Voluntary blood donation: The foundation of a safe and sufficient blood supply system

By Dr. Gratia Muyu

We celebrate World Blood Donor Day every 14th of June each year. Blood transfusion is an indispensable component of health care. It contributes to saving millions of lives each year in both routine and emergency situations, permits increasingly complex medical and surgical interventions and dramatically improves the life expectancy and quality of life of patients with a variety of acute and chronic conditions.

Patients who require transfusion as part of their clinical management have the right to expect that sufficient blood will be available to meet their needs and to receive the safest blood possible. However, many patients still die or suffer unnecessarily because they do not have access to safe blood transfusion. The timely availability of safe blood and blood products is essential in all health facilities in which transfusion is performed, but in many developing and transitional countries there is a widespread shortfall between blood requirements and blood supplies.

(TOP: Blood donors show their love during the Valentine’s Day blood drive in February this year. Photo: KTTA).

Many medical advances that have improved the treatment of serious illness and injuries have increased the need for blood transfusion for patients’ survival, to support them through recovery or to maintain their health. Surgery, trauma and cancers, for all of which there is a high probability of the need for blood transfusion, are replacing communicable diseases as leading causes of death. About 234 million major operations are performed worldwide every year, with 63 million people undergoing surgery for traumatic injuries, 31 million more for treating cancers and another 10 million for pregnancy-related complications.

In countries where diagnostic facilities and treatment options are more limited, the majority of transfusions are prescribed for the treatment of complications during pregnancy and childbirth, severe childhood anaemia, trauma and the management of congenital blood disorders. Haemorrhage, for example, accounts for over 25% of the 530 000 maternal deaths each year; 99% of these are in the developing world. Access to safe blood could help to prevent up to one quarter of maternal deaths each year and blood transfusion has been identified as one of the eight life-saving functions that should be available in a first-referral level healthcare facility providing comprehensive emergency obstetric and newborn care.

Children are particularly vulnerable to shortages of blood in malarious areas because of their high requirement for transfusion arising from severe life-threatening anaemia resulting from malaria, often exacerbated by malnutrition. The malaria burden is highest within the WHO African region and majority affect children under five years of age.

Road traffic accidents kill 1.2 million people and injure or disable between 20 million and 50 million more a year, a large proportion of whom require transfusion during the first 24 hours of treatment; 90% of deaths occur in developing and transitional countries. The timely availability of blood at emergency health care facilities is one of the determinants of patient survival.

Sufficiency and security of national blood supplies

Blood transfusion services face a dual challenge of ensuring both a sufficient supply and the quality and safety of blood and blood products for patients whose lives or wellbeing depend on blood transfusion. Blood supplies need to be constantly replenished since whole blood and blood components have a limited shelf-life. Most countries battle to meet current requirements while at the same time responding to increasing clinical demands for blood.

WHO estimates that blood donation by 1% of the population is generally the minimum needed to meet a nation’s most basic requirements for blood; the requirements are higher in countries with more advanced health care systems. However, the average donation rate is 15 times lower in developing countries than in developed countries. Globally, more than 70 countries had a blood donation rate of less than 1% (10 donations per 1000 population) in 2006.⁵ In the WHO African region, blood requirements were estimated at about 8 million units in 2006, but only 3.2 million units were collected – about 41.5% of the demand.

Most countries, Kenya included, with low rates of blood donation are largely dependent on blood provided by the families or friends of patients who require transfusion.

Paradoxically, despite a markedly inadequate blood supply in many countries, unnecessary transfusions are often given when the availability and use of simpler, less expensive treatments would provide equal or greater benefit. Not only does this expose patients needlessly to the risk of potentially fatal transfusion reactions, but it also widens the gap between supply and demand and contributes to shortages of blood and blood products for patients who really need them.

Why voluntary blood donation?

Blood and blood products are a unique and precious national resource because they are obtainable only from individuals who donate blood or its components. Most countries urgently need a substantial increase in the number of people who are willing and eligible to donate blood in order to ensure a stable supply of safe blood and blood products that is sufficient to meet national requirements.

