Ban on professional blood donations may cause crisis

India faces a major blood supply crisis if an impending Supreme Court order bans professional blood donations.

''We are running out of time,'' admits Union Minister of State for Health Renuka Chowdhury who says she is hopeful of cobbling together a solution with available resources before the December 31 deadline.

While about six million units are needed annually, only three million units find their way into blood banks, says V N Sardana, joint director in charge of blood safety at the National Aids Control Organisation.

And if the success of recent blood donation camps are any indication, things are not going to improve. After AIDS came into the limelight, the response to such camps has been indifferent.

To begin with, holding blood donation camps is nothing more than a ''firefighting" solution to a national problem which has remained unsolved for decades, says V B Lal, president of the Indian Association of Blood Banks.

Blood donation camps are temporary affairs and do nothing to create a cadre of committed blood donors who can be relied on to provide a regular supply of blood once the present system is scrapped, Lal argued.

Blood banks might have gone on depending on professional donors but for alarming figures showing that a high 10 per cent of India’s HIV infection came from blood transfusions, says NACO director J V Prasad. Inadequate monitoring of blood and reuse of disposable syringes after improper sterilisation has brought many blood banks and nursing homes into disrepute. Sometimes blood is taken without waiting for the mandatory three months between donations.

Vatavaran, a non-governmental organisation, after a study on 17 private blood banks, concluded that most "blood shops" in the capital had inadequate testing and storage facilities.

It is likely that professional blood donors will go underground. But it "will go on clandestinely in private nursing homes," says J G Jolly, a Chandigarh-based campaigner against professional blood donations. Such donors can be found even at reputed hospitals, posing as friends or relatives of patients while waiting to make a replacement donation, says Jolly, who is also founder-president of the Indian Society of Blood Transfusion and Immuno-Haematology.

Jolly blames the situation on the apathy of the medical profession towards what is essentially a moral issue – buying blood from the poor. Besides, doctors pocket big commissions for directing patients to blood banks they have made a deal with.

While many blood banks may be "hole-in-the-wall" operations, Lal says there are others that are run more scientifically than government-run institutions, one of which, the Bombay Red Cross blood bank, was closed down after one of its doctors traced 12 HIV infections among thalassaemics to a racket runs by employees. Lal challenges the idea that the blood of a voluntary blood donor is any safer than that of professional donors. HIV prevalence is higher among the public than generally acknowledged; this showed up only in tests done on donors, making them look worse off, he adds.

Professional donors are safer because they are constantly screened and are the only dependable source of blood in emergencies, he said. While that may be true in the better blood banks, most of those in shady urban centres -- and in many rural blood banks too -- professionals too are rarely screened. The infrastructure does not permit it.

Jagdish Bharadwaj, president of the Fellowship Of Blood Donors, says professional donors are being given a raw deal. "Society has made good use of professional blood donors for decades but the government refuses to even acknowledge their existence," he claims.

In essence, Lal and Bharadwaj say, professional blood donors could save more lives than they take. While identifying such donors may be difficult, once the ban is effected, many of them may all move to shadier, more laxly regulated blood banks which will ask fewer questions. With as demand rises further, more regulations may be circumvented, even at the better places.

Until the doctors find safe replacement -- cheaper ways of monitoring and separating blood, cheap artificial blood, a more trustworthy blood collection system to reassure volunteers, or combinations of these – the blood shortage in the country is unlikely to ease up.