Donated breast milk (DHM) is human milk expressed by a lactating mother for use by an infant who is not her own. This resource is often medically necessary for critically ill or premature infants whose survival and development depend on human milk’s unique properties. Human Milk Banks (HMBs) serve as the primary regulated source, collecting, screening, and processing this milk to ensure its safety. Accredited banks employ extensive safety measures, allowing hospitals to provide the nutritional and immunological benefits of human milk when the mother’s own supply is unavailable or insufficient.
Formal Milk Banking Versus Informal Sharing
The safety of donated milk hinges entirely on its source, creating a significant distinction between milk acquired through a regulated Human Milk Bank and milk from informal sharing networks. HMBs accredited by organizations like the Human Milk Banking Association of North America (HMBANA) operate under strict, evidence-based guidelines covering every step from donor selection to final distribution. This regulated process ensures the milk is rigorously tested and treated to eliminate pathogens.
Informal milk sharing lacks formal safety oversight, introducing significant risks to the recipient infant. Informally acquired milk is typically unpasteurized and has not been tested for bacterial contamination or communicable diseases. There is also a risk of the milk being adulterated with formula or containing unapproved medications, alcohol, or other substances from the donor’s lifestyle.
Screening Protocols for Donors
The first layer of safety in formal milk banking is the comprehensive screening of the mother, ensuring the donor meets stringent health and lifestyle requirements. This process begins with an in-depth verbal interview and a written questionnaire covering the donor’s medical history and current health status. Staff inquire about recent illnesses, blood transfusions, organ transplants, and any history of chronic infectious diseases.
Lifestyle Assessment
A thorough lifestyle assessment is also conducted, leading to automatic deferral if the mother smokes, uses illegal recreational drugs, or consumes alcohol regularly. The use of most medications, vaccines, or herbal supplements requires careful review or may result in a temporary or permanent deferral. This initial screening ensures only healthy individuals with low-risk profiles are considered for donation.
Serological Testing
The final step in donor qualification is mandatory serological blood testing, performed by a certified laboratory. This testing screens for major communicable diseases that could be transmitted through breast milk, including Human Immunodeficiency Virus (HIV-1 and HIV-2) and Human T-lymphotropic Virus (HTLV-I and HTLV-II). Testing also screens for Hepatitis B and C, as well as Syphilis, confirming the donor does not carry these infectious agents.
Processing Procedures to Guarantee Safety
Once milk is accepted from an approved donor, it undergoes a complex laboratory process to guarantee microbiological safety before dispensing. The donated milk is first pooled into large batches, often combining milk from several donors to create a more consistent nutritional profile. This pooled milk is then filtered to remove any residual debris or sediment introduced during home collection.
Holder Pasteurization
The pooled, filtered milk is then poured into bottles and subjected to Holder Pasteurization (HoP). This validated thermal method requires the milk to be heated to a precise temperature of 62.5°C (144.5°F) and held for 30 minutes. This time-temperature combination is highly effective at inactivating the vast majority of bacteria and viruses like HIV, while retaining much of the milk’s beneficial immunological components.
After the 30-minute pasteurization period, the milk is rapidly chilled and immediately frozen for storage. The final safety step is post-pasteurization microbiological testing of a sample from every batch. This culture test confirms the absence of viable bacteria, and only batches that show no bacterial growth are approved for distribution.
Medical Indications for Receiving Donated Milk
Donated human milk is a prescribed medical intervention reserved for infants whose health outcomes are significantly improved by its use. The primary recipients are premature infants, especially those born weighing less than 1500 grams, who have immature digestive and immune systems. For these fragile infants, human milk provides easily digestible nutrients and protective components.
The most compelling medical indication is the dramatic reduction in the risk of Necrotizing Enterocolitis (NEC), a devastating intestinal disease common in premature babies. The immunological and anti-inflammatory properties in human milk help mature the gastrointestinal tract and establish a healthy gut microbiome, protecting against NEC. Donor milk is also used for infants with severe intestinal disorders, congenital heart disease, or other high-risk neonatal conditions where formula tolerance is poor.