Blood Security---access to safe blood as a right of the patient!

A well-organised Blood Transfusion Service (BTS) must be considered as an essential and integral component of any healthcare delivery system.

India does have a sound national blood policy (development of the same was incidentally largely facilitated by the Gujarat SACS), but the absence of a functional national blood service renders a patient hapless and helpless at the critical moments.

In event of a road traffic accident or any medical/surgical emergency, a patient is, more often than not, expected to organise blood for his/her own requirements. Inability on the part of the patient or his/her relatives to do so may even have a fatal outcome for the patient.

Besides the deaths in road traffic accidents, lack of access to safe blood still remains a major cause of maternal mortality in all parts of the country.

Safety of blood was ushered in an effective manner after the landmark and historic judgment of the Hon’ble Supreme Court of India on January 4, 1996, banning paid blood ‘donation’ by the professional blood “sellers” w.e.f. January 1, 1998.

The office of the Drugs Controller General of India and the respective Food and Drugs Control Administration department of the states are expected to closely monitor blood donation services in the country in liaison with the National and State Blood Transfusion Councils.

The National AIDS Control Organisation (NACO) and the State Blood Transfusion Councils have taken steps to improve screening, processing and storage of blood for utilization by the end users. But the stark reality is that there is still a severe shortage of accessible blood with varying levels of safety of the same throughout the nation.

The shortages in a scenario of a very strong felt need both by the patients and health care providers, fuel the blood ‘donation’ scandals like the ones seen in two northern states in the very recent past.

There are about 2,200 blood banks in the country. The sheer number of the blood banks with a paucity of personnel and temporal constraints with the regulatory authorities, are suggestive of a significant number of partially regulated/unregulated private blood banks (with profiteering as the main motive) with varying levels of standards.

The available global evidence and expertise in transfusion medicine indicate that perhaps even with a significantly lesser number of the blood banks (if functioning efficiently with appropriate linkages), the dearth of accessible safe blood may be easily tided over.

We need to have more and properly trained laboratorians, fewer and more efficient blood banks, district-level agencies that can handle all the processes necessary to make safe blood available to the needy.

A centralised database of ‘safe’ blood donors which is accessible to all, say by its presence in the public domain at the interactive websites of the State Blood Transfusion Councils ,will go a long way in facilitating the same.

A modern health care system cannot function effectively without a blood service that assures blood security to all the people. Access to safe blood must be perceived as a right of the patient.

Blood security necessitates that any patient requiring blood should be assured of a regular and sustained supply of blood as per the needs at any time. In most countries in the world, including many developing countries, blood services are run by the national/provincial/local self government or by organizations like Red Cross and Red Crescent Society.

A patient admitted to a hospital is thereby assured of the blood required for his/her treatment. All the drugs (including blood and its components) are provided by the healthcare delivery system. This is in accordance with the classification of blood as a drug and the health care providers must , therefore, be in a position to ‘indent’ for safe blood just the way it is done for the drugs from the stores division of the hospitals.

In our country and the constituent states, there is an absence of a centralised management of blood services which results in lack of standardised practices and processes, varying levels of capacities of the personnel, poor quality standards, inadequacy of blood availability vis-a-vis its demand; and most importantly a near-complete neglect of those requiring regular transfusions for chronic disorders necessitating blood transfusions.

With the onus of finding blood donors being with the patient, even if all the 147 blood banks in the state of Gujarat run well in accordance with the accepted standards of quality in an accredited manner, the goal of blood security for all citizens will still be a distant dream.

With 20 mother blood banks/Regional Blood Transfusion Centres (many working for accreditation by the NABH) and 47 functional blood storage centres affiliated with them in the state of Gujarat with 75% voluntary blood donation (excluding family and other replacement blood donation); blood security is indeed a dream; rather a shared vision we all are working on in a committed manner.

We must plan to address the issue of blood security by setting up a centralised blood collection and processing system at the mother blood banks and storage (and distribution beyond the captive consumption) centres, on a pilot basis.

A few mother blood banks which will be supported by organization(s) of voluntary donors, but run by professionals, will have to be roped in.

Blood collected from voluntary blood donors will be processed in a quality assured way through standardized and quality operating procedures in a professional environment of the mother blood banks.
It will be then distributed to the storage centres with maintenance of cold chain and stored there according to standard operating procedures.

Participating hospitals will simply have to indent the required units of blood from the mother blood banks or storage centres.

The existing blood banks in hospitals may function as storage and cross-matching centres.

Patients will get safe blood from a pool of repeat, regular ,altruistic(and therefore ‘safe’) donors selected and screened in a stringent manner obviating the present practice of running hither and thither to arrange for donors.

The present situation is highly conducive with a scenario of professional blood ‘sellers’ masquerading as replacement blood donors.

The success of the project will depend heavily on the continued support from the government, and proactive participation of the NGOs, voluntary blood donor groups/associations, VBD camp organizers and what have you.

Participation of all stakeholders must be ensured as an indispensable ingredient of the health care delivery mechanism.

A detailed road map and a pilot in a state need to be chalked out at the earliest for facilitation of ensuring blood security!

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Comment by Dr Rajesh Gopal on November 9, 2009 at 4:58pm
I strongly believe that working for and ensuring blood security in the developing world is equally important the way food security is being pursued through a concerted action at different levels.
Comment by Dr Rajesh Gopal on November 9, 2009 at 4:37pm
Blood security would be feasible only with the ownership by the community and other stakeholders ,which is being worked upon.

Association of Voluntary Blood Donors(the community) is a major stakeholder in the same. The activities pertain to effective transport,storage, distribution and accessibility-- ,obviously going beyond the traditional role/expectation of just 'donating' blood.

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