While transfusion management in patients with IgA deficiency is not a new concept, it is not without controversy. Inconsistent definitions of IgA deficiency and the nature of its relationship to anaphylactic reactions raise ongoing questions about effectively identifying and managing truly at-risk patients. Severe or absolute IgA deficiency is determined by a serum or plasma IgA level of < 0.05 mg/dL. However, most clinical IgA tests have a lower limit of detection of 5-7 mg/dL, making donor and patient testing challenging. Furthermore, not all patients with absolute IgA deficiency have anti-IgA antibodies associated with anaphylactic transfusion reactions. Also, not every patient with anti-IgA antibodies has severe IgA deficiency. The American Rare Donor Program (ARDP) frequently receives requests for IgA-deficient blood products, but requests are not always clinically indicated. Fulfilling such requests involves numerous operational and logistical challenges. Moreover, the decline of registered donors with absolute IgA deficiency due to age and limited screening for new donors is exacerbating inventory challenges. During this session, we will discuss the indications for ordering IgA-deficient products, introduce the ARDP algorithm for addressing these requests, and examine the associated challenges. We will also present a hospital-based blood center perspective on managing patients and donors with IgA deficiency and transfusion support options when IgA-deficient products are unavailable. Additionally, we will explore the considerations for donor screening and the importance of efficient communication between testing laboratories, blood centers, and the ARDP in identifying donors with IgA deficiency.