Blood Transfusion Security and Pakistan

The World Blood Donor Day (WBDD) is celebrated globally every year on June 14, the birthday of Karl Landsteiner, the discoverer of the ABO blood group. The Day is celebrated to raise awareness about blood safety and the significance of voluntary blood donations and also to acknowledge the contribution of voluntary blood donors in saving lives and making the national blood transfusion systems safe and sustainable.

Every year the World Health Organization (WHO) selects a new theme and a new slogan for the annual WBDD celebrations. The theme for the 2020 celebrations is “Safe blood saves lives” with the slogan “Give blood and make the world a healthier place”. The theme highlights the significance of individual efforts in contributing to the overall safety of the blood systems and making blood transfusion services accessible to all as a basic human right.

Every year 117.4 million blood donations are collected globally but 42% of these are collected in high-income countries, home to only 16% of the world’s population. In other words, the vast majority of the world’s population does not have sufficient blood to meet its need.

In Pakistan, until 2010, the entire national scenario was dominated by a demand driven fragmented blood transfusion system, which not only is hazardous but also promotes unsafe transfusions. Blood transfusion authorities were weak and regulation was poor with no real registration and licensing of the blood centers. Most significantly there was no national or regional platform to discuss and develop national consensus. As a result, Pakistan faced chronic shortages of blood for routine and emergency patients. Despite 70% of its population being under 29 years, only about 13% of the blood supplies in Pakistan come from voluntary blood donors, usually one time donors. The remaining blood is collected from ‘Family Replacement Donors’ as the system has conveniently outsourced its responsibility of mobilization of blood donors to the patient families who invariably accompany their hospital admitted patient in large numbers.

To reform the system and promote blood safety and access to safe blood, the Government of Pakistan initiated blood safety system reforms and established the Safe Blood Transfusion Programme (SBTP) with the support of German government in 2010.

In the first phase (2010-16) of the project, a nationwide network of development of 10 modern Regional Blood Centers (RBCs) and up-gradation of 59 existing hospital blood banks all over the country was funded by the German government.

The second phase of the Project is underway in which the scope and coverage of the project is being further expanded, through continued support from the German government, with the creation of more new RBCs supporting the linked hospital blood banks and the up-gradation of large existing public sector blood centers.

In countries without a functional blood transfusion service, people often reach out to their networks including Facebook to locate blood donors. In Pakistan, there are thousands of posts on Facebook each month seeking blood donors. To facilitate such needy families, the global social media giant Facebook launched a special blood donation Feature for Pakistan in 2018 in collaboration with SBTP.

So far 35 million people around the world, including 2 million from Pakistan, signed up on the Facebook Feature and committed to become voluntary blood donors.To translate these 2 million commitments into action (donation), SBTP implemented the use of the Feature in its RBCs. This initiative has positively impacted the number of walk-in donors and has proved to be a very effective tool in mobilizing donors especially in the COVID19 pandemic when the conventional sources of blood donation have dried up.

Pakistan has additional needs for transfusion due to a very high burden of thalassemia. It is estimated that about a fourth of the 2.7 million blood donations collected every year in Pakistan are consumed by the estimated 100,000 transfusion dependent thalassaemia major patients. The transfusion needs of many of these patients remain partially fulfilled or poorly managed as a result of shortage of blood donors and lack of national policy, plan or strategy. In addition, Pakistan is a disaster prone country with frequent incidence of natural and man-made calamities. The latest addition to this list of adversities is the global COVID19 pandemic. The role of ‘Convalescent Plasma’ in the treatment and reducing the severity of COVID19 is now assuming significance aspreliminary findings have demonstrated some encouraging results. At present, patient families are told by the treating physicians to arrange ‘Convalescent Plasma’ for which the families and civil society search frantically. The collection of plasma from the recovered patients in an organized and scientific manner is thus of vital significance and must be managed by the SBTP.  Incorporation of ‘Blood Security’ needs to be an essential component of the national disaster management plans with strong linkage with the SBTP.

COVID19 pandemic has forever changed our lives and behavior. Overnight, the healthcare sector has assumed tremendous significance. It is no more possible for the governments to ignore the gaps and deficiencies of the health systems including the blood transfusion systems. So let the WBDD 2020 celebrations serve as reminder to the global community and the national governments to pay special attention to their national blood programmes and especially ensure that in the post-COVID19 era blood safety and security are ensured which is not possible without achieving the goal of 100% reliance on voluntary and regular blood donations.

The author is Former National Coordinator of Safe Blood Transfusion Programme, Ministry of National Health Services, Regulation & Coordination

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