Evaluating Australia's plasma pathway and rethinking transgender donor sexual activity restrictions: Zero donor detections of transfusion-transmissible infections in 6 months following changes to source plasma donation eligibility for sexual activity and HIV pre-exposure prophylaxis.

BACKGROUND AND OBJECTIVES: Sexual activity-based blood donation restrictions aim to reduce incident transfusion-transmissible infections (TTIs) but are not required for source plasma because of additional pathogen reduction. On 13 July 2025, Australian Red Cross Lifeblood introduced a plasma pathway (PP) allowing previously ineligible individuals to donate source plasma irrespective of recent sexual activity or human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) use. This study describes donor demographics and donation prevalence of tested TTIs from the program's first 6 months. Separately, associated PP changes facilitated a contemporary TTI prevalence estimate among transgender donors during this period. MATERIALS AND METHODS: Descriptive demographics and TTI results were extracted from identified cohort donors from 13 July 2025 to 13 January 2026. TTI prevalence (per 10,000 plasma donations) was estimated by detected TTIs divided by the total number of donations. RESULTS: The PP supported 6673 donations from 7832 attendances by 3465 donors over 6 months. Zero (upper 95% confidence limit 6.94 per 10,000 donations) cases of HIV, hepatitis B virus or hepatitis C virus were detected. New donors constituted 40% of PP donors. Donations were predominantly from men reporting sex with men without (48%) or with PrEP use (30%). No TTIs (0, upper 95% confidence limit 25.76 per 10,000 donations) were detected from transgender donors during this period. CONCLUSION: TTI prevalence was lower than predicted. The PP demonstrates an inclusive way to limit restrictions on sexual activity and PrEP use without changing the safety profile. Other blood services should consider its introduction.