The Commercialisation of Blood Donation and Its Benefits

Blood is perhaps the most significant resource a person needs to survive. Human blood is an essential component of human life and there are no substitutes to it. Availability of safe blood and blood products is a critical issue in improving health care. And it can only be obtained from the individuals who are generous enough to donate it.

Why to donate blood? Answer to this is very simple – safe blood saves lives and improves health. Blood transfusion is a life saver playing a pivotal role in medical interventions and health care system including major surgeries, trauma, genetic blood disorders and organ transplantation; even blood transfusion is a major part of disaster preparedness. Millions of lives are saved each year through blood transfusions, but the concern is quality and safety of blood transfusion particularly in the developing countries.

The blood which is donated can be regenerated by the body in merely 4-6 weeks but in return provides life to various people as a single donation can potentially save up to 3 lives.

Blood donation is not only advantageous for the receiver but also for the donor because it comprises various health benefits as it helps in lowering the risk of cancer. It is beneficial in reducing the risk of heart and liver ailments by iron overload and thus prevent hemochromatosis. It stimulates the production of new blood cells and hence helps in maintaining good health. The collection of blood from voluntary, non-remunerated blood donors from low risk populations is an important measure for ensuring the availability and safety of blood transfusion.

Blood is however the most precious gift that anyone can give to another person called “THE GIFT OF LIFE”.

Background

According to the facts claimed by WHO about 117.4 million blood donations are collected worldwide. 42% of these are collected in high-income countries, home to 16 % of the world’s population. About 12 700 blood centres in 170 countries report collecting a total of 100 million donations. Collections at blood centres vary according to income group. The median annual donations per blood centre is 1 300 in the low-income countries, 4 100 in lower-middle-income countries and 8 500 in upper-middle-income countries, as compared to 23 000 in the high-income countries. There is a marked difference in the level of access to blood between low- and high-income countries. The whole blood donation rate is an indicator for the general availability of blood in a country. The median blood donation rate in high-income countries is 32.6 donations per 1000 people. This compares with 15.1 donations per 1000 people in upper-middle-income countries, 8.1 donations per 1000 people in lower-middle-income countries, and 4.4 donations per 1000 people in low-income countries. 66 countries report collecting fewer than 10 donations per 1000 people. Of these, 37 countries are in the WHO African Region, 7 in the WHO Region of the Americas, 5 in the WHO Eastern Mediterranean region, 4 in the WHO European Region, 7 in the WHO South-Eastern Asia Region, and 6 in the WHO Western Pacific Region. All are low- or middle-income countries.

Goal

Our goal is to organise such action plans and strategies that will enable people to make 100% voluntary nonremunerated blood donation (VNRBD). The increased demand and limited supply of blood has raised a highly relevant concerning issue these days. Many countries are not able to meet recommended amount of blood availability in blood banks. In recent years several measures that were taken to elevate the number of blood donors like providing incentives and special privileges has depressed the quality of blood. So the commercialisation of blood banks and payments to donors should be curbed by taking necessary steps.

Problem description

Blood transfusion services are facing dual challenge of ensuring both an appropriate supply and the quality/safety of the blood for patients whose survival or their wellbeing are dependent on blood transfusion. Blood supplies need to be constantly replenished since whole blood and blood components have a limited shelf-life. Most countries are struggling to meet their current requirements while at the same time responding to elevated clinical demands for blood.

Evidences from around the world reveals that the prevalence of infection with HIV, hepatitis viruses and other transfusion transmissible infections is invariably lowest among voluntary nonremunerated donors who give blood for purely altruistic reasons. Voluntary donors are more likely to be honest in answering the questions about their health and lifestyle that help to screen out those at risk of carrying these infections. They are also more likely to lead low-risk lifestyles, benefiting both themselves and the patients who receive their blood. In contrast, the prevalence of infection among family replacement blood donors and paid donors is generally the same as in the general population

Material and Methodology

The following mentioned are two different researches which were conducted in two different countries with the idea of bringing the resolution of voluntary blood donation.

Research 1:

Introduction of a program for voluntary blood donations in Iran, Iranian Blood Transfusion Organization (IBTO)

Place of study

Iran is a large country in the world (the 18th largest in the world) in terms of area with 1 648 0002 km ranging from Caspian Sea in the north to the Persian Gulf in the south and it is geographically divided to 31 provinces. Iran is a country with over a population of 73 million and it is one of the most populated countries in the Middle East

Study design

During the study, relevant information was gathered from multiple sources with a broad framework for the study and the introduction of the organisation IBTO.