WHO, the IFRC, the Council of Europe, the International Society of Blood Transfusion, the International Federation of Blood Donor Organizations and a number of other international and national organizations have defined voluntary non-remunerated blood donation as a founding and guiding principle. They recommend that all blood donations should be voluntary and non-remunerated, and that no coercion should be brought to bear upon the donor to donate.

A voluntary non-remunerated blood donor gives blood, plasma or cellular components of his or her own free will and receives no payment, either in the form of cash or in kind which could be considered a substitute for money. This would include time off work other than that needed for the donation and travel. Small tokens, refreshments and reimbursements of direct travel costs are compatible with voluntary, non-remunerated donations.

In systems based on voluntary blood donation, patients have improved access to safe blood transfusion in routine and emergency situations, without which their survival or quality of life might be threatened. The blood and blood products they receive carry a minimal risk of infection that might further compromise their health. They are not placed under pressure to find blood donors to receive treatment and feel a sense of being cared for by others whom they will never meet. In turn, this may motivate a spirit of generosity and a desire for reciprocal volunteering in the future.

Family/replacement donors cannot meet a community’s requirements for blood and blood products because they provide blood only for individual patients when requested. The blood given to patients will not necessarily be replaced by blood group or quantity. Hospitals that are dependent on replacement donors are rarely able to maintain a sufficient stock of blood to meet the transfusion needs of all their patients, particularly in emergency situations or for regular transfusions, or to share their blood supplies with other hospitals.

Paying people to give blood undermines the principle of voluntary non-remunerated blood donation. Where systems of paid and voluntary blood donation co-exist, people who might otherwise donate voluntarily may opt to receive payment for their blood, thus weakening the voluntary blood donor programmes.

Voluntary blood donation and the safety of blood and blood products

Voluntary blood donors, particularly regular donors, are the first line of defence in preventing the transmission of HIV, hepatitis viruses and other blood-borne infections through the route of transfusion. A number of studies have reported significantly lower prevalence of transfusion-transmissible infection markers among voluntary donors compared with other types of donors, with the lowest rates among regular donors.

Voluntary donors are recognized to be the safest donors because they are motivated by altruism and the desire to help others and by a sense of moral duty or social responsibility. They have no reasons to withhold information about their lifestyles or medical conditions that may make them unsuitable to donate blood. They are not placed under any pressure by hospital staff, family members or the community to donate blood and they entrust their blood donations to be used as needed, rather than for specific patients. The only reward they receive is personal satisfaction, self-esteem and pride.

In systems based on family/replacement donation, the onus of providing blood is placed on the patient’s family and friends rather than on the health system. Patients and their families are placed under considerable pressure to find blood donors at a time when they are already stressed because of the patient’s illness. Relatives who are unwilling or ineligible to donate blood and who cannot find other suitable replacement donors may resort to paying others to donate, even if this practice is forbidden by the country’s legislation. The problem is particularly acute when patients require regular transfusion for conditions such as thalassemia and blood is required every month or even more frequently. Patients are also disadvantaged if they have been referred from distant health facilities and have not been accompanied by relatives or friends.

Voluntary blood donors themselves benefit from health education and encouragement to maintain healthy lifestyles as well as regular health checks and referral for medical care, if needed. Provided that they receive good donor care when they donate blood, they feel personal satisfaction and self-esteem which provides a sense of social engagement and belonging that is recognized and valued by the community. Voluntary blood donors serve as effective donor educators, recruiters and health promoters. Studies have shown that the influence of active blood donors is one of the most effective strategies for donor recruitment.³⁰ Voluntary donors also play a valuable role as active agents in health promotion; in addition to practising healthy lifestyles themselves, they help to build healthy communities through their influence among their peers and families. Even donors who are no longer able to donate due to age or medical conditions can still play an important role in promoting voluntary blood donation in their families, workplaces and communities.

As we celebrate world blood donor day on 14th of June, we are all encouraged to give blood. The theme this year is “Give blood, give plasma, share life, share often.”

How to register as a blood donor: