Of blood donation & safe blood transfusion

Dr. Dharmakanta Kumbhakar

(The writer can be reached at drkdharmakanta@yahoo.com)

Published on the occasion of World Blood Donor Day

Blood and transfusion of blood components are essential parts of the modern-day health care system and most of the time, a life saving one. Patients who require blood/blood components transfusion as part of their clinical management have the right to expect that sufficient safe blood/blood components will be available to meet their needs. Safe blood/blood components transfusion comes under legal protection as it is life saving and also fatal. Article 21 under part-III of the Constitution of India spells out that no person shall be deprived of his life. The Consumer Protection Act of 1986 also covers blood as a commodity.

The quantity and quality of blood pool available for transfusions is still a major concern across the globe, especially in the developing countries.

In India, safe blood/blood components are constantly on high demand. To transfuse the safest blood/blood components to the needy patients, it is globally accepted that the best source of blood is from voluntary blood donations (VBD) and preferably from Voluntary Non-Remunerated Blood Donors (VNRBD). The WHO advocates and recommends to its member States to develop national blood transfusion services based on voluntary non-remunerated regular blood donation in accordance with World Health Assembly resolution, adopted in 1975. WHO’s goal is for all countries to obtain all their blood supplies from voluntary donors by 2020. As on today, in just 62 countries, national blood supplies are based on 100% VBD, with 40 countries including India still dependent on family donors and even paid donors. The Indian national level of VBD is about 75%. States like Tripura, West Bengal, Tamil Nadu and Maharashtra are having more than 95% of VBD. Even after 42 years of World Health Assembly resolution, the issue of blood safety, equitable access to safe blood/blood components and their safe and rational use are still remaining as major challenges in India.

Presently, the blood centers in India operate in a particular way — if a patient needs blood transfusion, a replacement donor from his/her family or friends should donate. In some conditions where blood transfusion is required off and on, sometimes more than 100 units to a particular patient, then how can the family or friends bring all the required number of replacement donors? This gives rise to the issue of involvement of professional or paid donors disguised as replacement donors. It is well established that paid donors constitute a group with high risk behavior leading to greater chances of transfusion-transmissible infections in the recipients. The Indian Panel Code (Chapter XIV, Sections 269 and 270) provide protection against the spread of infectious diseases due to negligent and malignant acts. The Supreme Court of India has banned paid blood donation since January 1, 1998. Moreover, there are frequent incidents of mass casualties in India during bomb blasts, gunshot injuries, road traffic accidents and natural calamities, etc., which require emergency massive blood transfusion; this at times creates the crisis of safe blood. If our blood centers do not have enough blood stocks, what will be the fate of these victims? Maintaining a constant reserve of safe and sufficient blood all the time is a big challenge for most of the blood centres in India.

To maintain a safe and sustainable supply of blood and blood components to all those in need, healthy VNRBD should come forward for VBD. Without a regular flow of actual voluntary blood donors to keep blood/blood components stock sufficient, delivery of good quality blood/blood components in the right quantity at the right time can never be ensured. Moreover, 100 per cent VBD is not a magic figure for India. Blood donation by 2% of the population can meet India’s basic requirements for blood. People from every section of the society should come together and join hands to formulate strategies to achieve 100 per cent VBD, so that any patient who needs blood/blood components transfusion can get the required blood/blood component units from the blood centers without replacement.

The most precious gift that we can give to each other is the donation of blood — a gift that can save lives and give a new lease of life to many persons in need. Donating blood is a noble work and it gives opportunity to the youth to directly connect with social issue of the area where they live. Timely provisions of quality blood also give life to many and make them happy. There are many ways to be a better human being and to serve the mankind. Blood donation is said to be one amongst the best services that a man can do. Donating blood means giving life to some one and it is believed that voluntary blood donors command the highest respect for their sacrifice. VNRBD donates blood or its 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. The only reward they receive is personal satisfaction, self-esteem and pride. They are saviors of mankind.

In India, any healthy person aged 18 to 65 years old having weight more than 45kg and hemoglobin level more than 12 gm/dL can usually donate whole blood ,although other limits apply to donations of plasma and platelets. For safety reasons, users of injectable drugs, carrier of transmissible infections (HIV, HBV, HCV, Syphilis and Malaria etc.), recipients of organ transplants or transfusion cannot longer be blood donors. As a rule, at the interval of three months, any healthy person can donate blood up to four times per year. Plasma and platelet may be donated frequently. If someone really loves oneself and other fellow beings, the only way to express it is to donate blood voluntarily. All the eligible donors should come forward with a pledge to promote 100 per cent VBD.