The testing of blood donors for TTIs before they donate blood (pre-donation testing) is the subject of debate. It is sometimes considered to be a cost-saving measure, particularly in high-prevalence situations. However, pre-donation testing of the donor does not ascertain the infectious status of the donation and will need to be followed by tests on the blood sample collected during the blood donation process. Pre-donation testing may lead to a wastage of resources and increased screening costs unless prevalence is extremely high. It increases the time taken for a donor to donate blood, causing undue inconvenience to donors, and also the risk of discrimination and stigmatization. The practice of pre-donation testing could undermine the long-term development of a sustainable blood donor programme based on well-selected voluntary non-remunerated blood donors who donate regularly.

All screening of blood donations for TTIs should be carried out only on samples taken during the donation process and in a quality controlled environment. In an effective national blood screening programme, pre-donation testing of blood donors has limited applicability. In settings where the prevalence of an infection is very high and donor selection would not be effective in reducing prevalence in first-time donors, pre-donation testing may be useful as an interim strategy while building a stable pool of regular voluntary non-remunerated donors.