ReadyDonor pg 6

Ensuring a Safe Blood Supply

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Blood Donation
I understand that in order to donate blood I must be at least 16 years of age.

I understand the basic steps of the donation process as outlined in the education materials.

Ensuring a Safe Blood Supply
I understand that I must provide truthful answers to each of the questions regarding my medical history.

I have read, and understand, the information provided regarding the spread of relevant transfusion-transmitted infections (such as HIV/AIDs) through blood donation.

I agree not to donate if the donation could result in a potential risk to recipients as described in the educational material.

Potential Adverse Effects of Blood Donation
I understand possible side effects of donating may include: lightheadedness, nausea, vomiting, pallor, fainting, hyperventilation, uncomfortable breathing, or convulsions due to the decrease in my blood volume; local infection, soreness/bruising, nerve irritation or arterial injury at the needle site; excessive tiredness; temporary tremors, tingling, unpleasant taste, chills, stiffness, headache, fever, hypotension, allergic reaction, anxiety, hemolysis (red cell breakage), air embolism, or clotting as a complication of apheresis procedures.

I understand that, under rare circumstances, there may be a need for medical treatment during or following blood donation.

Testing
I understand my donated blood is tested for a series of relevant transfusion-transmitted infections including, but not limited to: Hepatitis B and C, HIV, and syphilis.

I understand that, if testing shows a risk of transmitting disease, I will be notified and my record will indicate that I am ineligible to donate.

If I am notified of such circumstances, I agree to no longer donate blood or components.

I understand that, except as required by state or local law, the test results are released only with my consent.

 

COVID-19 & Convalescent Plasma
As part of The Community Blood Center’s response to the COVID-19 Public Health Emergency, a sample of your blood may be tested for antibodies to the COVID-19 virus. This is one of the more than 12 tests performed on every unit as we prepare blood for clinical needs. This testing is not licensed and should be considered experimental. It is not done as a blood safety measure or to diagnose disease. The sole reason for this testing is to identify donors who may qualify for a special plasma donation. Plasma donated from someone with antibodies to COVID-19 can be used to potentially treat a patient with this disease. This plasma is called convalescent plasma. You can learn more about convalescent plasma on our website, communityblood.org.

The Community Blood Center only notifies blood donors of test results when they are positive. If antibodies are detected in your blood sample, you will receive a phone call from our team in approximately 14 working days informing you of this positive test result. We will then work with you to schedule a convalescent plasma donation. You will also receive a formal letter in the mail. There is always a possibility your unit was not tested. Therefore, if you are not notified of a positive test result indicating the detection of coronavirus antibodies, you should not assume you had a negative test result.

If you are trying to determine your prior exposure to COVID-19, please contact your personal physician for guidance.

 

Please Note
You may be required to answer one or more of these questions again at the time of your donation. In some cases, you may be required to answer one or more questions again with your Donor Technician at the time of your donation.

You may also choose to review a question with your Donor Technician for clarification.

 

I give permission to The Community Blood Center, Inc.:

  1. to have performed on my blood whatever tests may be required to improve the safety and quality of blood transfusions.
  2. to have a sample of my blood stored for future testing.
  3. to have such samples and products used in research.

I give permission to The Community Blood Center to contact me at the contact information I provided.

I understand I will be given an opportunity to ask questions about blood donation and that I am able to withdraw my consent at any time to stop the donation process.

I am donating my blood to The Community Blood Center for use as it may deem advisable.

CONTINUE

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