Blood donation in India

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Blood donations in India are conducted by organisations and hospitals through blood donation camps. Donors can also visit blood banks in hospitals to donate blood. Efforts by the government and advocacy groups over the years have helped bridge the gap between demand and supply. The regulatory framework for blood donation and blood bank management rests with the Central Drugs Standard Control Organisation, while technical bodies like the National Blood Transfusion Council and National AIDS Control Organisation formulate guidelines and recommendations for transfusion medicine and blood bank management. [1] Challenges persist with regards to regulation of blood banks and transfusion practices as the sector is largely fragmented with uneven distribution of blood banks and supply of blood in parts of the country. Donors are usually provided with refreshments after the procedure, which include glucose drinks, biscuits and fruits. Some organisations offer transportation facilities, as well as certificates or badges as gratitude. [2]

Contents

History

The history of voluntary blood donation in India dates back to 1942 during the Second World War when blood donors were required to help the wounded soldiers. The first blood bank was established in Kolkata, West Bengal in March 1949 at the All India Institute of Hygiene and Public Health and was managed by the Red Cross. The donors were mostly government employees and people from the Anglo-Indian community who donated blood for a humanitarian cause. The number of voluntary donors declined after the war and donors had to be paid for the blood. Leela Moolgaonkar, a social reformer, initiated voluntary blood donation camps in Mumbai from 1954. [3] The 1960s saw many blood banks open in different cities. In 1975, the Indian Society of Blood Transfusion and Immunohaematology headed by J. G. Jolly declared 1 October as the National Voluntary Blood Donation Day. [4]

The HIV pandemic in the 1980s led to the government setting up the National AIDS Control Organisation (NACO) in 1992 to oversee the policies in preventing the spread of AIDS. Subsequently, the National AIDS Control Programme was launched which led to improvements in patient screening and hygienic transfusion procedures. A public interest litigation was filed in the Supreme Court in 1996 to abolish the practice of selling blood which became effective on 1 January 1998. [2] This led to a temporary shortage of blood as voluntary donations were still relatively low. [5] The NACO in 2002 adopted the WHO Guidelines on the Clinical Use of Blood. [6] Selling or donating blood in exchange for money is illegal under the National Blood Transfusion Services Act 2007 and those found convicted may face a prison sentence of up to three months with fine. [7] A petition was filed in the Supreme Court in March 2021 challenging the blood donation guidelines that prohibits transgender people, members of the gay community and sex workers from donating blood. [8]

Criteria to donate blood

There are several parameters that determine the eligibility of an individual to donate blood. Guidelines laid down by the Ministry of Health, Government of India have to be followed by blood banks for donor screening. [2]

Overall health and vital signs: [9]

Individuals under certain conditions are deemed ineligible to donate blood: [9]

Clinical demand

The number of voluntary blood donors increased from 54.4% in 2006–2007 to 83.1% in 2011–2012, with the number of blood units increasing from 4.4 million units in 2006–2007 to 9.3 million units in 2012–2013. [3] In 2016, the Ministry of Health and Family Welfare reported a donation of 10.9 million units against a requirement of 12 million units. [10] In 2018 the Ministry of Health and Family Welfare with support from its various institutions published a detailed report on the blood requirement in India. [11] 12.7 million units were donated in 2020, lower than projected due to the COVID-19 pandemic. [12] A study in 2022 extrapolated the eligible donor population in India at 402 million. The supply was estimated at 33.8 donations against the demand of 36.3 per thousand donations, translating to a shortage of one million units annually. Medical specialty had the highest demand for blood at 6.0 million units (41.2%), followed by surgery 4.1 million (27.9%), obstetrics and gynecology 3.3 million (22.4%) and pediatrics 1.2 million (8.5%). [13]

Regulatory mechanisms

Human blood is covered under the definition of drug under the Drugs and Cosmetics Act, 1940. Blood bank activities are regulated under this act and they are required to obtain timely renewal of the license from Drug Controller General for operation and have to comply with the terms presented in the license. It specifies accommodation, manpower, equipment, supplies and reagents, good manufacturing practices, and process control to be followed in Indian blood transfusion services. [14] Dual licensing of blood banks by federal and state regulatory bodies was made mandatory in 1993, with a renewal required every 5 years. [1] NABH is the main accreditation body for hospitals and blood banks in the country. [15] [16] The National Haemovigilance Programme was launched in 2012 to monitor adverse transfusion reactions, and subsequently in 2015 the National Blood Donor Vigilance Programme was initiated. [17]

