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# Using these guidelines

The Geographical Disease Risk Index (GDRI) should be used to assist selection of donors giving whole blood, blood components (red cells, platelets, plasma and granulocytes), haemopoietic progenitor cells and tissues for therapeutic use.

The GDRI forms a constituent part of Chapter 3, Chapter 20 and Chapter 22 of the Guidelines for the Blood Transfusion and Tissue Transplantation Services in the UK.

JPAC is responsible for these guidelines and receives professional advice from its specialist Standing Advisory Committees and other relevant expert groups. The GDRI is primarily reviewed and updated by the Standing Advisory Committee on Care and Selection of Donors (SACCSD). It is reviewed regularly to ensure that donations are of the highest quality and of sufficient quantity to meet the needs of recipients.

Comments about the content of the GDRI, including notification of errors, omissions and suggestions for improvements, should be sent to JPACOffice@nhsbt.nhs.uk.

## On this page

- General principles
- Country inclusion criteria
- Malaria risk categories
- Use of maps in the GDRI
- Travel information
- Version control

## General principles

### Important

These guidelines are for healthcare professionals who are trained in their use.

JPAC cannot answer individual donor queries or provide personal medical advice. Help with such matters may be available through a local blood and tissue service.

Donor selection aims to minimise the risk of transfusion transmitted infections. This includes infectious diseases that a donor might have been exposed to if they have travelled or lived abroad. The GDRI provides guidance on which countries or regions carry a risk of a number of infectious diseases, including malaria, West Nile Virus (WNV), Dengue and other arboviruses, Trypanosoma cruzi (T. cruzi), and viral haemorrhagic fevers. For T. cruzi, assessment of risk includes whether an individual or their mother was born in an endemic country.

The GDRI is regularly updated to reflect changes in the geographical spread of individual infections. Where there is a rapidly emerging geographical disease risk, this can be added to the list of diseases covered by the GDRI.

The list of countries is compiled specifically for risks relevant to the blood and tissue supply in the UK and may vary from risks or recommendations provided for the protection of the traveller. It is not comprehensive but reflects the diseases which are of the most concern for the UK Blood and Tissue Services (UKBTS).

To assess the risk of an individual carrying such infections, look up the countries:

- that they have visited
- in which they were born
- in which their mother was born
- in which they were resident for at least six months
- in which they were transfused before 1 January 1980

If a risk is shown for that country, refer to the relevant entry in the appropriate Donor Selection Guidelines (DSG) for the donation type to assess the individual's suitability to donate.

See the Cross-references page for links to the relevant entries in each DSG.

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## Country inclusion criteria

With effect from Release XX, the entries in the GDRI are primarily countries and territories that have an ISO 3166 code. The spelling of entries is according to the Foreign Commonwealth and Development Office (FCDO) list, which includes adaptations to UK English spelling.

Previous versions of the GDRI contained some entries which are not countries or territories; these do not have an ISO 3166 code and are not included in the FCDO list. These have either been retained as keywords in the A to Z index or deleted.

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## Malaria risk categories

Information concerning malaria risk has been sourced from UK reference sites (including Travax and TravelHealthPro and through JPAC surveillance processes for emerging infections. Some modifications have been made to account for typical donor travel patterns, entry points to the countries concerned, areas where malaria surveillance is compromised and for ease of use for end users. Malaria risks within the GDRI are not identical to the health advice offered to travellers regarding anti-malarial therapy.

Countries with malarial risk are categorised into three groups:

Category A

  Countries where the malarial risk is present in the whole country all year or with very clear seasonal guidance.

Category B

  Countries where only parts of the country are affected.

Category C

  Countries where malaria is limited to discrete pockets, where the risk of infection is low, or where there are few visitors to affected areas. It is likely that tourists who visit these countries will be able to donate but individual assessment must be applied.

  Donors are likely to have detailed knowledge if they have visited any malarial areas. The healthcare professional should establish whether the donor sought advice prior to travel and if they were advised to take antimalarial precautions.

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## Use of maps in the GDRI

Some countries have regional infection risks that do not apply to the whole country. Where appropriate, maps are provided to assist staff in assessing whether a donor has travelled to a risk area. The majority of maps in the GDRI relate to malaria risk but maps may also be provided for tropical viruses or WNV outbreaks in Europe.

When using maps in the GDRI:

- Apply the GDRI guidance for all infection risks - only use the map for the named infection risk(s) associated with that map.
- Always use the text of the GDRI as the main source to make decisions. This will include guidance on how to interpret any map that has been provided.
- Malaria maps may present information about neighbouring countries but this should not be used for malarial assessment.

The following colours are used in the malaria maps:

Red

  Risk: High risk

  Action: Apply Malaria donor selection guideline

Dark pink / hatched

  Risk: Variable risk / low risk

  Action: Apply Malaria Donor Selection Guideline

Light pink

  Risk: Low to no risk

  Action: Can donate

Yellow

  Risk: Surrounding country with malaria risk

  Action: Do not use for malaria assessment

Green

  Risk: Surrounding country with no malaria risk

  Action: Do not use for malaria assessment

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## Travel information

### Airport stopovers

Travel risks do not apply for transit through an airport during which the traveller has not left the airport. When the donor's visit to a country has consisted???only???of an airport stopover, there is no need to refer to the GDRI.

### Sea Travel and Port Stopovers

Travel risks apply to time in port or if anchored offshore and should be assessed as time on land.

### Overland Travel

Travel risks apply if the donor has travelled overland through a risk area (e.g. by car, bus or train).

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## Version control

The GDRI is under the continuing review of SACCSD and the Standing Advisory Committee on Transfusion Transmitted Infection (SACTTI). This is to ensure that they are accurate and up to date.

All changes are the responsibility of the Professional Director of JPAC and have the approval of the Executive Working Group (EWG) and the JPAC Board.

Terms used for version control of the guidelines

Change Notification

  This notifies the Medical Director and the Quality Manager of each of the four UKBTS to upcoming changes to the guidelines.

  The implementation of any changes is the responsibility of the individual services.

Edition

  An extensive revision of the entire set of guideline entries.

Release

  Changes to the one or more entries in the current Edition of the guidelines which involve a change to the medical or scientific content.

Issue

  Changes to the one or more entries in the current Release of the guidelines which do not involve a change to the medical or scientific content or have been made to correct an error or omission.

  Each Release of the guidelines will be Issue 01 unless otherwise stated.

The Quality Manager of each UKBTS will be notified of upcoming changes by electronic distribution of a Change Notification.

The Quality Manager is responsible for effecting changes to locally held copies of the guidelines, or to information adapted from the guidelines for use within their respective service. An effective version control and change procedure must be in place to ensure only current versions of the guidelines are in use and that all authorised copies, electronic and paper, are traceable.

### Live version of the guidelines (this website)

The website will always display the current version of each guideline entry, as shown in the A to Z index, and each entry will shown the date of its most recent update. Changes will be published on the website on the effective date given in the relevant Change Notification.

### Offline version of the guidelines (source files)

A source file is a downloadable copy of the guidelines. A source file containing the current version of the guidelines is always available on the Source files page.

In addition, whenever a Change Notification is distributed to indicate upcoming changes, an updated source file incorporating those changes will be made available. This will supersede the current source file on the effective date of the Change Notification and any previous source files will be removed.

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Last updated in GDRI Edition 002 Release XX (Date)

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