Opinion: What should hospitals do when patients demand unvaccinated donor blood?

OpinionFirst Opinion Podcast What should hospitals do when patients demand unvaccinated donor blood? A rare but real phenomenon creates new challenges for doctors, blood banks, and medical systems Manage alerts for this article Email this article Share this article By Torie BoschJune 1, 2026 Editor, First Opinion Torie Bosch[email protected]Torie Bosch is the First Opinion editor at STAT. Below is a lightly edited, AI-generated transcript of the “First Opinion Podcast” interview with Deva Sharma. Be sure to sign up for the weekly “First Opinion Podcast” on Apple Podcasts, Spotify, or wherever you get your podcasts. Get alerts about each new episode by signing up for the “First Opinion Podcast” newsletter. And don’t forget to sign up for the First Opinion newsletter, delivered every Sunday. For many people, there’s something a little unsettling about the idea of a blood transfusion. It’s someone else’s cells becoming part of their body. And in the aftermath of the Covid pandemic, some patients, including parents of patients, are objecting to the idea of a donation from someone who has been vaccinated. But how can and should hospitals respond to these requests?Advertisement Welcome to the “First Opinion Podcast.” I’m Torie Bosch, editor of First Opinion. First Opinion is STAT’s home for big, bold ideas from health care providers, researchers, patients, and others who have something to say about medicine’s most important and interesting topics. This season, we’re focused on the intersection of medicine and culture. Today, I’m speaking with Deva Sharma. She’s an assistant professor of hematology, oncology, and transfusion medicine at Vanderbilt University Medical Center. After a quick break, I’ll bring you our conversation about how concerns about the safety of blood from vaccinated donors are complicating patient care. Deva Sharma, welcome to the “First Opinion Podcast.”Advertisement Deva Sharma: Thank you so much, Torie, for having me. I’m excited to be here today. Bosch: So do you remember the first time you learned that some patients were concerned about being transfused with blood from people who’d been vaccinated? Sharma: Yes, I do. I do remember. Bosch: Can you tell us about it? Sharma: Yeah sure. So you know interestingly I think a lot of people have fears about vaccines especially the Covid-19 vaccine, but they know how the medical community feels about this, so they’re afraid to tell us as physicians. So the first time I learned about this, I heard about this through our nursing staff. The patient’s families were comfortable approaching our nurses. They were also comfortable calling our blood bank and making pretty firm requests for unvaccinated blood. So their feelings were strong, but I think they went through different venues to make those requests. Bosch: So patients knew they needed a transplant and their family members were like calling the blood bank saying, “Can you give us unvaccinated blood? “ Sharma: Yes, essentially multiple calls from different people. Bosch: Uh, does that work? Can you call a blood bank and make requests like that? Sharma: No, absolutely not. Any sort of blood modification or request have to go through an ordering physician. And also, currently, regulatory bodies do not require that blood products from collection facilities are labeled specifically based on the vaccination status of the donor. Bosch: So in March, you co-authored a study that got a lot of attention that examined patients in need of blood transfusions who insisted on, to get around this problem, insisted on direct donations from donors they knew were unvaccinated, which I assume would be mostly like friends and family members. So tell us a little bit about the study, about sort of what the design was, what it looks like, and what you found. Sharma: Yes, and this study was motivated again by increasing reports from our blood bank that people were calling and requesting blood from donors who specifically did not receive the Covid-19 vaccination. And these requests are called directed donations, meaning people want a family member or a relative to donate the blood for them because they can ensure or they feel they can insure vaccination status of that loved one. And so we know that there are multiple potential harms of directed donations.Advertisement So we wanted to specifically look at all of the directed donations retrospectively that we had received during the study period. And then we wanted to evaluate which ones were specifically related to concerns about Covid-19 vaccination status. And we also wanted to look to see if there were any potential downstream harms of the direct donation process. Bosch: And so what did you uncover? Sharma: Yeah, we actually found that for the patients who requested or who had requests for directed donations due to concerns about Covid-19 vaccination status, there were delays in medical care, including delays in transfusion for very severe anemia and also delays in surgical care because the process of obtaining a directed donation is not a quick process. Bosch: And how many patients did you look at? Sharma: We performed this retrospective study in 15 patients, and 13 of them were transfused with at least one unit. Bosch: So one unit’s coming from a friend or family member or somebody they knew. Sharma: Yes, coming from a donor that’s their selection essentially. Bosch: That was 15 people within between Jan. 1, 2024, and Dec. 31, 2025, if I remember correctly, which is both a lot and not a huge number. But do you have a sense of how widespread this might be outside of Vanderbilt University Medical Center? Sharma: I think that this practice is probably much more widespread. And in fact, this is sort of a national, I think, fear of Covid-19 vaccinations, especially a fear of mRNA or genetic material transmission. And so I’ve seen other reports of this happening sort of across the country. Bosch: After the study was published, did you hear from other physicians at