Where is the Rakth Kranti?

Recently, the medical world was faced with another ugly truth in its dark underbelly— a racket was unearthed about children being lured with food to donate blood. The racket came to light when two teenagers were found unconscious outside their village near Jaipur. The victims were lured to a private nursing home in a nearby town and drugged, before their blood was forcibly extracted. The police found that racketeers either paid gullible people a paltry sum of Rs 500 to 700 per unit of blood or simply kidnapped them and forcibly extracted blood and then sold it for Rs 5,000 to Rs 10,000 to nursing homes and hospitals.

While the law is taking its own course to book the guilty, this incident clearly highlights the illegitimate measures that many nursing home and small hospitals in the country resort to, for fulfilling their requirement of blood in face of an acute shortage of blood. According to the Indian Society of Blood Transfusion and Immuno-haematology (ISBTI), while the annual requirement in India is for nine million, the supply is only about six million units. What compounds the shortage of blood is the fact that the donated blood is not optimally utilised as the blood is used as a whole product rather than components. According to estimates, in India the ratio of use of blood components to whole blood is 15:85, while globally it is 90:10. Experts say that the skewed ratio is mainly because clinicians are unwilling to shift to use of component blood and for blood banks —component separation entails an additional investment in terms of facilities like centrifuge, storage, and also trained technicians.

The acute shortage of blood results in death of 1.5 million people per year. The shortage particularly impacts children suffering with thalassaemia, victims of malaria, malnutrition, trauma victims and women with complications in pregnancy. Additionally, India faces severe shortage of blood during emergencies as many blood banks do not maintain buffer stocks. According to protocols laid down by National AIDS Control Organisation (NACO), 25 per cent of all blood collected by a blood bank has to be kept aside as buffer stock to be used only in case of an emergency. However, only 20 per cent of the blood banks follow the protocol strictly.

The demand has spawned a breed of 'professional' blood donors, a practice that is banned in India. As high as 47 per cent requirement of blood is believed to come from these commercial donors— who also happen to be the main source of diseases transmitted through transfusion. In India, three persons per thousand get the HIV infection through blood transfusion, six per thousand persons get the Hepatitis C infections and as many as 1.5 per cent persons get infected by the Hepatitis B infections through the blood transfusion each year. According to WHO, only 54 countries globally have achieved 100 per cent voluntary donation.

Clearly, the efforts of ISBTI to promote voluntary blood donation have not been enough for India to achieve 100 per cent voluntary non-remunerative donors, even if ISBTI have declared 'rakht kranti' (blood revolution). India needs to immediately opt for a national blood donor registry, which mobilises blood donors to respond to critical shortages in their communities. The fact that a registry by Rahul Verma, Creator, Rarebloodgroup.org to help patients with the Bombay blood group (one of the rarest in the world) has taken off well, implies that Indians are willing to form pool of donors. The framework for the registry already exists as NACO regularly conducts blood donation drives and screens blood to ensure its safety. Countries like UAE and China have benefited from its pool of voluntary blood donors— ensuring both availability and safe blood.

To ramp up regular voluntary blood donation, young and repeated donors can be offered incentives like free train and bus tickets and some academic encouragement. Additionally, Government should make it mandatory for blood banks to use blood components than whole blood. It's also time for hospitals to educate themselves about the correct NACO guidelines on replacement blood. Many leading hospitals insist on replacement of the same blood group by the relatives of the patients, when the NACO guidelines state that the replacement can be of any blood group. So, lets mobilise to start the ‘Rakht Kranti’ revolution ourselves.

Rita Dutta
rita.dutta@expressindia.com