Donor retention and return patterns in Saudi Arabia : Implications for blood safety and supply stability

BACKGROUND: Sustaining a safe and sufficient blood supply requires not only recruiting first-time donors but also retaining them over time. In Saudi Arabia, donor retention remains poorly understood, with limited data on return behavior, demographic influences, and temporal trends. This study aims to evaluate patterns of donor return at a tertiary hospital in Saudi Arabia and explore implications for blood supply stability. MATERIALS AND METHODS: This is a retrospective observational analysis of 48 241 blood donations by 38 562 unique blood donors at King Fahd Armed Forces Hospital from November 2019 to November 2024. Donors were classified as first-time or repeat donors based on donation frequency. Inter-donation intervals, monthly donation trends, and seasonal influences (Ramadan and Hajj) were assessed using descriptive statistics and chi-square tests. RESULTS: Only 13.2% of donors returned for a subsequent donation, yet these repeat donors contributed 30.6% of all blood units. The average inter-donation interval was 455 days, with 29.2% returning after more than 500 days. Significant seasonal variation was observed in which repeat donation rates declined during Ramadan (27.1%) and Hajj (29.5%) compared to other months (31.0%) (p < 0.0001). Demographically, older age was positively associated with repeat donation, while female participation remained low. CONCLUSION: Donor retention in Saudi Arabia is low and characterized by wide variability in return timing. These findings underscore the need for structured, behaviorally informed retention strategies. We propose a relationship-centered strategic framework to improve donor engagement, leveraging personalized communication, cultural inclusivity, and temporal targeting to enhance blood supply resilience.