all? Sharma: did not hear from other physicians personally, but I have seen in the news that this is definitely tracking in multiple areas of the country, Northeast, Southeast, Midwest. Bosch: What are the fears exactly? Like what? They’re afraid of the spike protein, the mRNA, and all those sorts of things get thrown around. But when you really talk to them, what is it that they think is going to happen if they get this blood from a vaccinated donor?Advertisement Sharma: When I talk to patients, their fears about the vaccine are not uniform. Some patients express a fear or they’ve heard talk about infertility associated with the Covid-19 vaccine. Some people have a fear of genetic material transmission and how that might transiently or permanently alter them. Other patients, I think, frame the discussion about bodily autonomy and say they should really have control over what goes in their body and a medical professional or any other outside body shouldn’t really regulate that. Bosch: It almost, you know, just sort of eavesdropping on chatter online as I enjoy doing — it’s a strange hobby — I’ve seen screenshots from like breast milk exchanges in which people expressly say that they are only interested in donor breast milk from unvaccinated donors and people who are selling breast milk are able to command a higher price if they haven’t been vaccinated. And so sometimes it starts to feel almost like there’s these vague health concerns, but also there’s this sort of almost like an identity thing, right? Like “I am unvaccinated and therefore pure.” Does that kind of jibe with the way you hear this at all? Sharma: I think it jibes with the way that I’m hearing this. And also, I think the very strong preferences that are associated with these directed donations, so much so that family members are willing to allow sort of a delay in medical care for their loved one. If it’s a pediatric patient, for example, they’re willing to accept a delay in surgical care or a delay in transfusion for very severe anemia based on this concept of purity. Bosch: For some reason, I had really foolishly assumed that this was all about adult patients. But it’s not, you’re saying. It’s also about child patients. Sharma: It definitely affects pediatric patients. And nine of the 15 patients in the study were pediatric. And when you look at the medical literature, there is increased, I think, attention to this directed donation question of pediatrics because the requests are more common in pediatrics.Advertisement And there’s also the compound ethical question of an adult making a decision that may harm them is one thing, but I think it becomes more ethically complex when there’s a delay in care to a child. Bosch: Right, and so the stakes are higher on both sides then, right? You know, the parents are in their beliefs, right, they need to do this to protect their kid. But on the physician side it’s, “we can’t delay things because you have this kind of like vague objection.” One thing that the study noted was that physicians have been trying to discourage this directed donation approach. Is it often successful when you try to talk a patient out of it? Sharma: [I find that it’s often not successful, and that patients will often say things like, “well, if you won’t provide this care, I will go find this care elsewhere. If you will do this, you know, I had a health care professional in XYZ state who did this for me and I will seek it.” I think one thing that may help to dismantle the strategy is really to get inside the minds of people who have this preference. And so I think that organized focus groups could help. I think you have to understand a person’s belief if you want to address it. And I think that’s where perhaps a systematic approach could really be beneficial. Bosch: And are these people who don’t want blood from a vaccinated donor, are they generally unvaccinated themselves? Sharma: I have found that a number of them are unvaccinated. Bosch: But some of them have been vaccinated? Sharma: I haven’t specifically asked vaccination status of each of them. But I have seen at least two requests where the person requesting was, I suspect, unvaccinated. Bosch: Hmm, that makes sense. Yeah, I was curious if even people who maybe got the first vaccine were now like, regretting it and so didn’t want more vaccination in their blood, so to speak. I mean, it’s interesting, like as a bodily fluid, it seems like we think about blood kind of in different ways than other bodily fluids, right? You know, as the lifeblood, right. Do you think that there’s something sort of special about the way people think about blood that makes them extra cautious or concerned here?Advertisement Sharma: Yes, I do. I have a really great colleague who describes a blood transfusion as essentially an exogenous tissue transplant. And it is because you are receiving blood cells from a different human being. And the blood collection centers are required by regulatory bodies like the FDA to monitor for risks of transfusions such as transfusion, transmitted infection, and other things. But there are a lot of things that we don’t monitor for when patient receives a blood product. For example, the cigarette smoking status of a person isn’t monitored. There have been publications about nicotine transmission and neonates after blood transfusion. So it’s certainly not benign. I think people also think about blood differently because an incompatibility can lead to a fatality pretty quickly. So when I entered the field of transfusion medicine, I was told that blood is more regulated in the hospital than practically any other biological agent, drug, or device. I think people think about it differently because, one, it’s vital for life. Blood transfusions make giving chemotherapy and surgeries possible without fatalities. But also, transfusions need to be done in a safe manner. I think the general public appreciates that any kind of error could lead to a fatality. Bosch: And so I’m looking at this piece that your co-author wrote for STAT back in, oh my gosh, it