SAFETY WITHOUT SHORTAGES: BALANCING NAT-DRIVEN DEFERRALS WITH BLOOD AVAILABILITY IN SOUTHWEST NIGERIA

Abstract

The adoption of nucleic acid testing (NAT) in Nigeria presents a critical challenge: balancing the significant improvement in transfusion safety with the risk of exacerbating blood shortages. This is particularly acute in a high-transfusion-transmitted-infection burden setting like Southwest Nigeria, where fragile supply chains and a reliance on replacement donors complicate the process. This review analyzes the impact of NAT-driven donor deferrals on blood availability through a narrative synthesis of literature from 2010 to 2025. Findings indicate that while NAT effectively shortens the serological window period and reduces residual risk, its use in this HBV-endemic context leads to increased deferrals. This can transiently shrink the donor pool and worsen shortages, especially in systems lacking component separation, patient blood management, and robust quality systems. To address this, a three pillar framework is proposed, integrating a resilient donor base, system efficiency through measures like mini-pool NAT and patient blood management, and enabling policy and governance including accreditation and sustainable financing. The conclusion is that safety without shortages is achievable if NAT adoption is phased and embedded within comprehensive donor, system, and policy reforms that are tailored to local epidemiology and capacity.