Voluntary blood donation rate has hit the 80% mark. National Aids Control Organization's (NACO) latest assessment says that 80% of estimated 10 million units of safe blood availability required for the country have been achieved through a network of 2, 609 blood banks - public, voluntary/trust, private hospitals and private standalone ones. And, about 80% is through voluntary blood donation. (Sinha, 2011)
This news from Times of India should have made all of us who work for voluntary blood donation jump in joy and distribute sweets on the streets. After all, all of us (the blood banks, the Government, the voluntary organisations, the camp organisers and the blood donors) have been working so very hard to improve voluntary blood donation. Seeing such a stupendous increate in voluntary blood donation should have put up a large smile on our faces. But, to be frank, it does not help me feel any better.
Quoting (NACO, 2007) “Definitions Related to Blood Donors Donations
A) Voluntary non-remunerated blood donor
1) A person who gives blood, plasma or other blood components of his/her own free will and receives no payment for it, either in the form of cash or in-kind which could be considered a substitute for money. This includes time off work, other than reasonably needed for the donation and travel. Small tokens, refreshments and reimbursement of the direct travel costs are compatible with voluntary, non-remunerated blood donation.
2) "Voluntary" blood donation refers to "unpaid, non-remunerated" blood donation
3) An altruistic donor who gives blood freely and willingly without receiving money or any other form of payment.
Other categories of blood donors
B) Family / Replacement blood donor
1) A donor who gives blood when it is required by a member of the patient's family or community. This may involve a hidden paid donation system in which the donor is paid by the patient's family.
2) A family / replacement donor is one who gives blood when it is required by a member of his/her family or community. This often involves coercion and/or payment which compromise the safety of the blood.
3) A member of the family or a friend of the patient who donates blood in replacement of blood needed for the particular patient without involvement of any monetary or other benefits from any source.”
The definition of a voluntary blood donor is very clear in this document. Moreover, it is coherent with that proposed by international organisations including WHO. A replacement donor or a family donor is NOT a voluntary blood donor and so we believed ever since we started working in the field of blood donation. Now let's look at the latest annual report from where the above quoted news report has sourced information.
"In the year 2006-07, Voluntary Blood Donation (VBD) was 54.4 percent which was the baseline for NACP-III. It increased to 59.1 percent in 2007-08, 61.7 percent in 2008-09 and further to 74.1 percent in 2009-10 (till January 2010) against the NACP-III target of 90 percent. During the year 2010-11, the percentage of voluntary blood donation was 79.4 percent against the target of 80 percent".
(NACO, Annual Report 2010-11, 2011)
With disbelief I read this news. And the next thing I did was to call up a couple of blood bankers to seek their help in understanding this news. I was shocked at this data because we have not seen any miraculously effective steps being taken across the table which could lead to such phenomenal growth in Voluntary Blood Donation.
On the condition of anonymity I was told that the one omission that we see in the annual report this year is the percentage of the replacement donations and this because NACO has issued new definitions for a Voluntary Blood donor which simply include the family, friends and relative blood donors who are clearly categorised as replacement donors in (NACO, Voluntary Blood donation Program - An Operational Guide, 2007)) as voluntary blood donors now. I tried to find the new definition on NACO website without success.
Now, if indeed there has been a definition upgrade the way I have been given to understand, it is a very disturbing development for several reasons:
-It violates the very basis of problem identification which the entire voluntary blood donation was being built around. The slight change it definition makes it incompatible with the WHO proposed definition of voluntary blood donation.
-The whole point of avoiding coercion in blood donation is compromised if relatives are counted in as voluntary blood donors opening the donors not just for unsafe blood but for also exploitation all under the perfectly accepted banners and norms.
-It leads to undermining of the actual extent of the problem and thereby creates a false sense of comfort in the blood donation community as a whole. With such false sense of having achieved what was being sought out for, the urgency and the importance that is attached to the matter will get diluted.
Hospital based blood banks and several stand alone blood banks have been allowed to operate without giving them the permission to organise blood donation camps. This in itself is endorsing the fact that there can never be 100% voluntary blood donation as per the definitions set by NACO in 2007. The only possibility for a blood bank without a camp license to get voluntary donors from is through walk in voluntary donors.
Though there are no facts to give accurate ration of voluntary walk in blood donors I came across, it is an open secret that such donors are a very small minority. Instead of solving this issue of how to organise blood for all of these blood banks where today we do not permit camps in an effective manner we have the policy makers calling replacement donations as voluntary. This will break down the possibility for a 100% voluntary blood not just in an immediate sense but for a long time in future.
An amazing contradiction which is found in the same news report reads as below:
"Almost 47% of the blood collected in India is through replacement donors - those who give blood only when it is required by his family or friends. Voluntary donation is yet to pick up. The 450 ml of blood donated is regenerated by the body within two-three days. Donating blood regularly does not make you prone to diseases," Dr Bhatia had said. (Sinha, 2011)
79% voluntary blood donation. 47% replacement blood donation. Still news reports of people being bled in captivity coming in (Carney, 2011). Something is seriously wrong. Something is seriously being manipulated and underreported.
It is incredible how our Nation has picked up a fight against professional blood donation and moved towards voluntary blood donation since Supreme Country Verdict on 1st January 1998 banning professional blood donation. Though we are not close to 100% VBD yet, nevertheless a lot has been achieved. Such news reports appear to be mocking the efforts of all the Government and non-government institutions who have worked relentlessly to contribute to the cause of achieving 100% VBD in our India rather than congratulating them for the good work done so far and bracing them up for the challenge that lies ahead. For us the volunteers, the journey is far from over whether it gets so reported or not.
Carney, S. (2011). Blood Money. In S. Carney, The Red Market (pp. 153-173). Gurgaon: Hachette Book Printing India Pvt. Ltd. .
NACO. (2011). Annual Report 2010-11. Retrieved 01 02, 2012, from http://nacoonline.org: http://nacoonline.org/upload/REPORTS/NACO%20Annual%20Report%202010-11.pdf
NACO. (2007, 7). Voluntary Blood donation Program - An Operational Guide. Retrieved 1 2, 2012, from http://www.nacoonline.org: http://www.nacoonline.org/upload/Policies%20&%20Guidelines/29,%20volunta...
Sinha, K. (2011, 12 17). Voluntary blood donation hits 80% mark. Retrieved 1 2, 2012, from timesofindia.indiatimes.com: http://articles.timesofindia.indiatimes.com/2011-12-17/india/30528211_1_blood-replacement-donors-donation