Construction of a decision model for donor testing in cases of suspected antibody‐mediated transfusion‐related‐acute‐lung‐injury

Abstract

AbstractObjectiveTo propose a rational basis for donor testing in cases of suspected antibody‐mediated transfusion‐related lung injury (AMT).BackgroundAnti‐leukocyte antibodies in donated blood are established causes of transfusion‐related lung injury (TRALI). However, the question of whether to test donors for antibodies is not identical to whether the case meets definition criteria for TRALI. There is a balance between the potential benefits of testing and the costs of donor deferral and investigation. We propose that a decision‐making process based on optimising the balance between risk and benefit requires a subjective choice of the relative value of different outcomes of testing.MethodsWe have developed a formal decision model to illustrate how these choices affect testing decisions.ResultsUsing a Bayesian probability model, we show that the diagnostic benefit and TRALI prevention benefit of testing donors have a complex interrelationship with the number of implicated donors and clinical suspicion of antibody‐mediated TRALI (AMT) and that rational testing choices vary according to value assigned to outcomes.ConclusionsThe challenges to the use of a formal decision model for clinical testing are discussed and conclude that a formal model is a useful consensus‐building tool for improving consistency and openness in decision making.