Wanted: blood donors for life

India needs to infuse fresh initiative into its voluntary blood donation programmes.

G. Ananthakrishnan

INDIA HAS a chronic shortage of safe blood. The blood banking system is able to provide only half the blood required for surgeries and the shortfall is met through donations made by family members of patients or paid donors.

After health risks in blood transfusion were widely publicised, the Supreme Court ordered a review of blood transfusion services in 1996 leading to a series of reform measures: a National Blood Transfusion Council was set up, paid donations were banned in 1998 and blood banking organisations, including private ones, came under scrutiny. India is one of 39 nations that allow only voluntary, unremunerated blood donation.

The progressive measures, however, have not made a significant difference to the availability of blood. When the national ban on paid donors came into force, only half of the six million units needed came from blood banks. That situation has remained largely unchanged over the seven years during which a national blood policy was implemented and steps were taken to eliminate unsafe practices and commerce in blood; licensing of blood banks became a requirement and criteria were set for holding donation camps.

The system of donation by voluntary unremunerated donors is now under great stress. Many private hospitals routinely demand that patients come up with replacement units; the onus is on them to find donors through family, friends or community organisations. Such compulsion defeats the principle of voluntary donation and patients and their kin feel pressured by hospitals. In many instances the patients must approach paid donors because they do not have access to voluntary donors.

Private health institutions add to the problem quite often by turning down blood supplied by authorised banks. They insist that patients arrange for replacement units even if the hospital already possesses the blood. Charges may be added to the patient's hospital bill for blood, sometimes in excess of the legally prescribed testing charges.

Banking on altruism

The international experience with blood transfusion services indicates that many countries have largely overcome such issues by encouraging voluntary donation programmes. All successful donation programmes are founded on the principle of altruism, which inspires people to donate with the full knowledge that it will not help them in any immediate or direct manner.

Altruism is a force that unites people. It is explained within a theoretical framework by social policy thinker Richard M. Titmuss in his major work, The Gift Relationship: From Human Blood to Social Policy. Arguing strongly for altruism, Titmuss exposed the socially disruptive consequences of paid donations, drawing heavily on the American example. When blood is treated as a commodity, it creates obstacles to altruistic donation, encourages profiteering, makes patients guilty about burdening families and turns many into "blood indigents."

During the time of Titmuss' work a few decades ago, patients requiring surgery in the United States had to replace blood, at a ratio of two units to one or pay for it as if it was an economic good; healthy individuals had to take out insurance and pay premiums in cash or blood units to cover the risk of future surgery. The availability of blood was ensured through paid or professional donors.

Though not unique to the U.S., this patently unsafe system was first blamed for post-transfusion hepatitis. It had to undergo radical change when the HIV/AIDS question came to the fore in the 1980s. With unimpeachable evidence available on the higher incidence of HIV infection among paid donors compared to altruistic donors, several countries including the U.S. shifted to voluntary donations.

High risk

Risk of disease is particularly high today because half the blood collected from new donors in countries with a low Human Development Index is through replacement or paid donors, as estimated by the World Health Organisation (WHO).

India has a good legal framework but it needs to infuse fresh initiative into its voluntary blood donation programmes. Mobilising youth to donate holds the key. Zimbabwe has done it and so has South Africa.

The two African countries have been able to enlist their youth in a national campaign to donate blood from the time that they leave school. "Pledge 25" in Zimbabwe is an acknowledged global model. South Africa, which has a high HIV incidence among the general population, replicated the Zimbabwe programme and succeeded not merely in collecting more blood but also in promoting a safe and healthy lifestyle among the young donors. They have, therefore, a lower risk of acquiring HIV infection. India, by contrast has no national programme to match.

A more effective voluntary blood donation programme depends on political and social commitment. Many countries have a national blood service to pursue the agenda. Such a service will attract altruistic donors who will stay committed for life. It can also create a central facility in each State to produce blood products such as red cells, plasma and platelets with the highest levels of safety.

There are millions of young Indians in the 15-19 age group (over 53 million as per the 2001 census). They are the lifelong donors who could make the country self-sufficient in blood.

June 14 is Blood Donor Day.

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