was almost a year ago. That’s terrifying. So your colleague, Jeremy Jacobs, wrote this piece for STAT back in 2025, touching on this topic before your study was published more recently. And one thing he wrote that was really interesting was the concern that this blood coming from a directed donor could actually be riskier for patients than blood coming from a donor who may or may not be vaccinated. Can you talk a little bit about some of the ways this could be risky beyond possibly delaying care? Sharma: Yes, certainly. Directed donations do come with a number of different risks. For example, if you ask a loved one to donate their blood to you, they may engage in risky behaviors, such as multiple sexual partners or IV drug abuse or other things that may increase their risk of transmitting an infection to you as the recipient.Advertisement When you’re a first-time donor, infectious disease screening is completed, but there’s always a window period to any kind of infection, and there is a probability that an infection may not be detected on the standard screening for transfusion transmitted infections. So there are published data already that demonstrate a higher risk of transfusion-transmitted infection. If I’m your aunt and you ask me to donate, I’m going to be too embarrassed to admit to some of my riskier behaviors. And there is a screening donor questionnaire, but it’s only as good as the person answering it is truthful. So there’s that component as well. And then another challenge is relatives have shared HLA homology. Some of their HLA proteins are similar. And because of that, it increases the risk of a transfusion reaction called transfusion associated graft versus host disease. And that’s a pretty fatal transfusion reaction without an emergent stem cell rescue procedure. And what happens with transfusion associated graft versus hosts disease, it’s like a Trojan horse effect. If we’re sisters and I give you my blood, we have enough shared HLA protein that you may not recognize my T cells as foreign in the blood product, but my T-cells or immune cells recognize you as foreign because there’s still some HLA discrepancies. So that can mount a very severe attack on your own tissues by the T cells or immune cell. That transfusion risk can be mitigated by irradiation, but not all facilities, especially smaller hospitals, have irradiators on site. And that irradiation step is really critical to prevent that potentially fatal transfusion reaction. Bosch: And especially since the idea here is these patients or their families, if the patient themselves is unable to take part in these discussions, they think that it’s so much safer for this to come from their family member. But in fact, it’s more dangerous for them. When you explain that, do they understand it or do they sort of just not believe you when you say that this comes with its own complications, getting blood from a relative?Advertisement Sharma: The response I often get is, “this has previously been done for me. I had XYZ health care professionals who have done this for me, and if you won’t do it, I’ll find someone else who will do it.” Bosch: And when they say that, when they say, “I’ll find someone else,” can they find someone else usually? Like are these often circumstances in which they could just walk out the door of Vanderbilt Medical Center and walk in the door somewhere else? Or is it more difficult than that? Sharma: I think they can find someone else because currently, most institutions don’t have standardized policies about this. So it’s really left at the hands of the individual clinician to counsel about the risks and benefits of a directed donation. And I will admit that all physicians receive some training about blood transfusions and blood transfusion safety, but certainly directed donations is typically not covered in most specialties outside of transfusion medicine. So the clinician receiving the request may not know about the risk-benefit ratio of directed donations, which is an added factor. In fact, many hematologists have limited familiarity with the risk benefit ratio of direct donations. That factor, in addition to the fact that most places don’t have institutional policies on directed donations, I do think it would be probably fairly easy for someone to go elsewhere. Bosch: Do you think that more institutions or any institutions should have policies about directed donations? Sharma: I think institutionalizing a policy has multiple benefits. One, I think if a physician has counseled a patient about the risks of directed donation, I am concerned about risk of transfusion transmitted infection. I’m concerned that there may be a delay in your transfusion or surgical care because of this practice. There’s no predictability of when the unit will arrive. It can arrive after the scheduled surgery. I think, if a physician has concerns about a directed donation and the patient’s safety, if there’s an institutional policy, it takes the complete onus off of the individual health care professional and they can lean on a broader policy where multidisciplinary stakeholders like physicians from different specialties like transfusion safety officers, quality officers, ethicists, where a whole body of people has really given thought to it and organized an approach. So I think there is that benefit to an institutional policies.Advertisement Bosch: So you conducted this study over basically the course of two years with 15 patients. It ended at the end of 2025. Since that period ended, have you continued to see patients requesting unvaccinated blood? Sharma: The requests have continued. I haven’t looked at it sort of over the last month, but certainly there are continued requests for directed donations or blood products from a family member or a friend. Bosch: So, you know, even though we’re now six years past the start of the pandemic, the sort of idea of fear of the of the Covid vaccine is still really prevalent in some people’s minds. Sharma: Definitely prevalent, and not all of the situations do people specifically