Repeat voluntary non-remunerated blood donors — Is our society ready?

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Dr Joy Mammen, Prof, Dept of Transfusion Medicine and Haematology, Christian Medical College, Vellore, talks about how mindset change is essential to ensure blood adequacy in India

Till date, despite medical advancements, it is still not possible to substitute blood with any artificial manufactured product. The only source of blood as a therapeutic product is another human being, and it is not without its own risks. In addition to the risk of transmission of infectious diseases such as HIV, Hepatitis B or C, malaria and syphilis, there are other immune and non-immune reactions that can occur. The risk of transmission of infections can be prevented by selection of safe and low-risk donors.

It is important, therefore, to realise that these infections can be present in donors in a dormant state such that donors appear to be healthy but are actually infected. Such persons are said to be in the ‘window period’ i.e the time interval between a person (potential donors) being infected with a disease and laboratory tests being able to detect it during the screening process at the blood bank. In some cases, they can be ‘carriers where they have not been able to completely overcome the infection and it remains dormant. The potential risk of transmission of infections can however be reduced if it can be assured that the donors who are the source of the blood do not carry infection.

The first line procedure is a donor interview to ensure that donors who are at potential risk of being in the window period can be determined and excluded, most of the time. Appropriate information and counselling have to be provided to the donor if she/he needs to be deferred. The blood collected from screened donors then needs to be subject to various mandatory tests to ensure freedom from infections. The donor interview process is often trivialised in many centres and blood donation camps, especially the ‘mega-camps’ where quantity often takes precedence over quality and safety.

According to WHO, voluntary non-remunerated blood donation (VNRBD) means that a person gives blood, plasma or cellular components of his/her own free will and receives no payment for it, either in the form of cash or in kind. In the South-East Asia region, barring a few countries like Sri Lanka and Thailand, most countries still report a significant proportion of replacement donors as ‘voluntary.’

Studies have shown that first time voluntary donors have a similar risk profile to replacement donors. It is only when the donor has donated repeatedly over a period of at least two consecutive years, that it becomes possible to be confident about the reduction in risk. Developing a pool of repeat voluntary blood donors requires careful planning, targeted and sustained campaigns in the community, which require both human and financial resources.

Sustained engagement with donors requires more than sporadic messages on electronic media, posters or one-off TV advertisements. The state and national blood transfusion services also have not been able to invest consistently to systematically develop awareness and conduct a nationwide campaign. Although educational organisations facilitate blood donations, it is often to fulfil the letter of regulation (to conduct one donation camp in an academic year) rather than to nurture a sense of altruism in our future citizens.

Blood donation is not something that is talked about in our society. Most of this happens around the International Blood Donor Day (June 14) or the National Voluntary Blood Donation Day (October 1). Most people only think about blood donation when their close relatives or friends are in need of a transfusion. Unless they are fortunate to be in close proximity to a blood bank that has adequate voluntary blood donations, they will go through a fairly traumatic experience of finding replacement donors to ensure that the blood bank gets enough donors in exchange for the units given to their patient. The lack of a dependable pool of repeat voluntary donors and the absence of commitment to donate regularly contributes to periodic shortage of blood in the blood banks.

In more developed countries, the society has taken on the onus of motivating and mobilising donors through organisations such as the Red Cross, other NGOs or religious organisations or directly through local community campaigns. In India, this is highly fragmented (as is our blood transfusion service) and the lack of coordination continues to reflect in the national voluntary donation statistics and more so in the low proportion of repeat donors among them.

It is not all dark and gloomy; many thousands of donors donate daily around the country so that blood is made available to patients who require it. The national statistics (self-reported by blood banks) says that more than 80 per cent of the 11 million units collected, were voluntary donors, according to an assessment done in 2016. Recent efforts to harness social media and participation of corporates have made some inroads, mostly among urban populations.

However, unless we as a nation are willing to change our mindset and be receptive to the idea of ‘giving without getting in return’ our blood banks and hospitals will continue to be caught in a regular cycle of shortages and never wean off dependence on replacement blood donors. It’s time we took the old WHO slogan from the year 2000 seriously: “Safe Blood Starts with me: blood saves lives.”

blood donorChristian Medical CollegeDr Joy MammenVellore
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