Donor human milk is a valuable product used to support the most vulnerable infants, primarily premature or critically ill infants in hospital neonatal intensive care units (NICUs). This milk provides easily digestible nutrients and immunologic components that significantly reduce the risk of serious conditions like necrotizing enterocolitis. The safety of this donated milk is safeguarded by non-profit milk banks, which adhere to rigorous standards established by organizations like the Human Milk Banking Association of North America (HMBANA). This process requires comprehensive donor screening to ensure the milk is safe for fragile recipients whose immune systems are underdeveloped. Potential donors must successfully navigate a multi-step screening process that mirrors the stringent requirements for blood and tissue donation.
Screening for Infectious Disease
Disqualifiers for milk donation involve active or historical infectious diseases that can be transmitted through blood or bodily fluids. Milk banks require all prospective donors to undergo a blood test panel to screen for specific pathogens. This mandatory serological testing includes screening for Human Immunodeficiency Virus types 1 and 2 (HIV-1/2) and Human T-lymphotropic Virus types 1 and 2 (HTLV-1/2). A positive result for any of these viruses, even if the donor is currently healthy, results in permanent exclusion from the program.
Testing is also performed to detect the presence of Hepatitis B and C viruses, both of which pose a serious risk of transmission to the infant recipients. A syphilis screening is included in the required blood work to detect this bacterial infection. Any positive result on this initial blood panel is an immediate and permanent contraindication to donation, regardless of whether the donor is currently receiving treatment. The blood test serves as the definitive barrier against major viral and bacterial contamination.
Beyond permanent exclusions, certain acute illnesses require a temporary hold on milk donation until the donor is fully recovered and symptoms have resolved. A donor experiencing an active viral infection, such as the influenza virus or a common cold, must stop pumping for donation until they have been symptom-free for a specified period. Acute gastrointestinal infections also necessitate a temporary deferral to prevent any potential contamination of the milk supply.
Donors with active cold sores or other herpes simplex virus lesions must also temporarily stop donation until the outbreak has cleared completely. This precaution is taken because the herpes virus can be shed and potentially contaminate milk during collection, posing a risk to the fragile infants receiving the product. Milk banks maintain ongoing communication with approved donors, requiring them to report any changes in their health status or household illnesses so that appropriate temporary deferrals can be put in place.
Medication and Substance Use Restrictions
The use of certain substances and medications is a primary area that leads to either temporary or permanent disqualification because of the potential for transfer into the human milk. Absolute disqualifiers include the use of any illegal or recreational drugs, including cannabis, even in states where its use may be legalized. The presence of these substances in the milk poses an unacceptable risk to the neurological development of vulnerable infants.
The use of tobacco products, including cigarettes, cigars, and any form of nicotine replacement product, automatically disqualifies a donor from the program. Nicotine and its metabolites readily pass into human milk and can have negative effects on the infant’s cardiovascular and sleep systems. Therefore, milk banks require donors to be completely free from nicotine exposure to ensure the milk’s purity.
High daily consumption of alcohol is a permanent disqualifier. Even moderate alcohol intake requires a specific waiting period before the milk can be collected for donation. Donors must be able to confirm that they have not consumed alcohol for a set number of hours prior to pumping for donation, ensuring that no residual alcohol is present in the milk. This restriction is based on the principle that even small amounts of alcohol can be harmful to a small infant.
Many prescription and over-the-counter medications require review by the milk bank’s medical director before donation can proceed. Chronic use of certain medications, such as immunosuppressants or specific psychiatric drugs, often results in permanent disqualification because of the drug’s known contraindication for infants. Medications that are generally considered compatible with breastfeeding, such as acetaminophen or ibuprofen, are typically acceptable. However, high-dose or long-term prescription medications and certain herbal supplements, like fenugreek, necessitate a detailed review and may require a temporary hold or a complete deferral. Milk banks require a complete list of all medications and supplements a donor is taking to make an informed, case-by-case determination based on infant safety.
Exclusions Based on Medical History and Recent Procedures
A donor’s past medical history and recent procedures are carefully reviewed to identify potential risks that may not be apparent in a current health screening. Receiving a blood transfusion or blood products within a specific timeframe, typically within the last four to twelve months, results in a temporary exclusion. This deferral period is necessary because a transfusion carries a small, residual risk of transmitting an infectious agent that may not be detectable immediately after the event.
Similarly, a recent organ or tissue transplant, including a corneal transplant or skin graft, is a disqualifying factor for a period of at least twelve months. The donor must be past the established incubation period for potential infectious diseases associated with transplantation. New tattoos, permanent makeup, or body piercings received within the last twelve months also result in a one-year deferral because of the small risk of bloodborne infection exposure during the procedure.
Certain chronic health conditions that require complex medication regimens can also lead to exclusion, especially if the treatment protocol is incompatible with infant safety. For example, a history of cancer within the last three years or ongoing treatment for certain autoimmune disorders may result in disqualification. These exclusions are often related to the necessary use of high-risk medications rather than the condition itself.
Recent travel to areas where certain infectious diseases are endemic also triggers a mandatory waiting period before milk can be donated. This includes travel to regions with active outbreaks of diseases like Zika or where the risk of Creutzfeldt-Jakob disease (CJD) is higher, based on specific historical criteria. These travel-related deferrals ensure that a donor is not in the incubation period for an illness that could be transmitted through the milk.