History of blood transfusion began in 1492 when Pope Innocent VII sank into coma and the blood of 3 10 year old boys was given to him through mouth. Unfortunately, all four died. During the decade of 1670’s, Dr. Jean Baptiste Denys performed several transfusions and used animal blood for humans. In 1818, Dr James Blundell performed the first successful transfusion of human blood. He transfused 4 ounces of blood from a husband to his wife.
But, it was not until the beginning of 20th Century that blood transfusion became safe. In 1901, a Scientist from Vienna, Karl Landsteiner discovered distinct types of blood and the era of safe blood transfusion started. Prior to that blood transfusion was like card games, you may live or you may die as incompatible blood types coagulated.
The blood transfusion was largely used in World War-I when Red Cross helped several war victims without any discrimination. There were large drives and people donated blood as a part of national pride. Though most of the donations of First World War were hand to hand (or vein to vein), the concept of blood banking came as early as 1915. Blood Banking on a large scale was first introduced in Russia in 1930s with setting up of 65 major blood banks across the country and more than 500 subsidiaries. With blood banking doctors didn’t need to worry about blood loss and could perform more extensive surgeries. It also enabled major leap in the field of medicine. But requirement of blood was increasing day by day. Soon there was a gap between demand and supply. Blood banking was all set to grow into a big business.
And paying for blood started in US, the capitalistic king of the world. By 1956, clinics in United States were for more than 5 million pints of blood annually. Blood collection shops sprang up in every major city. In India, national unions negotiated their rates with the governments and soon professional donors plied their trade in every major city in Indian subcontinent.
The red market was saving lives and no one had trouble with the ethics of supply chain. It took until 1970 for a British Social Anthropologist Richard Titmuss to express his concerns about professional blood transfusion. He was influenced by his country’s ethical stance on the issue. Millions of people in England donated blood in World War 2 without the intention of being paid and as a national pride. He showed that bought blood increases the chances of hepatitis and it was also exploitative as the blood banks looked for cheapest source of blood. They also started turning to prisoners to donate blood indicting a kind of slavery. Titmuss wrote, “Those who give as members of society to strangers will themselves eventually benefit as members of society.”
Remarkably, despite massive opposition from the commercial blood lobby, people listened. The United States passed law that made paying for any kind of blood illegal. Though, there is an exception for plasma which continues to be a source of second income for many people in US. This trend followed in the world for blood as well as other human tissue markets.
Unfortunately, there are flaws in these laws. It fell short of leeching profits from this business. Now while individuals can’t sell their blood, doctors and hospitals can. For ex you may not pay for a Heart, but you have to pay for heart transplant. Thus, hospitals increasingly turn profits from organ transplant and blood transfusion.
The second flaw in this system is that it fails to account for basic standard of medical privacy. In medical fraternity, while the authorities might be able to track individual donors, these records are sealed from everyone else. Thus someone who receives a kidney whether from living or dead, doesn’t know the person who gave up his organ. Though this is meant to protect the interest of donors, it also obscures the supply chain. Recipients buy human tissue with no knowledge of how it was procured.
The current system is a perfect storm for unmitigated human exploitation. From a village in India nicknamed Kidneyvakkam because most of its residents have sold their kidneys for money, to the grave thieves in West Bengal (India was the largest supplier of human skeletons till 1985 when the practice was banned by Supreme Court. It is still the largest supplier, though illegally). From the numerous professional blood donors, to the body snatchers, child thieves and surrogate mothers and the poor who sell their body parts to survive, Red Market is spread all across the world. And the supply chain is generally from poor to rich.
If every unit of blood can be traced down to its donor no blood sellers would be locked in rooms for years at a time to create a supply of blood. If every organ can be accounted for; no one could be killed or kidnapped for kidney. If origins of every adopted child can be tracked, no child would be kidnapped from their parents.
That’s why the role of voluntary donation becomes important. Forty years after Titmuss published his results, globalization has made the speed and complexity of red markets bewildering. Its time to stop ignoring red markets and start taking responsibility for them. Its time to start donating.