Methods

The mission of IBTO is to provide and ensure a safe and adequate blood supply in Iran. Selection of low risk donors in pre-donation consultation and interview sessions based on behavioural, medical and demographic factors has improved the transfusion safety even before specific lab screening tests have been conducted. In fact, a lot of efforts concentrated on recruitment of VNR donors and to this end the Blood Donor Recruitment and Retention Office was established. A variety of measures were made to increase the number of voluntary regular donors including technical efforts, information dissemination activities, demographic studies, campaigns, awareness raising programs, publicity, publications, commemorative ceremonies and the like.

Duration of study

IBTO established in 1974 is a single no profit organization which is responsible for the nation’s blood supply. Since the establishment of IBTO we have been witness to an increase in the number of blood centres from 6 to 7 in the scratch to more than 200 in 2011 across the country.

To this end every province throughout Iran has its own blood transfusion establishment as a regional blood transfusion service and there are some satellite blood centres throughout provinces considering population size, extent of the province, the number of medical universities, hospitals and clinics, the number of multi-transfused patients, the number and type of clinicians (specialty or sub-specialty), the number of active hospital beds, the number and size of disasters, distance among cities, the number of known or incoming sophisticated and specialized hospital wards such as transplantation, open heart surgery, chemotherapy, trauma units, and the availability of transportation substructure.

The first key factor in blood safety is to have a pool of voluntary non-remunerated blood donors (VNRBD) for every blood transfusion establishment. IBTO is witnessing the transition of blood donor types in Iran from paid donors before 1974 to mixed picture of VNRBD and family-replacement blood donation until 2007 and since this period IBTO has come to decision of ruling out the small percentage of the family-replacement blood donation (4% in 2004, 3% in 2005 and 1% in 2006) and finally succeeded to achieve 100% VNRBD in 2007). There was a well adopted program and commitment within IBTO for introducing and incorporating this issue. To this end, Blood Donor Recruitment & Retention Office in IBTO headquarters was established with responsibility for introducing a national work plan, marketing and monitoring all programs associated with donor recruitment and care. Then every provincial blood transfusion service in Iran established the same office in a smaller size. The main activities of these offices are to identify the specific characteristics and motivations of different target populations, identify a focal point ⁄ contact person for each target population or group to maintain good communication and strengthen public contribution and involvement, tailor the donor communication and education strategy to suit each target population, work with community service organizations, target donor populations through faith-based organizations, youth and women’s organizations, educational institutions, sporting and cultural groups, workplaces, commercial enterprises and rural communities, collaborate with NGOs, and prepare SOPs for donor selection, education and retention that must be followed by all blood transfusion centres as a nationwide plan Other objectives for this key element in blood safety include launching a partnership with the mass media for raising public awareness about blood transfusion activities and the importance of blood donation, face to face training, publishing marketing materials including books, brochures, pamphlets, CDs and posters, adding certain educational topics on blood and blood donation to books in schools, organizing mobile drives in safe places, increasing the number of blood collection centres, improving the blood collection premises as clean, tidy and modern environments, developing telephone recruitment programs to bring back lapsed donors to blood centres organizing, campaigns on key role figures or leaders for blood donation, establishing a work plan and SOPs for shipping blood components from the provinces with high donation rate to other places with lower rate, implementing a short-term iron supplementation strategy for female blood donors, launching a program specified for regular blood donors by identifying and appreciating them during special occasions including National Blood Donation Day or World Blood Donation Day and publishing an educational pamphlet for them (in 2011 when the percentage of regular blood donors in Iran was 49%, implementing a nation-wide software for blood centres for proper identification of those willing to donate blood and preventing re-entrance of temporary or permanent deferral blood donors, continuously monitoring and evaluating the donor deferral rate and the reasons, providing informative materials about high and at risk behaviours, doing call-for through SMS, email, and phone, issuing colour cards for regular donors, and awarding medals to record blood donors.

Research 2: Two decades of voluntary nonremunerated blood donation in Shenzhen, China

We summarized the strategies to achieve self-sufficiency and security in the blood supply in Shenzhen during two decades, including the legal construction of VNRBDs and the continuously improving strategies to recruit and retain nonpaid donors. The collection data of whole blood (WB) and apheresis platelet (PLT) donations were retrieved, and donor demographic and donation characteristics were analysed.