mention the Covid-19 vaccine, but I think the fear is still definitely prevalent. Bosch: Now, before the pandemic, would people also make these directed donor requests? Sharma: Yes, before the pandemic people did make these requests, especially in pediatric patient populations because people wanted to, I think with their own child, they were more cautious or concerned about the blood products that their child was receiving. Bosch: Were some of them perhaps concerned about the children with hemophilia who received HIV from transplants back in the ’80s? Or is it kind of vaguer than that? Sharma: I think it’s vaguer than that. I do think the general public understands that the risk of HIV transmission from transfusion is low at this point. Bosch: What would you like to see happen next? I mean, so you mentioned policies. Are there any things you would like to see physicians do differently, any recommendations you have for them on how to address these patients? I guess one reason I ask that is you say you looked at 15 patients over this period for the study who wanted directed donations. Thirteen got them, so two did not. Were you then, does that mean you and your colleagues were successful in convincing the other two not to go ahead with the directed donation? Sharma: No, in these cases, there wasn’t any successful swaying of opinion. When I think about next steps, I think that because there is a lapse in knowledge about the potential risks of directed donations among many of the specialties that are going to receive these requests, I do think something that could help is education of specialties, especially surgery, anesthesia, hematology, oncology. These are specialties where patients that typically use a lot of our blood inventory. So I think education about the risks is helpful. I do think if patients request directed donations, providing them with some sort of written handout about the potential risks too is important, including the risk that the blood product may — it’s going to a blood collection facility, it may not even be available at the time of surgery, so this could lead to worsening anemia, a cancelation of their surgery. I don’t know if most patients understand these risks when they request the product. So I think that education of both patients and health care professionals outside transfusion medicine is important. I also think that, like I mentioned before, I do think focus groups are important to understand the root causes because I do they’re heterogeneous. Like some patients want pure blood. Some patients have a, “is this DNA gonna morph me?” concern? And some patients have unrelated concerns. So I think we do need to understand the heterogeneity and understand where our patients are before we can dismantle any type of beliefs that may lead to a blood transfusion that could harm them. And lastly, I think the biggest thing that would help is if professional societies continue to make statements and recommendations for policies. There’s certainly some indications where directed donations are important. Especially for example, if a patient has antibodies to a rare blood group antigen and the only compatible donor is a mom or dad or sister or brother, those are situations where we should consider directed donations. So I do think that having institutional committees with transfusion medicine physicians and transfusion safety officers and ethicists, to I think delineate those situations, is important. That way, I think the onus isn’t just on one health care professional, because patients can be very persistent or very sort of insistent. And I think that can stress the individual. And so that way, the whole burden, the whole heavy rock is not on one person’s shoulder at one particular time. Bosch: Yeah, you’re saying that reminds me as we start to wrap up of how we opened, which was you saying that many times patients don’t bring this up initially to the physician, they bring it up to nurses or at the blood bank. So, I mean, any particular thoughts about how to support those sorts of folks on the front line of hearing these requests initially? Sharma: Yeah, sure. I think those calls to the blood bank are definitely very stressful because the patients are insistent, “this is what I want.” They cannot administer blood products with modifications without written physician orders. So it puts, I think, a tremendous onus on them to do something that they can’t do. So I do think that having institutions having policies that are sort of well thought out, well organized, developed by multidisciplinary stakeholders would really help to support them. Because then rather than say, we can’t do that, they can refer to, we have an institutional policy on this topic. Bosch: Well, Deva Sharma, thank you so much. This is really fascinating. Sharma: Thank you so much, Torie, for interviewing me today. This was a great discussion. Bosch: And thank you for listening to the “First Opinion Podcast.” It’s produced by Hyacinth Empinado. Alissa Ambrose is the senior producer and Rick Berke is the executive producer. You can share your opinion on the show by emailing me at first.opinionatstatnews.com. And please leave a review or rating on whatever platform you use to get your podcasts. And until next time, I’m Torie Bosch, and please don’t keep your opinions to yourself. children’s health, ethics Submit a correction requestReprints Torie Bosch Editor, First Opinion Torie Bosch is the First Opinion editor at STAT. Newsletter Weekly alerts when a new episode drops from STAT’s First Opinion podcast Recommended First Opinion June 1, 2026 The military’s medical corps has a serious recruitment problem First Opinion June 1, 2026 Medical schools diversified. So where are all the diverse doctors? Advertisement First Opinion May 29, 2026 I’m a weight-loss doctor. Here’s why I worry about GLP-1 ‘microdoses’ First Opinion May 28, 2026 Ebola at the World Cup? Here’s what we should actually worry about First Opinion May 27, 2026 MIT president: Why so many optimistic scientists are losing heart Subscriber Picks