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Sunday, January 20, 2019
R. Dev Raj
NEW DELHI, Sep 18 1997 (IPS) - Transfusion-related HIV infections are compelling a clean up of India’s chaotic blood-banking system — heavily dependent on professional donors and woefully short of basic equipment.
According to J.V. Prasad Rao, project director of the World Bank-funded, National Aids Control Organisation (NACO) a high 10 percent of HIV transmission in the country is attributable to transfusion of unscreened blood and blood products.
“Although an overhaul of the blood banking system has been due for decades, there is a new urgency because of the rapid spread of HIV among the general population,” Rao said.
That urgency is reflected in the fact that a little over half of NACO’s 28 million dollar budget for the year has been earmarked for voluntary donation camps and for upgradation of the country’s 1,400-odd blood banks — nearly half of them privately owned.
“The money will go into the distribution of testing kits for various infections such as HIV, malaria, Hepatitis-B and also for blood component separation equipment,” Rao said.
But there is a more compelling reason for the urgency. The government has just three months left to comply with a Supreme Court order on completely phasing out professional donors who account for half of India’s blood supply.
In a landmark judgement in January 1996, the apex court gave the government one year to shut down unlicensed blood shops and two years to source blood exclusively from volunteers or replacement donors.
While the government, supported by World Bank funds, has managed to upgrade and license 1,008 blood banks, phasing out professional donors is providing to be a taller order and come January there is bound to be serious shortages.
As things stand, there is a 50 percent shortfall with total annual collection amounting to three million units against a demand of six million units, says Dr. V.N. Sardana, joint director and blood safety expert at NACO.
Dr. Sardana is critical of the absence of a national programme for blood safety resulting in fragmented management. “In spite of the existing hospital-based system many large medical institutions do not have their own blood banks which has led to the mushrooming of commercial blood banks,” he said.
Because commercial blood banks are profit-driven and openly source supplies from professional donors, they are also accused of compromising on safety issues. However, institutions like the Indian Red Cross (IRC) have not earned a better reputation for blood safety.
In July 1995, the IRC unit in Bombay was raided by the Food and Drugs Administration (FDA) and ordered closed after 12 cases of HIV infections of thalassaemics were linked to blood from the unit by one of its own doctors.
The public interest litigation against which the Supreme Court passed its landmark judgement was itself based on a nationwide study made in 1990 by a reputed firm of chartered accountants which found that 85 percent of blood collected in the country was not screened for HIV or other infections.
According to the firm, A.F. Ferguson, the blood transfusion infrastructure was marked by a lack of critical resources, trained professionals, staff, equipment and finances. Medical courses also did not recognise transfusion medicine as a speciality, the report pointed out.
Consequently, even if donated blood was tested, proper assessment of the health status of donors was rarely made and many of them were anaemic from repeated withdrawal of blood or were substance abusers, according to the report which still provides base-line data for blood banking services.
However, the court, recognising the critical role of commercial blood banks, ordered their representation in a newly formed National Blood Transfusion Council (NBTC) to help formulate rules and policy.
Grouped under the banner of the Indian Association of Blood Banks (IABB) the commercial banks have mounted a vigorous defence of the “paid donors” system, besides conducting workshops and training sessions for personnel across the country.
Says Dr. V.B. Lal, president of the IABB, “safe blood is blood that has undergone all the mandatory tests and has been found to be disease-free irrespective of whether the donor was paid or not.”
Dr. Lal challenges the idea that voluntary donors are safer than paid professionals and cites a NACO document which shows that the incidence of HIV positive cases is actually higher among volunteers than among professional donors.
Professional donors are safer because they are constantly screened and they are the only dependable source of blood in case of emergencies, Dr. Lal said.
“Unless the public is motivated to donate blood regularly and a cadre of committed voluntary donors created, all talk of switching over to voluntary donation can only mean further shortages,” said Dr. Lal who has been running his own blood bank in the heart of the capital for 50 years now.
