Whole blood donor behavior and availability after deferral: Consequences of a new ferritin monitoring policy.

BACKGROUND: To prevent (negative consequences of) temporary deferral due to low hemoglobin, the Dutch national blood service Sanquin introduced a ferritin monitoring policy in 2017. Ferritin is measured after the donation (as opposed to before donation for hemoglobin), and low ferritin levels lead to deferral of 6 (ferritin 15-30 ng/mL) or 12 months (ferritin <15 ng/mL). We explored the consequences of this policy on donor behavior and availability. STUDY DESIGN AND METHODS: We included all Dutch whole blood donors who made a donation (attempt) between 13 November and 31 December 2017. At that point, the ferritin monitoring policy was randomly implemented in 8 of 29 regional clusters of collection centers. We extracted information from Sanquin's donor database about donors' deferrals, subsequent donation attempts, and donation cessation (up to 31 December 2019). Donors deferred for low ferritin were compared to those deferred for low hemoglobin or other reasons, as well as to donors who were not deferred. RESULTS: A total of 55 644 donors were included (11% deferred). For donor behavior, we found that donors deferred for low ferritin less often unsubscribed and switched to other donation types, yet also made fewer donations in the follow-up period. For availability, we found they were less often deferred, yet they were unavailable to donate for a longer period. CONCLUSION: Results suggest that the implementation of a ferritin monitoring policy may lead to a decrease in donor availability and reduced donations. However, the policy is successful in retaining more donors and reducing low hemoglobin deferrals.

The implementation of the ballast water management convention in the Adriatic Sea through States' cooperation: The contribution of environmental law and institutions.

The Adriatic Sea, a semi-enclosed and vulnerable environment, deserves special attention regarding the risk of introducing Harmful Aquatic Organisms and Pathogens via ships' ballast water as new species findings occur at an alarming rate. This species introduction vector was addressed with the 2004 International Convention for the Control and Management of Ships' Ballast Water and Sediments, which entered into force in 2017. The efficient implementation of this convention calls for Adriatic States' cooperation on environmental specifics that have not been dealt with neither by national nor by international measures yet. Based on legal and institutional data gathered, and considering the regional maritime traffic and environmental specifics, this paper reveals that the integration of current environmental law commitments as well as a better dialogue between public institutions from shipping and environmental sectors may foster the implementation of ballast water management obligations through appropriate Adriatic States' cooperation.