Act in vain

Act in vain

If the government thinks it can ensure safety in blood transfusions by focusing on jailing those who donate blood in exchange for money, it has got its priorities upside down.

The head of the panel preparing the National Blood Services Transfusion Act has been quoted recently as saying that the Act will work to completely wipe out paid blood donation. Paid donors could face rigorous imprisonment and a big fine, and the aim is to rely solely on voluntary donors to ensure the safety of the blood used in transfusion.

This stance doesn’t factor in the harsh reality. It’s true that blood from paid “professional donors" carries higher risk of infections such as HIV and hepatitis, compared with that from voluntary donors, and that India needs to move towards 100% voluntary donations, just as many countries have managed to. But given the known shortages of this lifesaver, the need is to first build up the supply of safe blood, which calls for checking serious lacunae in the management of our transfusion system, before stemming half the country’s source base.

It has taken a rather faulty system to allow a thriving professional donor practice, even though the national blood policy of 2002 says a firm “no" to payments. And despite the government knowing the risks to public health, precious little has been done by way of the very basics—diligent and efficient screening of blood collections—not only because of a general lack of skills and facilities, but also the unfortunate lack of commitment.

The blame goes squarely to the government. It was back in 1987 that the National AIDS Control Organisation was set up with one of its aims being blood safety; in 1996 national and state blood transfusion councils were set up, in response to a Supreme Court ruling on a writ petition filed in 1992(!) against the Government of India to address the shortcomings in collection, storage and supply.

However, as a 2007 IIM Ahmedabad study affirmed, “blood transfusion services in India (still) rely on a very fragmented mix of competing independent and hospital-based blood banks... Most hospital- based blood banks often operate with minimal infrastructure and inadequate/irregular supply of blood. In addition, there are a large number of trusts, independent commercial and private blood banks... There’s no supervision of supply from the blood banks to hospitals and nursing homes... Also, there is no monitoring of the clinical use of blood and blood products."

Little surprise that nearly 48% of our blood supply comes from paid and replacement (family/friends) donors, and that the former slip in through the cracks in the system with ease, often posing as replacement donors. Even more serious is that both screening and handling of the collections are often far below prescribed standards of safety.

For a country to rely fully on voluntary donations, 1-3% of its population has to give. India’s total comes from under 1% of its population. Augmenting this supply base has to be the top priority. The latest (2004) WHO survey shows that the share of total donations collected from voluntary, non-remunerated blood donors in developing and transitional countries was 47% in 2004. And of the 39 countries with 100% success in 2002,?five were developing countries. India, therefore, has company, and the phase is clearly that of a transition for most. Shutting off a big source, before there is an actionable plan that allows greater reliance on volunteers,?could?be?catastrophic.

Meanwhile, ensuring strict screening and strict labelling of the source—paid or voluntary—to make the risks clear is a must. Finally, the argument for altruism notwithstanding, there’s need to understand what motivates donors. But admitting to the reality of shortages is vital. Vietnam does that, for example, and is structuring rewards to encourage safe donors.

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