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Guidance on Blood Type Determination

Proposal Overview

Status: Public Comment

Sponsoring Committee: Operations and Safety

Strategic Goal: Promote living donor and transplant recipient safety

Read the guidance document (PDF; 01/2020)

Contact: Pete Sokol

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What is current practice and why address it?

Blood type determination is one of the most crucial components of the process for matching donor organs to transplant candidates. Failure to accurately determine blood type can result in significant adverse events, including graft failure or patient death. The intent of this guidance document is to increase patient safety and create awareness of the importance of addressing all issues that may affect the accuracy of blood type determination.

What’s the guidance?

  • Reviews conventional methods for blood type determination.
  • Identifies factors impacting blood type reliability.
  • Lists acceptable blood type and transfusion sources.
  • Identifies alternative genetic testing methods and when they should be used.
  • Outlines practices to resolve donor blood type conflicts.

What’s the anticipated impact of this document?

  • What it’s expected to do
    • Help OPOs and transplant programs:
      • Develop procedures when conventional methods of blood testing result in indeterminate or conflicting results.
      • Identify triggers for when to use alternative testing methods.
      • Identify practices to resolve conflicting blood typing results.
  • What it won’t do
    • This guidance document is not a mandate. It provides recommendations for members to consider when resolving conflicting or indeterminate blood typing results.
    • It will not detail procedures for OPOs or transplant programs or take the place of clinical judgment on blood type determination.
    • It does not create or change OPTN policy. There is an accompanying proposal that addresses policy changes.

Themes to consider

  • Living donor safety
  • Recipient safety
  • Organ Procurement Organization (OPO) and transplant program quality improvement

Terms you need to know

  • ABO Blood Type: The classification of human blood into four groups: A, B, AB, and O.
  • Blood Products: Any therapeutic substance prepared from human blood. This includes: whole blood, blood components, and plasma.
  • Conflicting: Two blood tests from the same donor or candidate that present with different blood typing results.
  • Indeterminate: A blood test that does not provide a clear result.
  • Protocol: a predefined written procedural method.
  • Click here to search the OPTN glossary.


OPTN Histocompatibility Committee | 02/17/2020

The Histocompatibility Committee appreciates the opportunity to provide feedback on modifying blood type determination and reporting policies and its associated guidance. The Committee supports use of DNA-based determination of ABO in combination with traditional serological typing and utilized for discrepancy resolution. It is important to note, however, that testing requires additional expertise and carries additional CLIA requirements, in addition to various state testing requirements. Please consider providing a hemodilution calculation every time a sample is sent in for testing. This could create additional documentation and reporting burden on the organ procurement organization, but it would help ensure that the sample quality is sufficient for definitive testing. It is recognized that guidance is not prescriptive of practice, and appreciate the steps the Operations and Safety Committee is taking toward clarifying the process. Histocompatibility Committee Vote: Guidance on Blood Type Determination: 7 yes, 2 no, 7 abstain

Region 4 | 02/20/2020

Strongly support (11), Support (9), Neutral/Abstain (2), Oppose (0), Strongly Oppose (0)

Region 8 | 02/20/2020

8 Strongly Support, 10 Support, 2 Neutral/Abstain, 0 Oppose, 0 Strongly Oppose

Region 6 | 02/21/2020

Strongly support (8), Support (9), Neutral/Abstain (0), Oppose (0), Strongly Oppose (0)

Region 5 | 02/21/2020

Strongly support (13), Support (8), Neutral/Abstain (1), Oppose (0), Strongly Oppose (0)

Anonymous | 02/28/2020

5 Strongly Support, 28 Support, 0 Neutral/Abstain, 0 Oppose, 0 Strongly Oppose