According to Dr. Lal, the government has done precious little to encourage volunteers beyond the occasional blood-donation camps. “There have also been strong cultural taboos associated with blood which the government did nothing to dispel,” he said.
However, NACO project director, Prasad Rao thinks that blood should never be treated as a commodity. “No system can be based on the blood of destitutes, although dire poverty and widespread ignorance are important factors in the trade.”
Rao is convinced that a planned media campaign involving popular cricket stars, the issuance of “donor cards” and camps would help motivate reluctant Indians to donate more blood.
“On Oct. 1, which has been declared National Voluntary Blood Donation Day, a special drive is being launched to build awareness including a run by volunteers,” Rao said.
But, Dr. Lal dismisses the programme as a gimmick which cannot sustain the kind of committed donorship which will be needed in a large country like India, once commercial blood banking is scrapped.
The most likely scenario is that, given the demand for blood and the sheer profitability of the blood trade, it will simply go underground. “The blood-letting will go on clandestinely within the four walls of private nursing homes,” says Dr. J.G. Jolly, a veteran campaigner against commercial banking.
Besides said Dr. Jolly, who is founder-president of the Indian Society of Blood Transfusion and Immuno-haematology (ISBTI) professional donors can be found at respectable hospitals posing as the friend or relative of a patient and wishing to make a “replacement donation”.
Dr. Jolly blames the situation on the apathy of the medical profession towards what is essentially a moral issue — buying blood from the poor. “Doctors are known to patronise private blood banks in return for commissions in the same manner that they would recommend a particular drug brand or chemist,” he said.
“The whole business is based on desperation — desperation of those who need blood and desperate poverty,” Dr. Jolly said.
A study conducted by an NGO ‘Vatavaran’ on 17 private blood banks in the capital confirmed that many of them had inadequate testing and storage facilities.
Vatavaran found that while professional donors contributed more than 100,000 units annually to Delhi’s blood supply, voluntary donations accounted for some 30,000 units with another 20,000 units coming in as replacements from the friends and relatives of patients admitted in big hospitals. But the annual demand in Delhi is 300,000 units.
Interestingly, Vatavaran’s study revealed that 40 percent of blood sellers were actually college students who started out as volunteers and then took to selling blood for pocket money.
Most commercial blood banks pay 250 rupees (seven dollars) per unit of blood to donors, but charge buyers around 750 rupees per unit although the rates very greatly. In contrast, government hospitals and the Red Cross charge a token 250 rupees per unit of blood against consumables.
Meanwhile, Delhi’s 7,000 odd professional donors are demanding rehabilitation since the Supreme Court will put an end to their livelihood if implemented.
Says Jagdish Bhardwaj, president of the Fellowship of Blood Donors (FOBD), “Society has made good use of professional blood donors for decades but the government refuses to even acknowledge our existence.”
Bharadwaj said it is typical of the attitude that the Supreme Court declined to hear out the FOBD but allowed society to go on depending on professional donors during the two years grace it has given the government to switch over to voluntary blood donation.
Dr. Sanjay Kapoor, of the Voluntary Health Association of India (VHAI), a leading health NGO, likens the situation of
professional blood donors to that of prostitutes. “Society needs them but refuses to recognise them.”
Dr. Kapoor is certain that professional donors will survive in spite of the Supreme Court judgement simply because the government has done nothing on the ground and because of the heavy demand for blood.
“The simple fact is that blood transfusion is still surrounded by too many misconceptions and fears such as loss of virility or vitality and lately HIV transmission and other infections have become associated with sticking needles of any kind,” Dr. Kapoor said.
For its part, shortage or no shortage, the government is determined to stamp out the system of paid donors and federal Minister for Health Renuka Chaudhary has vowed to deal sternly with clandestine operations.
“We are running out of time on the Supreme Court order and we hope there will be no shortage of blood in January,” she said.
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