Important note: Information in this article was accurate in 2004. The state of the art may have changed since the publication date.
International Federation of Red Cross and Red Cresent Societies - 6 April 2004
John Sparrow in Beijing
The good news was tempered by a worrying fact when experts gathered in Beijing this week for a global conference on how to increase and effectively manage a safer sustainable supply. Of the estimated 81 million units of blood donated annually worldwide, less than 40 per cent are collected in the developing world where 82 per cent of the planet's population lives.
The 9th International Colloquium on the Recruitment of Voluntary, Non-Remunerated Blood Donors, organized by the International Federation and co-sponsored by the World Health Organization, heard that the needs created by sheer numbers of people, the prevalence of sexually-transmitted disease and poor understanding of blood donation were among the factors posing challenges.
Moreover, heightened safety standards have tightened the criteria for blood donor selection, and the world's donor base in shrinking. "It is critical that we bring together people who are responsible for motivating, recruiting and educating blood donors, to exchange views, assess the ever-evolving challenges and learn from the success stories," said Alistair Henley, head of the Federation's East Asia delegation, as the four-day conference opened on Sunday.
The colloquia started in 1986 to create a dialogue on the practical approaches needed to encourage people to give blood without payment. Transfusion-transmitted infections such as HIV and hepatitis can be eliminated or substantially reduced through a safety strategy based on collecting blood only from voluntary, non-remunerated donors in low risk populations.
No one argues with that but, as was clear from the first two days of the conference, many countries still have a long way to go. With only a small percentage of the blood they need for transfusions, supplies are often bought by hospitals from high-risk sources. One Asian delegate confided that only ten to 14 per cent of need in his country was met, and of the total only 21 per cent was from voluntary unpaid sources. Although the situation had improved, some 60 per cent was from professional donors, bringing with it great risk of infection.
The screening of blood, too, is far from universal. "Generally it isn't [screened]," the head of a regional hospital in a Central Asian state told this writer recently, "unless it comes from suspicious people." The upshot is that the incidence of transfusion-transmitted HIV and hepatitis A and B continues to increase in some countries.
A shortage of safer blood also has a severe impact on women and children. Many transfusions are given to women with pregnancy complications and children with severe life-threatening anaemia. Globally, 18 per cent of health problems relate to pregnancy and 43 per cent of children under the age of five are anaemic.
Said Peter Carolan, the Federation's senior officer for blood and the conference organizer, "Once upon a time the donation of all blood was promoted as a gift. But things have changed greatly over the last couple of decades and blood today is seen not only as a gift but as a drug, and like all drugs it can have side effects."
Carolan is precise with terminology. "What we are striving for, what we need more of, is safer blood. Absolute guarantees on blood supplies can never be given. There will always be new infections for which at that moment there is no test. But we can, and must, make blood as safe as is humanly possible. A great part of that lies in acquiring voluntary, unpaid blood from low-risk populations. When you have such a donor base, with a reliable medical history, you have come a long way towards the goal."
"Reliable donors are not everything. You still need stringent screening mechanisms and blood management, and governments must set the standards there. But sufficient blood donated by unpaid, altruistic people is a prerequisite of safety, and one of the greatest gifts we know."
Carolan is upbeat despite the challenges, and encouraged by the success stories being shared at the conference. He points out that the principle of voluntary, unpaid blood donation is championed by well over a hundred Red Cross and Red Crescent National Societies involved in blood donor recruitment. The Chinese Red Cross, host of the Beijing conference and celebrating its centenary year, is one of them.
Madame Peng Peiyun, President of the Chinese Red Cross, told the conference that her country had made great progress since a blood donation law was introduced in 1998. Today nationwide, more than 61 per cent of all blood used in Chinese hospitals came from voluntary, unpaid donors, and in 75 cities the figure was 100 per cent. The challenge, she said, was to keep the drive going and the Chinese Red Cross was placing ever larger emphasis on recruiting more donors from among young people, particularly in the universities.
The statistics confirm her case. In 2001, the Chinese government allocated US$ 270 million to upgrade blood transfusion services across the country, and there has been fruitful collaboration between the Ministry of Health and the World Health Organization in several areas of blood safety. More than 88 per cent of China's blood donors were voluntary and unremunerated in 2002, compared to less than 54 per cent in 2000, and the implementation of a WHO quality management programme has greatly strengthened services.
The colloquium has brought together around 180 specialists, with speakers from Austria, Australia, Bangladesh, Bulgaria, Canada, China, Fiji, Finland, India, Iran, Israel, Japan, Luxembourg, FYR Macedonia, Mexico, Mongolia, the Netherlands, Nigeria, Norway, the Philippines, Poland, Samoa, Singapore, South Africa, South Korea, Sri Lanka, Switzerland, the United Kingdom and Uruguay. It is being held in partnership with the International Federation of Blood Donor Organizations, the International Society of Blood Transfusion and the Association of Donor Recruitment Professionals.
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