On CUE: Streamlining the donation process without compromising safety

The Issue

“Confidential Unit Exclusion” or CUE allowed donors with risk factors for transmissible diseases to confidentially indicate that their blood may be unsafe for transfusion by placing a “do not use my blood” sticker on the record of donation.  CUE was implemented in the mid-1980s, but since then testing for transmissible diseases has improved. While initial studies showed CUE had some value, more recent data suggest otherwise.

The Evidence

To see whether CUE contributed to blood safety in Canada, Drs. Goldman and O’Brien from Canadian Blood Services’ Medical Services and Innovation examined donations that were positive for transmissible diseases over a four-year period. Most (>99 %) transmissible disease-positive donations were marked “CUE-safe” by the donor. Of the 7,104 donations marked “CUE-unsafe” and discarded, just 7 tested positive for any transmissible diseases, predominantly for hepatitis B. An anonymous survey of 40,000 donors showed that there was confusion over how and when to use CUE and suggested that most donors selecting “CUE-unsafe” had no known risk factors for disease, and selected “CUE-unsafe” in error. Overall, the findings indicated that CUE does not provide any measureable increase in safety, but results in the destruction of 0.15 % of donated units each year

blood bags

The Impact

The CUE has been removed since June 2015, after Canadian Blood Services submitted and received a license amendment change from Health Canada to do so. This change streamlined the blood collection process, improved system performance without compromising safety and reduced discards by approximately 1,500 units a year. 

Published on
Back to research highlights