For many years, monetary inducement of blood donation was relied on all over the world barring a couple of countries. In India all the blood banks started functioning depending on poor paid blood sellers. Transmission of infection is a serious complication of blood transfusion In spite of sophisticated laboratory techniques to screen blood from donors, safe blood transfusion cannot be ensured unless the quality of donors is assured at the source. Blood donors recruited in lieu of payment would be untruthful about their history of past ailments and sell blood by suppressing their health status particularly when they should exclude themselves. A global study has revealed that prevalence of infectious diseases in paid donors is higher than in voluntary donors. Naturally, incidence of transfusion transmitted infections from commercial* blood banks is higher than those from non-profit making blood banks.
To ensure blood safety, a move towards a totally voluntary blood donor service for all blood products has long been advocated at the international level. As already indicated, under the directive of the Supreme Court buying blood from blood sellers has been officially banned in India from January 1, 1998. But many transfusion centres or blood banks of the country, in view of banning of buying blood from professional blood seller have switched over to replacement donor system. They put the responsibility of bringing donor for the blood bank on the patient or their friends/relatives instead of going out to motivate and recruit voluntary blood donors. This has resulted in patronisation of blood seller system where money is not officially paid at the blood bank but unofficially outside the blood bank door by the patients’ relatives.
The most serious danger of family donor system is that the difficulties described above may create entrepreneurial opportunities for the blood sellers to pose as family surrogates, on payment in an organised manner. Such systems have the ability to make the sellers dependent upon this activity for their livelihood. The resulting deep corruption may be difficult to eradicate, yet so dangerous to both the donor and the patient. The professional donor is tempted to give blood too frequently; stories are common of professional donors admitted to hospital in shock after several donations in one day. Moreover, it is not possible to rely upon health history information provided by the professional donor because such ‘donors’ often come from economically and socially deprived sections of society. Therefore, there is a greater likelihood that the ‘donor’ will be anaemic and in poor general state of health. They will be less likely, out of financial need, to reveal any medical condition.
In India, hospitals particularly specialised ones are in the metropolitan cities or in state capitals. Rural people coming to these hospitals cannot bring donors of required group with them. Naturally they fall prey to blood sellers.
These blood sellers are poor people themselves who sell their blood for want of money caring little for their own health. They suffer from various ailments and are often drug addicts, alcoholics and carriers of blood transmissible infections. Their only concern is to earn money. It makes no difference to them whether the recipient suffers or dies because of the poor quality of blood. They often sell their blood at short intervals in different names to different blood banks. Often, their blood is poor in respect of haemoglobin content in view of their frequent blood letting. They hoodwink the haemoglobin test prior to donation in different ways such as by taking iron tablets orally. From the point of view of social values, buying and selling of human blood is a positive insult to humanity and can be compared with trading in human slavery. To the sick, counting days for a bag of blood, the community has a moral and social responsibility. Refusal to donate blood when one is fit to do so takes away one of one’s right to expect that somebody would donate blood in time of one’s need.
There is another angle which must be emphasised. Human blood is not a merchandise; it is a collection of living human tissues (Outside a donor’s body the cells must be ‘fed’ to continue living). Trading in such living human organisms cannot be legally permitted. And blood cannot be priced by the market-mechanism. Awareness is also growing all over the world that requirement of ‘safe blood’ is an “entitlement” under universal “Human Rights” which cannot be denied to any individual.
In some blood collection drives, donor-organisers lure donors by costly gifts having monetary value. The gifts do not ensure real voluntary blood donation. If enticements truly motivate people to donate blood, they have the same potential danger as ‘selling’. It brings in people who are not supposed to donate blood. Quality of blood collected from ‘donors’ with enticements having monetary value does not ensure safe blood. Thus, enticement serves no useful purpose. Instead, it adds the unnecessary costs and logistic complications. In a study at Kolkata it was revealed that costly gifts attracted more first time donors, who had a higher prevalence of viral blood transmissible infections but did not attract more repeat donors. Regular donors feel insulted by such gift. Real non-remunerated altruistic voluntary blood donors have the following advantages over the paid, replacement or directed donors:
- Voluntary donors are not under any pressure to donate blood and therefore would be truthful about their health status.
- They would meet the natural criteria of low risk donors.
- They can be easily converted into regular voluntary donors.
- Regular voluntary donors are more likely to be free from transfusion transmitted diseases. This is time tested.
- They would self exclude themselves whenever not fit to donate in view of their education.
- These voluntary blood donors would easily respond to the call for rare group donor or ‘on call’ emergency donors in view of their high level of motivation and commitment to voluntary blood donation.
Therefore, elimination of commercialisation in blood banking can ensure safe blood transfusion. The starting point is recruitment of voluntary blood donors through education to meet the national need. Through awareness programmes common people should be motivated not to accept blood from commercial blood banks. There should be no coercion to get replacement donation. All government blood banks should provide blood to private hospitals and nursing homes. Conviction, dedication, enthusiasm, perseverance among the donor motivators and organisers within the transfusion service or from outside can eliminate the commercialisation in blood banking, of course, with adequate support from the government.