World Blood Donation Day: India must make separation of blood components mandatory to reduce wastage

India has less than one percent blood reserve. Blood cannot be created or substituted. This is a national crisis that charity alone cannot resolve. In the weeks leading up to the World Blood Donation Day, Firstpost went undercover to three hospitals in Delhi – Safdarjung Hospital, All India Institute of Medical Sciences and Guru Teg Bahadur Hospital. While the former two are under the purview of the Central Government, the administration and operation of the latter is done by the Government of Delhi. Outside these three hospitals, there were touts who supply units of blood at a cheaper rate. Mohan (name changed), who supplies blood outside GTB in East Delhi, informed that one unit of blood can range from Rs 800 to Rs 5,000 in a hospital but for patients who need blood units consistently, like those with thalassemia and haemophilia, he can supply blood for Rs 500 a unit. This is the blood requisition form he handed out and promised to arrange five units at a lesser price. [caption id=“attachment_6815621” align=“alignnone” width=“825”] Blood requisition form touts use to supply blood at cheaper rate[/caption] Similarly, outside the Safdarjung and AIIMS hospitals, it wasn’t hard to find an agent. India’s black blood market opens itself up to anybody standing with a blood donation form outside a hospital gate. Jeetendra Singh Shunty, a former BJP MLA from Shahdara runs the Shaheed Bhagat Seva Dal quite close to the GTB hospital. His NGO organises free cremations for poor and unclaimed bodies, and also runs a blood donation drive. This World Blood Donation Day, Shunty is donating blood for the 100th time. When asked about the black blood market, he shared that this is something nearly everybody in Delhi knows about but hasn’t become a priority for any government till now. “Private blood banks in hospitals like Apollo, Max and Ganga Ram might charge anywhere between Rs 12,000 to Rs 15,000 for blood transfusion. Sometimes, even if families of the patient donate the blood, a hefty charge for the transfusion burns a hole in people’s pockets," said Shunty, pointing out that standardisation of price is difficult because the supply keeps fluctuating. Those at the Indian Red Cross Society’s Blood Bank in New Delhi feel disheartened at the fact that there is a black blood market. “It’s sad to think and talk about blood being sold for some money, but it is the reality that blood is being sold illegally. We view this as a humanitarian service,” shared Dr Poonam Walia, attached to the organisation. Dr Walia informs that blood tourism is another reason why there’s always shortage of blood. This, however, she adds, is not accounted for. Besides, since donated blood is not separated into its various components like RBCs, WBCs, plasma and platelets, each of which are used to treat specific clinical conditions, puts additional burden on the county’s existing blood reserves. Often, an entire unit of blood, instated of a specific component, which is the specific need of the patient, is given to the patient. Dr KK Kalra, former CEO of the National Accreditation Board for Hospitals & Healthcare Providers pointed out that the awareness regarding blood component donation among the medical fraternity is low. He feels that there’s a need for a campaign to conserve and increase blood reserves on the scale of Polio awareness programme. “If somebody needs platelets or RCBs, entire units of blood are finished off,” he shared. [caption id=“attachment_3594333” align=“alignnone” width=“825”] Representational image. AP[/caption] Dr Kalra, however, feels that there is no real need for a centralised body because both private and government blood banks need to procure a license from the Central Drugs Standard Control Organisation (CDSCO) and blood is an immediate, localised need. Prasanna Shirol of the Organisation for Rare Diseases India (ORDI), a non-profit national umbrella organisation representing the collective voice and needs of all rare disease patients and stakeholders, is of the view that the government must set up tech intensive labs where components can be separated. “The issue isn’t just lack of awareness. If we need to rationally manage blood reserves, we need labs where plasma or RBCs can be separated from the rest of blood that still remains usable,” he shared, adding that private manufacturers have started manufacturing intravenous immunoglobulin (IVIG) for patients with primary immunodeficiency and this is a key blood component. “In this case, only the plasma is used. There are hundreds of varieties of this disease,” Shirol explained. Blood, blood components and plasma are categorised as a ‘drug’ under Section 3(b) of Drugs and Cosmetics Act, 1940 of India. This serves as the legal framework for regulating the functions of blood banks, which provide recovered plasma for plasma fractionation to various fractionating companies in India (6). In a dense paper on the componentisation of blood titled ‘ Indian plasma fractionation industry: challenges and opportunities’ Ranjeet S Ajmani writes, “Blood banking is a relatively very small level of operation as compared to plasma fractionation, which is a very big industrial operation with a very heavy emphasis on GMP norms and viral safety concerns. The issues related to plasma fractionation industry did not come up for serious discussion at higher level of deliberation, as there were hardly any companies working in this field and that is why at that point in time it was very invisible and insignificant from the point of view of public healthcare system. This could be one of the reasons that many of the haemophiliacs who received contaminated lyophilised cryoprecipitate during late 1980s and early 1990s died silently without any large public outcry and any compensation.” Dr Suresh Hanagwadi’s life exemplifies the struggle within the system. A haemophilia patient who suffers from the deficiency of ‘factor 9’ is the former president of the Haemophilia Federation of India and also runs a blood bank in Davangere, Karnataka. “Clotting factor concentrate is imported by the Hemophilia Federation of India (HFI), a patients’ organisation which has 80 chapters across the country. There’s a need to incentivise and promote manufacturing within the country,” he shared. Innovations in the sector are still taking place in niche areas and a collective, national-level awareness campaign is missing. Raghu Rajagopal is the co-founder and director of DATRI, India’s largest adult unrelated Blood Stem Cell Donors Registry. DATRI has over 4 lakh donors registered with it. “If a patient has to go through a blood stem cell/bone marrow transplant and cannot find a match in the family DATRI helps in finding a match and facilitates the donor to go through the blood stem cell donation,” he said. The probability of finding a match within the family is less than 25 percent. Rajagopal feels that the concept that strangers anywhere in the country can benefit each other isn’t a familiar one. Till now, DATRI has matched 561 patients to donors. A national awareness program on componentisation and greater interaction between private and public blood banks on technology and reserves can help India manage its severe blood shortage.