The National AIDS Control Organisation (NACO) was formed in 1992 following the outbreak of AIDS. Following public interest litigation, a verdict by the supreme court in the case of Common Cause vs. the Union of India in January 1992 led to the establishment of the National Blood Transfusion Council (NBTC) at the federal level and State Blood Transfusion Councils (SBTC) for all the states to review the status of blood transfusion services in the country and conduct annual monitoring visits to blood banks. [18] While the regulatory authority is entrusted with the task of drug regulation, NACO and NBTC are the technical bodies that frame guidelines for the practice of transfusion medicine. In 2018, an expert working group of the NBTC proposed recommendations on manpower requirements for blood banks, which outlined the minimum number of staff at blood banks and their qualifications. [19] [20]

The Government of India in 2002 published the National Blood Policy to reiterate the commitment to safe blood and blood components. [21] It documents the strategies for making available adequate resources, technology, and training for improving transfusion services apart from outlining methods for donor motivation and appropriate clinical use of blood by clinicians. It has also taken steps for research and development in transfusion medicine. [18] There have been recommendations to include blood under the National List of Essential Medicines to control pricing transparency and affordability of blood. [22] The fragmented nature of organisational types that conduct blood donations, along with advancements in transfusion science and new practices in blood bank management technology have prompted calls from academics to review and amend the Drugs and Cosmetics Act from time to time. [1] [23]

Organisations

India has government-funded and private blood donation organisations. Some major organisations operate in many regions throughout the country while others are regional and operate with local support. Along with conducting blood donation camps, they also raise awareness on voluntary blood donation and public health. Most organisations maintain online portals or physical registry where donors can enter their details and receive updates when blood donation drives are conducted; this also facilitates a network between blood donors and organisations/hospitals. [24] Apart from such organisations, major hospitals in the country have their own blood banks where blood donation is conducted within the facility. As of 2015, there were 2.2 blood banks per million population in the country. [25] As per a 2016 study, around 51% of the 2493 blood banks surveyed across the country had component separation facility. [26]

Issues in blood donation

Despite a huge population, the demand-supply gap for blood units persists in many healthcare facilities in the country. As of 2022 the annual shortage of blood is estimated at one million units. [13]

Blood banks

A study conducted between 2009 and 2013 concluded a high rate of non-compliance on the part of blood banks on the quality and safety of transfusion services. [27] Cases of transmission of infective diseases like AIDS due to substandard medical facilities and practices in blood banks continue to be relatively high. [28] The National Blood Policy outlines the requirement for primary healthcare centres to have 24/7 service for blood transfusion, but over 80% of them lack blood storage facility. [29] With the sector being largely unorganized and fragmented, and lack of communication between hospitals with no real-time centralized data on availability of blood units between them, there have been instances of shortage of blood at hospitals being a major factor in deaths caused by time-critical events such as accidents. [30] [31]

Donors

Disparities in access of donors in regions have led to wastage of blood stock in some parts of the country, while at the same time creating a shortage of blood in some other parts. [32] Voluntary blood donation comprises about 70% of the blood demand, with the rest coming from replacement donors, whereas 62 nations in the world fulfill their blood demands through voluntary donations. [33] [34] A 2011 study reported that a mere 6% of women donated blood, mostly due to physiological problems and low hemoglobin count. [35] Anaemia is also reported as a major cause of deferral in blood donation, accounting for up to 77.9% of female and up to 37% of male deferrals. [22] Other hurdles in increasing voluntary blood donation include the fear of pain and weakness after the procedure, and illiteracy. [36]

Other Issues

Documented instances of forced blood extraction have occurred in India, among other countries, owing to its disproportionate ratio of available supply of blood and high poverty rate. One such ring gained national attention in 2008 when an emaciated man escaped from his captors near the city of Gorakhpur, in Uttar Pradesh. [37] [38] Blood donations reduced during the COVID-19 pandemic, primarily due to restrictions on travel and fear of contracting the disease at healthcare centres. [39] [40] [41]

Blood donation camp in New Delhi Civilian and Indian Navy personnel donating blood at a Blood Donation Camp in New Delhi (1).JPG
Blood donation camp in New Delhi

Initiatives to encourage blood donation

1 October is celebrated as the national voluntary blood donation day. [42] Blood donation agencies often organize workshops to educate people about the benefits of donating blood. [43] With a huge population of youth, blood donation drives are conducted by hospitals and organisations at college campuses. [44] [45] Blood donors and their family members are often given priority in case of emergency or accidents. 32 mobile blood banks were introduced in 2010 to facilitate donation in remote regions. [46] [47] In 2016, the government launched an initiative called E-RaktKosh (Rakt: blood, Kosh: repository), a web-based mechanism that integrates all blood banks in the state into a single network, providing information about blood camps and the availability of blood in hospitals throughout the country. [48] A mobile application for the E-RaktKosh portal was launched in 2020 to improve accessibility. [49]

See also

Related Research Articles

<span class="mw-page-title-main">Organ donation</span> Process of voluntarily giving away organs

Organ donation is the process when a person authorizes an organ of their own to be removed and transplanted to another person, legally, either by consent while the donor is alive, through a legal authorization for deceased donation made prior to death, or for deceased donations through the authorization by the legal next of kin.

