For Healthcare Professionals
Safety of donor milk
Donor health screening
Donor mothers are screened verbally and by written survey for lifestyle and medical history, as well as medication and herbal supplement usage, according to HMBANA guidelines. This screening follows American Association of Blood Bank (AABB) guidelines, wherever applicable to human milk.
Serological screening for HIV/I/II, HTLV I/II, Hepatitis B and C, and syphilis must be negative at the time of donation. Donated milk is pumped at home and frozen before donation. Once delivered to the Milk Bank, it is kept frozen at -20 degrees C. until thawed for processing. Mothers donate their milk to the Milk Bank on a volunteer basis and do not receive financial compensation.
Many women are eligible to donate, but many are also excluded – even if they are breastfeeding their own infants. It is assumed that the fragility of the infant receiving donor human milk necessitates careful scrutiny of the health and medical status of the donor, and avoidance of anything that would burden the already compromised recipient. Some of the reasons for deferral include:
- medication use
- herbal product use
- tobacco product use
- illegal drug use
- risks for HIV or hepatitis, including obtaining tattoos, body piercings, or acupuncture with non-sterile needles, or the receipt of a blood transfusion within the past year
- risks for Kreutzfeld Jakob Disease
- daily alcohol use
All donor applications are reviewed by the clinical director prior to acceptance. Some medications (such as progestin-only birth control pills or low-dose estrogen OCPs; thyroid replacement hormone; insulin; prenatal or multivitamins; and iron or calcium supplements) are acceptable. Donor mothers are temporarily deferred if they require other medications for short periods.
Milk is target pooled from one to three donors, to assure an acceptable nutritional content and a variety of immune factors. Milk intended for hospitals will contain a minimum of 20 kCal/ounce. Pools of milk with 22 and 24 Kcal/oz. will also be processed and available to hospitals.
The milk processing protocol includes these steps, using clean technique throughout:
- Frozen donor milk is thawed and nutritionally analyzed using a Foss MilkoScan FT 120, full-spectrum infrared spectroscopy. This equipment provides fat, lactose, and protein content of the milk, allowing for specific pooling to ensure adequate calories and protein content.
- Milk is cultured, pooled, and aliquoted into bottles.
- Bottled milk is then pasteurized at 62.5 degrees C.
- Microbiological cultures are obtained by an independent laboratory from individual donors’ deposits prior to pasteurization and pooling, to verify that no heat-resistant pathogens are present.
- Microbiological cultures are obtained from each batch of milk after pasteurization, to verify that there is zero growth of bacteria after the heating process.
- Milk that cultures positive post-pasteurization is discarded. Only milk that remains negative for 48 hours is dispensed.
- Pasteurized milk bottles are labeled with an expiration date 12 months after the earliest expression of milk in the pool, in addition to the batch number and pool number of the milk. Labels on milk sent to hospitals also contains Kcal/oz. and protein levels.
- Pasteurized milk bottles remain sealed with a tamper-evident cap until opened by the hospital staff or outpatient guardians who are preparing to feed an infant.