Legal construction of VNRBDs

The regulations issued by Shenzhen’s local congress in 1995 stipulate explicitly that Shenzhen should adopt the path of VNRBDs, and it also has detailed elaborations on organization, duty, nonremunerated donation, reimbursement, and management of blood use. The regulations also have some exploratory and innovative articles. China’s Blood Donation Law stipulates that the minimum interval between two WB donations should be 6 months. However, in light of the scientific experience from Hong Kong and foreign countries, Shenzhen stipulates in the regulations that the minimum donation interval should be 3 months. The regulations also stipulate that VNRBDs and their family members can enjoy free blood transfusion, and all the funds will be burdened by the Municipal Finance.

Recruitment of the Red Cross Society

The recruitment of nonremunerated blood donors originates from the Red Cross’s humanitarian actions to help the wounded and rescue the dying, and it has widespread appeal. So the Shenzhen municipal government initiates cooperation with the Shenzhen Red Cross Society to carry out VNRBDs. The government pays the bill for buying mobile blood donation vehicles and setting up fixed blood donation sites, and the recruitment for nonremunerated blood donors will be in the name of the Red Cross Society. Model donors will also be appraised and honoured annually. The joint action has powerful executive force, the recruitment carried out in the name of the Red Cross enjoys high public trust, and the government’s financial support also lays the material foundation for it.

Increasing the public awareness of VNRBDs

VNRBD has become a household term in Shenzhen, and that is indebted to the extensive participation of the whole society, which is manifested in the following five aspects: the extensive attention from social public media, the positive image of the Red Cross Society, face-to-face knowledge dissemination by volunteers, the advertising sponsored by the government’s finance, and publicity and promotion activities organized by the blood centre. By publicizing in micro blogs, schools, communities, companies, and hospitals, Shenzhen managed to popularize the knowledge concerning VNRBD. Voting on the most moving quotes was held among blood donors and the public, and many quotes were collected, such as “I am healthy, so I donate blood; I donate blood, and I feel happy,” “you donate a bag of blood, and it can save a life.” VNRBD has not only gained great recognition from the society, but also won its respect.

Blood donation planning

Taking advantage of the features of the headquarter economy, Shenzhen performed innovative exploration in group blood donation. After years of efforts, Shenzhen has nurtured two brands of group blood donation meticulously. One is Insurance Company of China, which is one of China’s top 100 enterprises. The other is Shenzhen branch of Lions Club International. Their blood donation months are respectively titled “Ping-An (the Chinese counterpart of ‘safety’) Blood Donation Month” and “Red Movement Month.” In their months, they go on the first line of recruiting nonpaid blood donors, organize planning and publicity, and hold 30 to 50 blood donation movements together with the SZBC every year. The social groups that participate in group blood donation not only fulfill their social responsibility, but also can improve their popularity by title sponsorship. Arranging large-scale public blood donation in the off season of each year can ensure the stability of blood sources and leads to win-win results.

Improving blood donation policy and services

In the year 1999, Shenzhen started to improve its strategies for VNRBD. The improved strategies required the minimum donation amount being increased from 200 to 300 mL and preferring 400 mL each time.7 The strategies also required improving the donation services8 and strengthening the retention of nonpaid donors.9,10 We set up five more fixed blood donation rooms and three parking sites for blood donation vehicles. These facilities provide convenient, safe, and healthy blood donation spots for citizens. All the staff should be dressed in uniform at the working sites, and they offer passionate smiling service. Follow-up phone calls will be made to those donors who suffer from adverse reactions of blood donation. When donors pass the blood tests, text messages will be sent to notify them. For those who fail to pass the blood test, phone calls will be made to inform them of the results. In this way their privacy will be protected. On festivals and donors’ birthdays, messages will be sent to donors to express festival or birthday greetings. Commending activities and get-together parties will be held each year to praise those outstanding individuals and groups that have done a great job in blood and marrow donation. In this way, each blood donor is paid adequate respect and attention.

