Table 1.

Risks, challenges and potential strategies pertaining to determination of donor eligibility, recruitment and qualification for CCP donation.

Donor considerations	Approach	Challenges
Donor awareness	Education/awareness about the process of becoming a blood donor (and thus a CCP donor)	A high proportion of convalescent plasma donors are expected to be first‐time donors Low familiarity with eligibility criteria and donation process First‐time donors are high risk for transfusion‐transmitted infections and higher risk for donation related adverse events than repeat donors Donors of CCP need to satisfy same eligibility criteria as community blood donors Attestation from a licensed physician as an accepted donor is needed in some settings In case of a deferral: need to properly communicate reason for deferral/ ineligibility including test results, for example infectious disease results.
Donor eligibility	Standardization of donor eligibility criteria	Lack of uniformity in donor eligibility criteria with respect to: Ascertainment of diagnosis Molecular testing at time of symptomatic disease vs. Evidence of antibodies against SARS‐CoV‐2 following resolution vs. Symptoms consistent with COVID‐19 in absence of testing Time since resolution of symptoms to be eligible to donate (e.g. 14 days vs. 28 days) Requirement for negative SARS‐CoV‐2 testing prior to donation The criteria for eligibility are continually evolving as more information is known Lack of consensus
	Medical Director use discretion to qualify donors Relaxing of selected eligibility criteria e.g. donation frequency	Need to preserve donor safety and comply with national/local regulations
Donor identification	Self‐identification Hospital‐based referral Mining electronic medical records and patient registries	Donor education: A high proportion of those who self‐identify will not qualify Variable reliability of self‐referrals Motivation of donors may alter information to secure early donation to aid a friend/family member in need; anticipated/promised reimbursement Recall: timing of symptom resolution Test‐seeking to confirm immune status Individuals may not be able to provide documentation attesting to confirmed infection Some donors may not have internet access or be internet savvy Donors may be wary of telemarketers and are unwilling to answer phone calls or and scheduling online Same donor may be associated with multiple hospitals/blood centres
Donor recruitment	Community and hospital outreach Social media Professional websites Formal news outlets Reflex patient notification following positive test Health departments	Lockdown policies restrict access to eligible individuals Donors may not be adept with technology, limiting uptake of websites and online applications Donors may be contacted by multiple organizations Motivators for and deterrents against blood donation not well studied in LMICs Electronic medical records and patient registries not widely available in LMICs
Pre‐donation qualification	Pre‐donation screening and administration of donor history questionnaire	CCP donors need to meet all the same eligibility criteria as community blood donors Individuals who satisfy criteria for CCP donation may be deferred for unrelated reasons, for example travel and MSM
	Gender and parity‐based screening	Depending on country/blood establishment policy, parous females may be deferred from blood donation as part of TRALI mitigation In some countries, parous females may be subject to HLA antibody screening
Compensation/reimbursement	Donor compensation	Policies regarding compensation vary widely by country Expectation of replacement and/or paid donation is common in low and low‐middle‐income countries. Confers risk of TTIs Limited reimbursement for travel and small gifts that cannot be monetized may be permissible in some high‐income countries Donors may be allotted special bonus points/blood centre non‐monetary currency for CCP donation COVID antibody testing may motivate incentivize donation Active recruitment of donors at paid plasma collection sites to support hyperimmune globulin and vaccine development could result in competition between community blood centres and dedicated plasma collection sites for eligible donors
	Community organizers	Community organizers may expect compensation for identification/referral of potential donors. The ISBT Code of Ethics does not support compensating community organizers for identifying/referring potential donors, outside of traditional compensation mechanisms for the appropriate reimbursement of tests performed
Donor Privacy	Informed consent	Loss of privacy and confidentiality Balancing respect for privacy and confidentially with need to access donor medical records to identify eligible donors for CCP Data sharing via email or other electronic means between referring hospitals and health agencies with donor centre Unintended release of private material (e.g. donor pictures, videos and clinical stories/histories) on social media without consent.
Donor safety	Procedural risks	First‐time donors are higher risk of donation‐associated adverse events than repeat donors, for example vasovagal reactions Risk and complications from the venipuncture and apheresis procedure, for example hypocalcemia during apheresis Some donors may be more comfortable with a whole blood donation versus apheresis procedure
	Repeat donations	Adverse effect on immunity following repeated donations has NOT been shown
	Psychological duress to donors	Donors may feel obligated to donate Societal pressure/expectation. May discourage admission of high‐risk behaviour impacting risk of TTIs Risk of repeated quarantine A high proportion of individuals have positive PCR tests from nose or throat swabs 14–27 days post‐symptom resolution conferring risk of quarantine until PCR negative The interpretation of persistent PCR‐positive test result is unclear, that is whether testing represents active infection (live virus)

CCP, COVID‐19 convalescent plasma; ISBT, International Society of Blood Transfusion; LMICs: low‐ and middle‐income countries; MSM, men who have sex with men; PCR, polymerase chain reaction; TTI, transfusion‐transmitted infections; TRALI, transfusion‐related acute lung injury.