<span class="mw-page-title-main">Blood type</span> Classification of blood based on antibodies and antigens on red blood cell surfaces

A blood type is a classification of blood, based on the presence and absence of antibodies and inherited antigenic substances on the surface of red blood cells (RBCs). These antigens may be proteins, carbohydrates, glycoproteins, or glycolipids, depending on the blood group system. Some of these antigens are also present on the surface of other types of cells of various tissues. Several of these red blood cell surface antigens can stem from one allele and collectively form a blood group system.

<span class="mw-page-title-main">Blood transfusion</span> Intravenous transference of blood products

Blood transfusion is the process of transferring blood products into a person's circulation intravenously. Transfusions are used for various medical conditions to replace lost components of the blood. Early transfusions used whole blood, but modern medical practice commonly uses only components of the blood, such as red blood cells, plasma, platelets, and other clotting factors. White blood cells are transfused only in very rare circumstances, since granulocyte transfusion has limited applications. Whole blood has come back into use in the setting of trauma.

<span class="mw-page-title-main">Whole blood</span> Unseparated donated human blood

Whole blood (WB) is human blood from a standard blood donation. It is used in the treatment of massive bleeding, in exchange transfusion, and when people donate blood to themselves. One unit of whole blood brings up hemoglobin levels by about 10 g/L. Cross matching is typically done before the blood is given. It is given by injection into a vein.

<span class="mw-page-title-main">Blood plasma</span> Liquid component of blood

Blood plasma is a light amber-colored liquid component of blood in which blood cells are absent, but which contains proteins and other constituents of whole blood in suspension. It makes up about 55% of the body's total blood volume. It is the intravascular part of extracellular fluid. It is mostly water, and contains important dissolved proteins, glucose, clotting factors, electrolytes, hormones, carbon dioxide, and oxygen. It plays a vital role in an intravascular osmotic effect that keeps electrolyte concentration balanced and protects the body from infection and other blood-related disorders.

<span class="mw-page-title-main">Blood bank</span> Place where blood donations are collected

A blood bank is a center where blood gathered as a result of blood donation is stored and preserved for later use in blood transfusion. The term "blood bank" typically refers to a department of a hospital usually within a clinical pathology laboratory where the storage of blood product occurs and where pre-transfusion and blood compatibility testing is performed. However, it sometimes refers to a collection center, and some hospitals also perform collection. Blood banking includes tasks related to blood collection, processing, testing, separation, and storage.

<span class="mw-page-title-main">Blood donation</span> Blood withdrawal for use by another person via transfusion

A blood donation occurs when a person voluntarily has blood drawn and used for transfusions and/or made into biopharmaceutical medications by a process called fractionation. A donation may be of whole blood, or of specific components directly (apheresis). Blood banks often participate in the collection process as well as the procedures that follow it.

<span class="mw-page-title-main">Hemolytic disease of the newborn</span> Fetal and neonatal alloimmune blood condition

Hemolytic disease of the newborn, also known as hemolytic disease of the fetus and newborn, HDN, HDFN, or erythroblastosis fetalis, is an alloimmune condition that develops in a fetus at or around birth, when the IgG molecules produced by the mother pass through the placenta. Among these antibodies are some which attack antigens on the red blood cells in the fetal circulation, breaking down and destroying the cells. The fetus can develop reticulocytosis and anemia. The intensity of this fetal disease ranges from mild to very severe, and fetal death from heart failure can occur. When the disease is moderate or severe, many erythroblasts are present in the fetal blood, earning these forms of the disease the name erythroblastosis fetalis.

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<span class="mw-page-title-main">Packed red blood cells</span> Red blood cells separated for blood transfusion

Packed red blood cells, also known as packed cells, are red blood cells that have been separated for blood transfusion. The packed cells are typically used in anemia that is either causing symptoms or when the hemoglobin is less than usually 70–80 g/L. In adults, one unit brings up hemoglobin levels by about 10 g/L. Repeated transfusions may be required in people receiving cancer chemotherapy or who have hemoglobin disorders. Cross-matching is typically required before the blood is given. It is given by injection into a vein.