Setting up a VNRBD service team

In May 2000, a total of 27 blood donors who were enthusiastic about VNRBD in Shenzhen first set up a VNRBD Service Team. The number of registered volunteers in Shenzhen has nearly topped 1900 as of the end of 2012, and these people play an important role in recruitment and retention of nonremunerated donors. These volunteers are not only regular donors, but also emergency blood donors. In addition, they also participate in the recruitment in donation vehicles and sites as former donors. Using their own experience, they encourage donors that can live up to the standard to donate 400 mL and encourage repeat donors to become PLT donors, regular donors, and donors of hematopoietic stem cells. Volunteers receive, meet, and see off donors or visitors face to face and one by one. They also answer questions raised by visitors with their own experience and carry out on-site mobilization. They made up for the shortage of on-site medical staff and make the recruitment sites passionate, lively, and efficient compared with the previous programmatic and boring recruitment sites.

Results

Research 1: The annual donation index in Iran has greatly increased from 0.39 in 1974 to 25.3 in 2010–2011. According to it increasing trend of blood donation reaching about 2 million blood units in 2011 has been witnessed, all of which obtained from voluntary non-remunerated blood donors with the annual index of 26 per 1000 population.

Research 2: From 1993 to 1998, paid and nonpaid blood donations coexisted in Shenzhen. From the year 1999, all WB for clinical use came from VNRBDs. From 1999 to 2012, the donors who chose to donate 400 mL each time and repeat and regular donors increased sharply to meet the fast growth of clinical demand. From the year 2005, the clinical demand for PLTs was entirely satisfied by nonpaid donations.

Discussion: The abovementioned researches performed suggests that a huge impact on the society and change among the people was brought which carried the idea of voluntary blood donation to an exceptional level. From the information I gathered I propose the following ideas which I believe can bring a change to the countries who are facing problems in meeting the demands of blood transfusions.

1. Approach the common people: blood donation centres must be established in every possible locality and must be reachable to any common person in the society.
2. Make connections: A team of volunteers must be nominated and recruited in every locality who works to maintain good communication with people and strengthens public contribution and involvement.
3. Empower women: In most of the countries, women are often a less involved in blood donation compared to male counterparts. A team of women must be organised that will go among women and encourage them in the society to come forward and put an example.
4. Youth support: The support from the youth population in any country has always put in any revolution to a next level. More and more youths must be gathered by organising seminars in schools, colleges and other educational institutions and encouraging them to give their hands to strengthen the program and volunteering the campaigns.
5. Collaborating NGO’S: A very big number of volunteers who are very generous and caring enough are running many NGO’S. They are concerned with many issues and problems among people and works every time for the improvement in the society. A hand of friendship from them can help to reach the people and refer the idea of the significance and benefit of blood donation.
6. E- communication: Designing the advertisements, short movies for the people about the need of blood donation and conveying it through televisions, newspapers, and social networking sites can highly influence people towards the issue and make voluntary blood donation.
7. Publishing the issue in the streets: Publishing books, brochure, pamphlets, posters and adducting certain educational topics regarding blood donation.
8. Red cross society: The voluntary humanitarian organisation to protect human life and health. Collaborations with such respectable trust and organisation can immensely change the site.
9. Honour people: Respecting and honouring the effort of certain people from the local community will be snatching people attention and as well will help in retention of regular donors.
10. Sustainable financing: Establish a practical expense estimate for all the components of the blood donation to design an appropriate budget. Use the epidemiological information and records for the expenditure planning. Assign a satisfactory spending plan for staff preparations and maintenance.
11. Suitable infrastructures and facilities and equipments: Providing proper screening on every step, trained staff, adequate space, clean and tidy environment, emergency transport for blood collection with door to door services

Conclusion

Since blood donation and the availability of non-remunerated donors is a very serious issue. The above study illustrates how increasing awareness and motivating people for ‘Voluntary blood donation’ can enhance adequacy of blood needs of a state or for that matter the entire country. This study also focuses on how we can initiate inserting the idea of volunteering among the people through very basic methods from making direct connections to the people to using different media, especially electronic media and social networking to propagate altruistic blood donation.

References

• https://www.who.int/en/news-room/fact-sheets/detail/blood-safety-and-availab1ility
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3372016/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3613665/
• https://www.ncbi.nlm.nih.gov/pubmed/25524632
• https://www.researchgate.net/publication/261544022_Introduction_of_a_program_for_voluntary_blood_donations_in_Iran_blood_transfusion_status_in_Iran
• https://www.who.int/bloodsafety/voluntary_donation/en/
• https://www.who.int/bloodsafety/publications/9789241599696_eng.pdf
• https://www.indianredcross.org/ircs/index.php