LAUSR

About 10% of the nation’s blood supply is collected from 16and 17-year-olds at high schools, comprising more than 1 million donations.1 Although blood donation is generally well-tolerated and benefits many donors with a sense of altruism, teenagers are at greatest risk of donation-related syncope and iron depletion. Many states recognize the importance of involving parents in decisions that affect their teenager’s health and require parental permission for 16and 17-year-olds to donate blood. Yet there is no national standard nor uniform requirement for parental permission for minor blood donors. A patchwork of laws, regulations, and voluntary standards has led to inconsistent practices across the United States. For example, 16-year-olds who are not old enough to donate blood in some states can donate blood with permission from parents or guardians in others or can donate without parental notification in still others. Moreover, state laws that govern voluntary blood donation by minors do not address their participation in research studies, which are covered by a different set of federal regulations.2 Because blood donors are often included in research studies, a universal standard to inform parents and obtain permission for minors to donate and participate in research should be considered. Currently, there are disparate practices regarding parental notification and permission in different states. To be accredited by the AABB, blood collectors must comply with 16 years as the minimum donation age or “as defined in applicable state law.” Almost all state laws allow 17-year-olds to donate blood, but 5 require either parental permission or notification (Table). Conversely, the laws in 37 states and Washington, DC, allow 16-yearolds to donate blood, but 5 require no parental permission. This situation evolved during the last 10 years as state legislatures acted to allow donation by 16-yearolds without modifying existing legislation allowing 17year-olds to donate without parental permission. This double standard may have stemmed from the mistaken belief that blood donation was as safe for adolescents as it is for adults. Although the risks are low for all donors, the odds of syncope-related injury after donation for a 16or 17-year-old are 2.5-fold higher than the risk for 18and 19-year-olds and 14.5-fold higher than the risk for adults 20 years or older, even after taking into consideration first-time donation status and other predisposing factors.3 Moreover, iron deficiency is prevalent among teenagers and aggravated with blood donation.4,5 Because of the different state laws and disparate practices at high school drives, many parents are not informed about blood donation and may not be aware of its possible implications. Moreover, state laws that govern voluntary blood donation do not address participation of minors in research studies, many of which are appended to the donation process. For example, different blood centers in the same state involved in the same research study have taken opposite approaches toward parental permission for consenting minors who donate blood. Whereas state laws address volunteer blood donation, federal regulations protect minors as research subjects and require that adequate provisions are made for soliciting not only the child’s assent but also the permission of the parents when the research involves minimal risk not greater than encountered in daily life or routine physical tests.2 Federal regulations define children as “persons who have not attained the legal age for consent to treatments or procedures involved in the research.”2 Most states consider individuals younger than 18 years as minors or children, unless certain exceptions apply. For example, some types of research are exempt from informed consent requirements entirely, such as use of deidentified blood samples or anonymized information collected during routine blood donation. But other exemptions from consent or parental permission that allow minors to participate in research are generally not encountered at typical high school blood drives (ie, emancipated minors, suspected child abuse, or public service programs such as prevention or treatment of sexually transmitted diseases). Blood donors are healthy volunteers, not patients, yet some institutional review boards have concluded that juveniles donating blood in states that do not require parental permission for blood donation can similarly consent to research studies involving minimal risk without their parents’ permission. We reject this view and recommend that blood collectors should instead inform parents about voluntary blood donation and participation in research. Potential donation-related complications should be considered in the context of academic schedules, competitive athletics, and novice drivers. Only parents and guardians have sufficient insight into their dependent children’s lives to weight these risks. Parental involvement might help better prepare adolescents for blood donation and how to cope with adverse effects or otherwise provide an opportunity to influence susceptible adolescents who should best decline or postpone the donation. Equally important is the potential effect of an investigational test or intervention performed under a research protocol on their teenager’s health or the possibility that the study will identify the need for additional testing, medical evaluation, or treatment. Examples of such research conducted on blood donors include investigational tests for emerging transfusion-transmitted diseases or treatment of blood donation–related iron depletion. Including parents in the informed consent process also accomplishes important community outreach and broader education about blood donation in general and public health issues in particular. A few blood collectors or school districts have addressed the gap by requiring parental permission for VIEWPOINT