In India, it’s possible that a trauma patient loses his life if the blood bank in the hospital he lands up in doesn’t have his blood type. This
By K Madan Gopal and Suryaprabha Sadasivan
If it hurts to think that many children sleep hungry while tonnes of food rots in fridges, realise the same may be happening with donated blood while lives are being lost. In India, it’s possible that a trauma patient loses his life if the blood bank in the hospital he lands up in doesn’t have his blood type. This may happen even as another blood bank nearby has stocks of the required blood type that will eventually expire unused. This may sound criminal, but it happens because most blood banks in India have no links with each other. They are not well-coordinated, which stops them from sharing resources and functioning efficiently for the very purpose blood is stored, i.e. saving lives.
Today, blood transfusion in our country relies on a fragmented blood-supply system, where control is exercised by different levels of the government, but at the point of delivery, the patient and his family have to run around arranging for blood themselves. Currently, there are myriad challenges, ranging from shortage, wastage, lack of standardisation to access and availability of safe blood. As per the official data of 2016-17, there was a shortage of 1.9 million units.
Often, opening more blood banks is pegged as the easiest solution to address the complex problem of access and availability of blood. In reality, shortfall of blood results more from inefficiencies in the existing blood banks in India and limited voluntary non-remunerated blood donation.
In an ideal scenario, over 3,000 blood banks in India and the current blood bank density of 2.2 blood banks per million persons should adequately address the blood requirement of this country. However, failure to properly process and store blood components separately leads to underutilisation of blood; that’s because each blood component is used for a different health need. Unplanned distribution and unviable size of blood banks also worsen the problem of unmet needs for blood.
This is exacerbated by the fact that as per the 2016-17 data, 5-6% collected blood is wasted, due to logistical reasons like expiry of components with shorter shelf life, deterioration during storage, and non-completion of blood collection in requisite quantities due to donor reactions. Technological upgradation of more blood banks where components can be separated and stored can also aid in substantial reduction of blood wastage in India.
The non-existent connectivity and interdependence between blood banks in India causes inconsistency in demand and supply among blood banks, besides leading to increase in wastage of blood and limited use of infrastructural resources. Majority of blood banks are completely dependent on donors in the vicinity, which further accentuates the demand-supply gap. While the e-Rakt Kosh under health ministry provides an online platform for placing blood stock status in public domain by all licensed blood banks, compliance is not 100%.
Developed countries like the US, China and those in Europe have institutionalised a centralised blood transfusion service, which acts as a hub for the network connecting blood collection centres across a region. This centralised network caters efficiently to the demand-supply inconsistencies and shares resources and blood as and when required. These systems are mostly based on voluntary blood donation. In Asia, Vietnam, which decided to centralise its fragmented blood services in 2001, managed to double its annual blood collection in 10 years. In the same period, it was able to collect 88.7% of blood from voluntary donors and ensure that 100% of its donated blood was screened.
Something similar has been envisioned in the National AIDS Control Organisation’s Action Plan for Blood Safety 2007. It planned partial centralisation of blood services through a hub-and-spoke model of regional blood transfusion centres (RBTCs). These hubs are proposed to be fully equipped to cater to multiple satellite blood banks or storage centres in the regions that perform limited functions.
These centrally-sponsored metro blood banks will come up in Kolkata and Chennai by 2020 and subsequently in Delhi and Mumbai by 2021. These banks will be high-volume blood-collection centres equipped with state-of-the-art technology in transfusion medicine for component separation, blood processing and quality systems.
In a hub-and-spoke model such as this, the highly-trained manpower in the regional hub can manage efficiencies of blood banks in the area through constant interactions. Though variations of this model can be adapted to the geographical and demographic context of different regions, what the most basic model entails is centralisation of blood collection and processing at the hub in a state and transporting blood and blood components to different storage centres. This would be backed up by efficient demand mapping and inventory management.
This can help curb wastage of extra blood collected at blood banks, especially now that bulk transfers between blood banks have been allowed by the National Blood Transfusion Council (NBTC) and are also permissible under the Drugs and Cosmetics Rules. Consolidation of advanced testing and processing will result in economies of scale, cutting costs and managing quality through standardisation. An interconnected network of blood banks and storage centres will make sure blood reaches where it needs to, on time.
The second challenge impacting the Indian blood system is the need for transition from dependency on replacement blood donations to a sustainable system driven by non-remunerated voluntary blood donation based on altruism. Besides the lack of structured blood donor programmes, there also exist a plethora of myths surrounding blood donation, which dissuade people from voluntarily donating. Not surprisingly, a recent Lancet study estimates that India has donations at a rate of only 8.2 per 1,000 people, which needs to be tripled to meet the blood needs of the country.
India must create a policy framework to address all aspects of blood availability and safety through a multi-sectoral and multi-stakeholder collaboration. The policy should enable an environment where there is increased public awareness and participation in voluntary non-remunerated blood donation. Only access to safe blood can truly build a robust foundation for a strong public health system in India.
The writer is Gopal is senior consultant (Health), NITI Aayog, and Sadasivan is healthcare practice lead, Chase India. Views are personal