The Perfect Can Be the Enemy of the Good
At the recent International Blood Safety Forum, many of the global representatives reflected on the challenge of building a voluntary, non-remunerated base of blood donors to sustain a safe blood supply. In my work, I have seen a spectrum of high index nations, and low- and middle-income countries (LMIC), grapple with this issue; yet it is particularly problematic in LMICs. In Sub-Saharan Africa alone, there is an estimated 40 million unit shortfall in the supply of blood annually.
In LMIC, blood is not consistently available nor readily accessible because of scant infrastructure and the demanding logistics associated with time dependencies and cold chain requirements. This shortage of blood exacts a terrible human cost. Post-partum hemorrhage (PPH) is the most frequent cause of death in pregnancy and childbirth. Severe anemia from malaria increases the likelihood of death in children less than 5 years old. The unavailability of blood also contributes to deaths for traumatic accident patients (85 percent in LMIC). Overall, approximately 23 to 56 million people each year are impacted, primarily in low-resource settings. We should do more to improve blood availability, in addition to blood safety.
The World Health Organization characterizes blood donors into three categories: voluntary non-remunerated; family/replacement donors; and paid donors. The voluntary non-remunerated donor is the gold-standard and the repeat donor is the safest, having been multiply-tested over time. Both family/replacement and paid donation are discouraged.
It is the category of the family/replacement that is most tricky. The definition is poorly understood and the practice patterns variable. I have seen settings where a donor must be found in lieu of payment for transfusion or situations where patient discharge is delayed until a replacement is identified. Yet, I have also seen more benevolent applications of family donation. I was recently consulting in the Caribbean and a community member posted on social media that her nephew was in an automobile accident. In this small island nation, many were related to the victim, yet they were driven by altruistic motivations to donate. Effective prenatal programs for expectant mothers may include education of family members about blood donation before the baby is delivered. This encourages blood donation from relatives given on behalf of the mother. These examples could be construed as a family donation.
Many times in the U.S., families and relatives sponsor blood drives in gratitude for kin who benefited from blood transfusion. We encourage these acts of civic responsibility regardless of familial relations. It is understood that someone will benefit from the gift, just as the sponsoring family did. Voluntary, non-remunerated donation should not impugn family or relatives, particularly if the alternative is no blood at all.
Linda Barnes; COO Bloodworks Northwest; LindaB@BloodworksNW.org