Donor milk is a resource for vulnerable infants, especially those born prematurely or with serious medical conditions in neonatal intensive care units (NICUs). These recipients rely on the nutritional and immunological benefits of human milk for optimal growth and protection. Due to the fragile health of these infants, rigorous screening ensures the safety and purity of donated milk. Medication use by a potential donor is the most common factor requiring detailed review and is subject to strict safety standards.
Standard Non-Medication Donor Requirements
Potential donors must meet specific baseline health and lifestyle criteria established by official screening bodies. Donors must be in good health, confirmed by their healthcare provider. This includes comprehensive blood testing to rule out infectious diseases transmissible through milk, such as HIV, Hepatitis B and C, and Syphilis.
Lifestyle factors are also reviewed to ensure milk safety. Donors must not use tobacco or nicotine products, illicit drugs, or recreational drugs. Daily alcohol consumption is disqualifying, and a waiting period is mandatory after occasional alcohol intake. Women who have received a blood transfusion within the preceding four months, or an organ or tissue transplant within the past year, are temporarily deferred.
Principles of Drug Transfer into Breast Milk
Strict safety standards are based on the scientific understanding of how medications move from the bloodstream into breast milk. Medications typically enter the milk through passive diffusion. The degree of transfer depends on the drug’s properties. Drugs with high molecular weight, high protein binding, or low lipid solubility are less likely to pass into the milk significantly.
The Relative Infant Dose (RID) is the metric used to assess potential infant exposure. It compares the infant’s estimated dose from the milk to the mother’s weight-adjusted dose. A RID over 10% may raise concern, but reviewers also consider the drug’s oral bioavailability and the infant’s ability to metabolize it. Medications safe for healthy, full-term infants may be unsafe for premature or critically ill recipients. These fragile babies have immature liver and kidney function, making them susceptible to the effects of trace amounts of medication.
Medications That Automatically Disqualify Donors
Due to the vulnerability of recipient infants, some pharmacological agents result in automatic deferral from donation. Any use of illegal or recreational drugs, including marijuana, is an immediate and permanent disqualifier. A history of chemotherapy or radiation treatments also permanently excludes a donor due to the high toxicity and persistence of these agents.
Certain classes of long-term prescription medications also result in deferral, which may be temporary or permanent. Complex psychiatric medication regimens, especially those affecting the central nervous system, are generally not permitted due to the risk of sedation or neurological effects. Immunosuppressants and medications for conditions like inflammatory bowel disease or an overactive thyroid gland are typically disqualifying. While common drugs like acetaminophen, ibuprofen, and certain asthma inhalers are acceptable, many other over-the-counter drugs, sedatives, and herbal supplements require a mandatory waiting period or exclusion.
The Milk Bank Medical Review Procedure
The eligibility process when medication is involved is highly structured. It begins with the donor’s honest disclosure of all substances used, including prescriptions, over-the-counter drugs, vitamins, and herbal supplements. The potential donor then undergoes a verbal interview and completes a written medical and lifestyle questionnaire.
The milk bank’s specialized screening staff, often including a medical director, reviews the information against current medical literature and safety guidelines. They may contact the donor’s prescribing physician and the baby’s pediatrician to confirm health status. If a medication poses a risk, the donor may face a temporary deferral, such as waiting after a course of antibiotics, or a permanent exclusion.