Donation of blood in Pakistan: Risks and Resources

There are four kinds of blood transfusion services

Allogeneic blood donations

In the allogeneic blood donations, donors donate whole blood for use in any individual needing a transfusion. Allogeneic blood donation represents the majority of blood donations in the country.

Directed blood donations

In the direct blood donations, donors donate blood or blood components to be used for a specific patient and must pass the same requirements that allogeneic donors face.

Autologous blood donations

In autologous blood donations, donors donate their own blood for their own use. They are not required to pass the same requirements that the others donors must.

Apheresis blood donations

In apheresis blood donations, donor donates platelets or plasma, and have their red blood cells returned to them during the course of procedure. This allows them to donate more frequently than every twelve weeks.

In Pakistan, following kinds of blood donors donate blood. However, their proportion varies from place to place and institution to institution.

Commercial blood donors

Commercial blood donor is donor who gives a blood on payment. He is also called professional blood donor or paid blood donor. In Pakistan, commercial blood donors meet 13% of the total requirements of the blood

1. In Karachi, 54% facilities, mostly small volume based blood transfusions services were found using paid blood for the transfusion.
2. Commercial blood donors are drug addicts, and have unsafe sexual behavior. They all are anaemia and donate blood very frequently
3. (4, 5) Prevalence of blood-transmitted infection is quite high. 20% are positive for hepatitis C infections.

6. 10% for the hepatitis B infection.

7. Quite a few cases of HIV infection have also been reported among them.

8. Gross anaemia, unsafe sexual behavior, drug abuse and high prevalence of blood transmitted infections make commercial blood donor’s blood unsafe for transfusion. All blood transfusion services should discourage commercial blood donors from blood donations at their facilities.

Family blood donor

Family blood donor is a donor who donates blood in replacement of blood needs of their patient without having any commercial motives. He may also be called replacement blood donor.

Family blood donation accounts for 62% needs of blood transfusion in the country (1, 9) There is misperception in the general population that family blood is the safest blood for transfusion. They believe that no family donor knowing his/her high-risk behavior or history of blood transfusion infection will ever donate blood to his/her relatives or friends. However, family, replacement blood has not provided safe for transfusion. Five percent are found positive for hepatitis B infection and 2.5% for hepatitis C infection.

10. This high prevalence of blood transmitted infection among family blood donor may be because circumstances may force them to donate blood despite having risk behavior or blood transmitted infection.

11. It may be because prevalence of hepatitis infections so high that they do not regard these diseases any significant and do not remember their exact occurrence. It is also a possibility that family who does not find donors among themselves may seek help from paid donors and they appear in the blood banks in the disguise of a family blood donor(9). One type of family donation is directed donations. In this kind of donation, family blood donor donates blood to be transfused to a specific nominated patient. Directed donations in general are not encouraged. They may have hazardous effects. Transfusion from first degree related blood donor might cause graft versus host disease (GVHS)

12. Blood from husband to wife may sensitize and may cause hemolytic disease to new born. Repeated blood donation from same donor may sensitize the patient and can cause adverse blood transfusion reactions.

13. Transfusion of blood from a potential organ transplant, donor (except renal transplant) may cause earlier rejection following transplantation because of presence of pre formed antibodies.

 14. However, directed blood donations might have some justifications in some specific cases like HLA matched platelet transfusion to unresponsive patients, or exchange transfusion or platelet transfusion from mother to her infant.

15. In general, family blood is also not regarded safe for transfusion. Family blood donors have high prevalence of blood-transmitted infections, compared to voluntary blood donors. They may donate blood without their own free will, under the pressure family or circumstances, which is against the spirit of voluntary blood donation.

Voluntary blood donor

Voluntary blood donor is a donor who donates blood of his/her own free will. He does not expect any monetary benefit or any other incentive, reward at the time of donation or in future. Their primary motivation is to help unknown recipients and not to obtain any personal benefit. In Pakistan 25% of total blood donation comes from voluntary blood donation (1).

Voluntary blood is safest blood for transfusion. They donate blood on their own free will; so they do not hide their high risk behavior and past record of illness. They are well educated and motivated, so they make it possible to select a safe and healthy blood donor. They are screened for blood transmitted diseases which each time when they donate blood; so reactive donors stop donating the blood once found reactive and counseled. Two percent voluntary blood donors are found positive for hepatitis B infection and 0.5% for hepatitis C infection in Pakistan. The prevalence of blood transmitted disease is much lower than 30% seroprevalence reported among paid blood donors, and 7% found among family blood donors (16, 17, and 18). All blood transfusion services should encourage voluntary blood donation at their centers, because it is the safest source of blood in the country and cause lowest wastage of reactive blood. Voluntary blood donors do not offer their blood when they feel themselves at high risk of any blood transmitted disease. Blood transfusion services can rely on them because they are willing to donate blood regularly and respond to appeal for blood donations during emergencies.

