By: Suhail Ahmad Khoja &Misba Rafiq
Context
World Blood Donor Day is held on 14th of June each year. The event was organized 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.
It is celebrated on the birth anniversary of Karl Landsteiner, an Austrian-born American biologist who was awarded the Nobel Prize in 1930 in Physiology or Medicine for his discovery of the ABO blood group system in 1901. This remarkable discovery increased the likelihood of survival for recipients of blood transfusion that was earlier quite low. The slogan for 2023 World Blood Donor Day campaign, celebrated on 14 June 2023, is “Give blood, give plasma, share life, share often.” It focuses on patients requiring life-long transfusion support and underlines the role every single person can play, by giving the valuable gift of blood or plasma. The host country for the global event of World Blood Donor Day 2023 is Algeria through its National Blood Transfusion Service.
Types of blood donors and Global scenario
Donating blood, “the gift of life” is one of the noblest activities performed worldwide 118.5 million times annually as per World Health Organization(2018), which in itself exemplifies human empathy and altruism. There are three types of blood donors: Voluntary unpaid donors, who are also the safest group of donors as the prevalence of blood-borne infections is lowest among this group. The second category is family or replacement and third one the paid donor.
World Health Assembly resolution WHA63.12 urges all Member States to develop national blood systems based on voluntary unpaid donations and to work towards the goal of self-sufficiency. Data reported to WHO shows significant increases of voluntary unpaid blood donations in low- and middle-income countries: An increase of 10.7 million blood donations from voluntary unpaid donors from 2008 to 2018 has been reported by 119 countries. The highest increase of voluntary unpaid blood donations is in the South-East Asia Region (127%) followed by the Region of the Americas (81%) and Africa (81%).
An Impending crisis: Imbalance between demand and supply of blood in India
In India, the annual estimated requirement of blood is 1.46 Cr units (estimated) but, the total blood collection reported in the Yr. 2019-20 was 1.25 Cr units only as per a report by Ministry of Health and Family Welfare (GOI). The report also highlighted a heightened need for voluntary non-remunerated (not paid) blood donations, to bridge the gap between the requirement and the availability, and to have ready a roaster of interested donors. During 2021, a total of 4,12,432 accidents were reported by all States/UTs, of which, 1,42,163 (34.5 %) were fatal accidents. The number of persons killed in road accidents were 1,53,972 and caused injury to 3,84,448 persons, as per Ministry of Road Transport and Highways report for 2021. Moreover, the report also highlighted the rising accident severity (persons killed per thousand accidents) from 36 in 2020 to 37 in 2021. Consequently, such a scenario calls for increasing the supply of blood at the hospitals to save as many lives as possible.
Recently, the Registrar General of India’s Sample Registration System (SRS) released the latest special bulletin on Maternal Mortality (MMR) in India (2018-20), which highlights a consistent decline in MMR in India. It also points out that MMR in India has declined by 6 points from 103 in 2017-19 to 97 in 2018-20 (5.5% decline). However, the number varies across states with Kerala having the lowest MMR at 19 while Assam having the highest MMR at 195. Despite some ambitious & appreciable policy initiatives of the Govt of India, one of the most common and preventable cause of maternal death is Postpartum Haemorrhage (PPH), i.e. excessive bleeding after childbirth. PPH accounts for about 35% of all maternal deaths globally and about 30% of maternal deaths in India.
Replacement of blood and blood products plays an important role in managing PPH. So, access to timely delivery of care and to safe and adequate blood for transfusion can be a game changer in the effort to eradicate maternal casualties. Moreover, the number of cancer cases in the country is projected to go up from 14.6 lakh in 2022 to 15.7 lakh in 2025, according to the Indian Council of Medical Research-National Cancer Registry Programme (ICMR-NCRP), the government informed Parliament on March 14, 2023. It necessitates an increased supply of blood required by cancer patients. By and large, demand for blood is projected to surge in India in the upcoming years, as compared to its supply.
Way forward
The WHO estimates that blood donation by 1% of the population is generally the minimum to meet a nation’s most basic need for blood. As per the data of 2016-17, India had a shortfall of 1.9 million units (or 15%) vis-a-vis the WHO norm. A major lacuna in the Indian Health system is the lack of an adequate and reliable repository of data on potential blood supply in the country. Moreover, the most educated people in India perceive blood donation to be an emergency service, i.e. donate blood when asked. Generally, people do not know their blood group, mostly the need for it lies during medical surgeries or blood donation. So a lot of time elapses in assessing a patient’s blood group before blood transfusion. Similarly, if a person meets an accident that causes blood loss, assessing blood group before due transfusion may be too late to save his life.
Aadhaar has the potential to resolve these issues by offering a centralized digital database that stores blood group information of individuals who have been tested. This database can be accessed by healthcare facilities in real-time, enabling them to quickly identify suitable blood donors for transfusion purposes. Such information would also be accessible and known to an Individual. The testing should be carefully conducted by the govt throughout the country using available health infrastructure. To ensure proper data privacy and security, apt measures ought to be taken to protect the sensitive information. By implementing these strategies, healthcare facilities can significantly reduce the time that elapses between assessing blood groups and blood transfusion, leading to improved patient outcomes and enhanced healthcare efficiency.
Aadhaar or Unique Identification number (UID) is a 12-digit individual identification number issued by the Unique Identification Authority of India (UIDAI) on behalf of the Government of India. It captures the biometric identity – 10 fingerprints, iris and photograph – of every resident, and serves as a proof of identity and address anywhere in India. If the UIDAI updates Aadhaar and includes the blood group of an individual on it, complemented with incentives for individuals who donate blood voluntarily ,such as certificates of appreciation , priority access to blood in case of need , or tax benefits , there are higher chances that the voluntary unpaid blood donation in the country would pick up pace. Initially, a randomized control trial in this regard is worth an attempt, because the gains would far outweigh the losses from such a policy lever. Though other equally important issues need to be addressed.
Strengthening blood donation Infrastructure must be prioritized. Implementing any measure requires collaboration among government agencies, healthcare professionals, NGOs, educational institutions, and the general public. It’s essential to continuously evaluate and monitor the effectiveness of these strategies aimed at increasing blood donation to make necessary adjustments and ensure sustainable improvement in blood donation rates.
Swani0845@gmail.com, misbarafiq1202@gmail.com
The writers are Post graduate students of Economics at University of Kashmir
