Directed donations for unvaccinated blood: A departure from evidence-based medicine associated with clinical harm, resource waste, and oversight gaps in a two-year single-center series

Abstract

Background and Objectives: Requests for “unvaccinated” blood have been discouraged by professional and regulatory bodies because they lack scientific support and may negatively impact patient care. We describe a single-center series in which patients or surrogates refused standard blood components unless sourced from directed donors perceived to be “unvaccinated.”. Materials and Methods: We performed a retrospective review of directed donations received at Vanderbilt University Medical Center between January 1, 2024 and December 31, 2025. Data included demographics, clinical scenario, component details, and documented operational or clinical consequences. Results: Directed donor units were received for 15 patients; 13 of these patients were transfused at least one unit (n = 31 directed components: 22 red blood cell [RBC] units, 5 platelet units, 2 plasma units, 2 cryoprecipitate units). Median age was 17 years (range 0.33–73); nine patients were pediatric (<18 years). An ethics consultation was documented for one case, and a transfusion medicine consultation was documented for one case. Seven patients (47%) had at least one directed unit that was not transfused to them. Two patients clinically deteriorated in the setting of refusal of standard components, one of which also received a transfusion that deviated from institutional transfusion guidelines to avoid outdating, and two additional patients had surgical delay/cancellation with rescheduling associated with directed component availability. Conclusion: In this series, all directed units were from “unvaccinated” donors. These requests were associated with care delays, escalation, and inefficiencies. Health systems should implement standardized counseling, documentation, and escalation pathways consistent with existing guidance.