How do I refer a potential milk donor to the milk bank?
The checklist below is intended to help staff caring for families to discuss the possibility of donating breast milk. It is important to make the family aware that the milk bank has strict criteria for milk donation so cannot always accept milk. The questions below are basic screening questions and a more detailed screen will be undertaken by milk bank staff following a referral.
| Referring Health Professional Name & Contact Details |
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| Donor Name, Address & Telephone Number |
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| Comments |
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| SCREENING QUESTIONS | Yes / No | Notes |
| Are you in good health? | ||
| Do you smoke or use nicotine replacement therapy including patches, chewing gum or inhalators (vaping)? | If yes = milk bank unable to accept milk | |
| Do any members of your household smoke? | If yes = milk bank unable to accept milk | |
| While expressing the milk, did you take any medication? Please note we may be able to accept milk from 3 days after finishing medications. | Please include information about all medications taken, some may be compatible with donation and others may not | |
| Do you drink more than 1 to 2 units of alcohol, once or twice a week? | If yes = milk bank unable to accept milk | |
| Was the milk expressed in the last 10 weeks? | If no = milk bank unable to accept milk | |
| Was the milk frozen with 24 hours of expression? | If no = milk bank unable to accept milk |
If you are discussing breast care choices after the loss of a baby with a family you may find the leaflet below “Lactation After Loss: Your Breast Care Choices” helpful as well as the “Donation After Loss” leaflet. Please download and distribute to staff if you feel the leaflets are helpful, we can also provide printed copies on request.
You may also find it helpful to visit our Memory Milk Gift – Donation After Loss pages.