<span class="mw-page-title-main">World Blood Donor Day</span> International observance, June 14

World Blood Donor Day (WBDD) is held on June 14 each year. The event was organised for the first time in 2004, by four core international organizations: the World Health Organization, the International Federation of Red Cross and Red Crescent Societies; the International Federation of Blood Donor Organizations (IFBDO) and the International Society of Blood Transfusion (ISBT) to raise awareness of the need for safe blood and blood products, and to thank blood donors for their voluntary, life-saving gifts of blood. World Blood Donor Day is one of 11 official global public health campaigns marked by the World Health Organization (WHO), along with World Health Day, World Chagas Disease Day, World Tuberculosis Day, World Immunization Week, World Patient Safety Day, World Malaria Day, World No Tobacco Day, World Hepatitis Day, World Antimicrobial Awareness Week and World AIDS Day.

Febrile non-hemolytic transfusion reaction (FNHTR) is the most common type of transfusion reaction. It is a benign occurrence with symptoms that include fever but not directly related with hemolysis. It is caused by cytokine release from leukocytes within the donor product as a consequence of white blood cell breakdown .These inflammatory mediators accumulate during the storage of the donated blood, and so the frequency of this reaction increases with the storage length of donated blood. This is in contrast to transfusion-associated acute lung injury, in which the donor plasma has antibodies directed against the recipient HLA antigens, mediating the characteristic lung damage.

<span class="mw-page-title-main">National AIDS Control Organisation</span> Indian organization for control of HIV/AIDS

The National AIDS Control Organisation (NACO), established in 1992 is a division of India's Ministry of Health and Family Welfare that provides leadership to HIV/AIDS control programme in India through 35 HIV/AIDS Prevention and Control Societies, and is "the nodal organisation for formulation of policy and implementation of programs for prevention and control of HIV/AIDS in India.".

<span class="mw-page-title-main">J. G. Jolly</span>

Dr. Jai Gopal Jolly, famously known as Dr. J. G. Jolly was an Indian physician and professor of the Department of Transfusion Medicine at the Post Graduate Institute of Medical Education and Research, Chandigarh, India. He is an internationally known expert in the field of blood transfusion, who pioneered the voluntary blood donation movement in India, and is regarded as the "Father of Transfusion Medicine in India". He spearheaded the campaign to prohibit sale and purchase of blood from professional donors in India, which was later incorporated into the National Blood Policy of India by the Government of India. He has generated awareness among the masses about the significance of blood donation programmes by observing "Blood Donation Day" on 1 October. This has helped in obtaining adequate quantity of quality blood from voluntary donors.

Blood donation in Bangladesh is an activity conducted by several different organisations. As of 2011, about 25% of the nation's blood supply came from voluntary donation, 20–25% from paid donors, and 50–55% from one-time donation for a specific patient.

<span class="mw-page-title-main">Sankalp India Foundation</span>

Sankalp India Foundations is a Bangalore-based non-government organisation. It is a youth organisation working for blood donation, thalassemia, bone marrow transplantation and disaster relief.

<span class="mw-page-title-main">Percy Lane Oliver</span> Pioneer of volunteer blood donation

Percy Lane Oliver was a British civil servant, who is credited with founding the first volunteer blood donation service. A layman, Oliver was working for the Camberwell division of the Red Cross in 1921 when he responded to a call from a local hospital requesting an urgent blood donation. This experience led him to organise a panel of donors whose blood types were known and who were available to donate on request. The donors, unusually for the time, were not paid. Oliver's blood donation service, which he ran out of his London home, would grow from 20 volunteers at its inception to approximately 2700 in 1938. His model of voluntary blood donation was adopted throughout Britain and in other countries.

<span class="mw-page-title-main">Monocyte monolayer assay</span> Laboratory test for clinically significant alloantibodies

The monocyte monolayer assay (MMA) is used to determine the clinical significance of alloantibodies produced by blood transfusion recipients. The assay is used to assess the potential for intravascular hemolysis when incompatible cellular blood products are transfused to the anemic patient. When donor cells possess substances that are not produced by the recipient, the recipient's immune system produces antibodies against the substance; these are called alloantibodies. Specific white blood cells, called monocytes, are tasked with ingesting foreign material and become activated during certain inflammatory events. These activated monocytes come in contact with antibody-sensitized red blood cells (RBC) and may or may not exhibit phagocytosis (ingestion) and destroy the donor red blood cells. If monocytes destroy the RBC, the antibody attached to those RBC is considered clinically significant.

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Further reading

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