Requirements of blood donations in the country

The total annual consumption of whole and packed blood cells reported 1.5 million units of blood per year (19). Considering 2% population may require transfusion of blood (11), the total demand of blood appears to be around 2.6 million units of blood per year. Pakistan has a population of around 137 million. Majority belongs to a blood donation age group i.e. between 17 and 60 year. If one percent of our population is motivated to regularly donate blood twice a year, the country can meet the total estimated need of blood through voluntary blood donations.

Myths and misperceptions related with voluntary blood donation in the country

·         Major demand of blood arises only in mass emergencies.

·          Families can cater the need of blood of any individual patient.

·         Donation of blood causes physical weakness.

·         Blood donation procedure is very painful.

·         Only very strong and healthy can donate blood.

·         Women are not fit to donate blood.

·         Family may suffer tomorrow if they donate blood voluntary today.

·         Blood donation requires a day off.

·         Blood donation may cause diseases like AIDS, hepatitis, etc.

·         Blood donated voluntary may be used commercially in the hospitals (20).

Education and motives of voluntary blood donors

A sustained education and motivation program is a must. It constitutes an essential part of a donor recruitment strategy. It should redress all myth and misperception of the general population prevalence in the country with regard to donation of blood. Educate people that a good stock of safe blood at blood transfusion services can only ensure safe and appropriate supply of blood in major emergencies. In thalassemia, hemophilia, leukemia, aplastic anaemia and renal failure repeated blood donations are required. In all such cases family cannot manage to arrange blood regularly. In major surgeries several units of blood are required at a time. It is not possible for the small size family to arrange blood from their own resources or when they come from other part of the country. Donors must be explained that donation of blood is a complete safe procedure, so no one can catch the disease through the donation of blood. Donation of one unit of blood does not have any harmful effect. Any healthy adult can donate blood safely. Only the country, regular donation of blood is a healthy activity. It lifts the self-esteems and promotes positive mental attitude. It is protective habit. A habit, that helps in leading a very effective and successful life. All major illnesses are picked up very early in regular blood donors because they regularly undergo medical examination and get immediate attention whenever any abnormality is noticed. Families of regular voluntary blood donors very uncommonly suffer from blood transmitted diseases, as these infections are nabbed very early in their buds. Heart attacks are uncommon among regular voluntary blood donors, compared to those of non-blood donor population of same age and sex group (21, 22, and 23).

Education materials and use of print and electronic media both regional and national can play a very effective and important role in a donor’s education, motivations and recruitment of voluntary blood donors.

Radio and television provide an excellent opportunity for blood donor recruitment. Organizers can reach a large number of people with relatively small efforts. It is particularly important to use the radio or television to broadcast urgent appeal for new and regular blood donors to donate their blood when stock is low, such as in the Holy month of Ramadan, or when unexpectedly large volume of blood is required after a large scale disaster. Internet can also offer useful opportunity to educate, motivate and recruit voluntary blood donors. Organization of voluntary blood donation camps in the holy month of Muharram also help in the recruiting new voluntary blood donors, and collection of voluntary blood. During this month people are found more inclined to donate blood to remember suffering of Holy Prophet’s family. Participation of celebrities from the media, sports, academics, region, politics and other fields also help in motivating people to donate blood.

Recruitment of regular voluntary blood donors

Donors who have once donated the blood can become regular blood donor. Their initial fear of donation of blood is lost and they realize the significance of their blood saving the lives of other people. Pleasant blood donation environment, warm reception, careful phlebotomy and personal attention are the most important factors in motivating the donors to donate blood again (24). The donor area should be attractive, well lighted, comfortably, ventilated, clean and open at convenient hours for the donors. Personnel should be friendly, sympathetic, professional and well trained. Whether blood is collected at the blood center or mobile units, every effort should be made to make the donor a pleasant experience.

Criteria for donors admitted as a regular donor

Following is criteria of selection of regular donor

·         Donation of blood at least once a year up to four times a year for men and three times a year for women.

·         Donated blood in the last year when called upon to do so.

·         No significant adverse blood donation reactions such as fainting have occurred during the last donation.

·         General state of health is good.

·         Donor is easily accessible and available for donation of blood (11)

Donor Call up

Regular education, motivation, recruitment, voluntary blood donors and retention can result in the establishment of a panel of regular voluntary donors. Once it is established, it should be easy to identify donors or due to give another donation. They need to be contacted and asked to donate blood once their donation is due. It may be a good idea to contact a family donor and persuade them to donate blood again. They may be willing to become regular voluntary donors. Their fear of first time donation of blood is lost and need of availability of ready stock have been realized.

Donor self-exclusion and deferral

Every transfusion services have a responsibility to educate existing donors and general public, who are potential blood donors, about the importance of avoiding risk behavior. It is also important to counsel donors about risk behavior and to encourage them to self-exclude if they have engaged in any behavior that may have exposed them to risk of transfusion transmitted diseases.