from the last treatment.
Thank you very much for wanting to donate blood products, there’s a tremendous need.
Best of luck,
Jake

Oops, I didn't notice your question had already been answered.
Jake

American Red Cross's exclusion guidelines dictate lifetime exclusion for blood donors whose cancer has had "recurrence", including non-blood cancers, which have never been known to be transmissible via blood products. (Their specific wording is that donation is acceptable if it was a non-blood based type of cancer and "the cancer has been treated successfully and it has been more than 12 months since treatment was completed and there has been no cancer recurrence in this time.) As Mayo Clinic is doubtless aware, survivors of prostate cancer after prostate removal and other primary therapy sometimes land in an ambiguous situation, where non-zero PSA recurs subsequent to primary therapy, but then hormone ablation therapy (leuprolide acetate or similar) reduces PSA back to below the measurement threshold, and it remains there for many years, perhaps a lifetime.

The ambiguity lies here: There is no evidence of remaining disease, but patient may and probably does have latent cancer cells in one or more distal locations (since, the post-excision measurable PSA could only have been emitted by escaped cancerous prostate cells), but, as long as leuprolide acetate therapy then keeps PSA below measurement threshold, and no tumors show up on medical imaging or via palpation, patient's cancer cell colonies' continued existence can only be suspected, not confirmed. If patient is really lucky, normal cell apoptosis and T-cell activity might even have invisibly ended the cancer, but that happy outcome cannot be confirmed, either: All cancer evidence for such a patient / cancer survivor remains indirect, as long as the latency lasts.

Such a donor, answering the screening questionnaire, ticks "yes" on the "Have you had cancer?" question, then the screener asks if it's been one year since completion of treatment. And, well, the correct answer depends on what one means by treatment:

Donor is getting periodic leuprolide acetate "depot" injections to suppress androgens, and is continuing to see PSA < 0.1 ng/ml (unmeasurable) blood-test results, say, for one-year plus. Yet, whether he has had "recurrence" of his non-blood-transmissible-as-far-as-science knows cancer is a judgement call, isn't it? (It depends on how you construe "recurrence".) Is American Red Cross going to enroll the donor onto a lifetime deferral list, merely for walking into one of its clinics and accurately answering screening questions? Would Mayo Clinic Blood Donor Program do so, if he goes there?

Also: Is hormone ablation deemed prostate cancer treatment for purposes of the "completion of treatment" screening question?

Also: Is patient's donation ethical? All medical literature on the subject seems to say solid-organ cancers have never been transmitted via blood products, but much of that literature perversely suggests donation following "cancer recurrence" should be avoided anyway, as cancer cells might be present despite this never having been known to occur, and could cause cancer in an immunocompromised recipient. So, do we know enough to exclude that possibility with high confidence, or don't we?

Such good questions @inigo. Please give my colleagues from the Blood Donor program a few days to post an equally thoughtful response.

In the meantime, assuming you personally have experience with prostate cancer, I'd like to invite you to join the Prostate Cancer group https://connect.mayoclinic.org/group/prostate-cancer/

I'm confident your knowledge and experience would benefit men newly diagnosed with prostate cancer when people have so many questions.

Thank you for the gracious welcome, @colleenyoung . I see it's been a bit over a week, and I gather that your colleagues are occupied on other matters. If they find time, I'll be grateful, but don't presume.

It seems to me, as a keenly sciene-interested layman, that American Red Cross's exclusion guidelines (like the FDA guidance they reflect) have unavoidable vague bits, which interact badly with prostate cancer's unusual traits, e.g., where it can be ambiguously inferred (or inferred absent) from PSA metrics, and where it's one of the many (solid-tissue) cancers never known to be transmitted in blood products over the entire history of blood transfusions.

Stop to consider: Blood transfusion has been an everyday thing since blood typing was discovered in 1900 (ABO) and 1902 (AB), 51% of recipients have been female, and a statistically significant minority of those have been immunosuppressed / immunocompromised / immunosenscent. If even one such recipient, over those 120+ years of regular blood transfusions, had ever developed prostate cancer from latent cancer cells in a blood product, we'd already know from the eye-opening coverage in Lancet or NEJM, but it didn't happen.

So, logic suggests one ought to be able to say "Even being ultra-cautious, one can confidently say it's perfectly safe to receive blood from a former prostate cancer patient who experienced biochemical recurrence but is now on androgen ablation, and has maintained unmeasurable PSA for a year-plus and no detection of tumors." But I'll be surprised if I ever hear that, because running a blood bank involves legal self-protection, and thus exclusion policies dictated far more by legal posture than by science.

For what it's worth, it turns out that some non-American Red Cross blood banks are happy to accept and use such donors' blood. Thought you should know.

Thank you @inigo . There has never been a documented case of transfusion-transmitted solid organ malignancy that we are aware of in the medical literature. Per AABB standards, there is no standard deferral period for non-hematologic cancers. It is up to the medical director at each blood collection agency. At the Mayo Clinic Blood Donor Center, we use a 1 year cancer-free deferral period. This deferral period is within the spectrum of deferral periods across the United States. Of note, patients receiving long term standard hormonal therapy treatment to help prevent cancer recurrence (e.g., 5 year tamoxifen regimens post-breast cancer cure) are permitted to donate if they are at least a year out from the end of their surgical/chemotherapy/radiation treatment for their most recent cancer/recurrence and have been cancer-free during the past year. Donor services nursing and physician staff review the medical histories of donors with malignancies (with their documented permission to review their medical records) to help determine blood donor eligibility against this standard.

Shepheard Community Blood Center is accepting hemochromatosis donors once your MD writes an order that you are cleared for donation. then starts all the screening questions. 478-346-7020 or 706-737-4551 call them. so professional and nice facility.

I hope you'll indulge a follow-up question, as to whether Mayo Clinic Blood Donor Program shares a different and related deferral policy my local blood bank just revealed:

After a great deal of pondering of patients like me, who are on hormone ablation therapy for latent prostate cancer, and a lot of discussion, my blood bank permitted my resuming donation for several years. @colleenyoung's help was instrumental.

But, at the latest donation, the screener asked "What is that?", and I explained that adjuvant radiotherapy had caused cumulative damage to my bladder, such that I had to have trigonal bladder resection and construction of an ileal conduit, i.e., urostomy surgery, and "that" is my urostomy bag. A week later, I was informed that the blood bank's medical director declares that donors with urostomies, colostomies, or similar surgery are an impermissible infection risk. Therefore, I may not donate blood, for life.

I'm not a urologist (and I'm pretty sure my blood center's medical director isn't, either), but would guess there is room for doubt about this policy's wisdom. What is Mayo Clinic Blood Donor Program's policy on this matter, and why?

Good follow-up question, @inigo. I'm tagging @shammer26 to ensure that she sees your question about blood donation when living with a urostomy.