|Blood Safety and AIDS: UNAIDS Point of View (UNAIDS, 1997, 8 p.)|
A lack of safe donors and the presence of unsafe ones
Donors can be divided into three types. The first is the paid or professional donor. There are very strong reasons why they should be prohibited. Paid donors very often come from the poorest sectors of society. They may be in poor health, undernourished and at risk of having infections that can be passed on through transfusions. In some places, paid donors sell blood mainly to buy drugs to inject themselves with. This practice - if they share needles and syringes that are not sterilized - is itself a high-risk activity for contracting HIV.
In addition, paid donors are likely to give blood more often than is recommended, with the result that their blood may become substandard - lacking in iron, for instance. This can be a considerable risk to the recipient. And through over-donating, donors are likely to damage their own health.
The practice of paying donors usually also goes together with the practice of selling blood to the recipients of transfusions. Under such a system, poor families may not be able to afford vitally-needed blood. And apart from everything else, having paid donors undermines the goal of having a voluntary, unpaid system. If unpaid donors see others around them receiving money for giving blood, they too may want to be paid.
A second type of donor is the replacement donor - sometimes called family replacement donor. In the replacement donor system, families of people needing a transfusion are asked to donate the same quantity as that given to their relation, and this blood may be used directly, where compatible, or else put into the general pool. For some years, WHO has strongly discouraged this type of arrangement The relations giving the blood are often paid donors, and not related at all. Even if they are related, there are doubts about the safety of their blood - as the normal criteria for selecting or deferring donors cannot be applied. However, the use of such donors is common in many developing countries where there is a great shortage of blood. Developing countries utilize only an estimated 20% of the world's blood supply, but have 80% of its population.
In some countries, the replacement system - often started with well-meant intentions by the authorities - has become a serious problem. In Cambodia, for instance, the International Committee of the Red Cross (ICRC), who are responsible for overseeing the blood supply, take photos of people, claiming to be relations, who attend blood donation centres regularly. If they are seen too often, ICRC refuses to take their blood.
Many countries have all the required regulations and legislation for a safe blood supply in place, but the laws are not enforced. It is urgent that we correct this situation. This can be achieved by whole-hearted political commitment. In many countries, prevalences of HIV and infections such as hepatitis B and C are increasing fast. In these places the blood supply will become even more unsafe than it may already be if the international recommendations for a safe blood supply are not followed.
The third - and safest - type of blood donor is the voluntary, unpaid donor. Such donors give out of altruism, and are not under pressure to donate blood. On the whole, they are more likely to meet national criteria for low-risk donors. And they are also more likely to be willing to donate blood on a regular basis and at properly-spaced intervals - subject to donor selection and deferral techniques. This is very important in maintaining a sufficient stock of blood.
Lack of screening
This problem is easy to describe, but often very difficult to solve. In many parts of the world, correct screening of blood - for HIV and hepatitis B, as well as for other blood-carried diseases, such as hepatitis C - is still applied to some and not all blood donations. In many developing countries, blood is screened only in the capital city and perhaps in one or two other large towns.
Lack of screening is most often the result of a lack of funding. It is expensive to set up a national system to test all donated blood. Good organization, planning and management are also required, and these are equally difficult to find. Trained staff at all levels are likely to be lacking, as are test kits to screen blood.
Transfusions are not always necessary or appropriate. Unnecessary transfusions increase the risk of transmitting HIV, especially in places where there is not adequate screening of blood. Apart from that, they create an avoidable shortage in the blood supply. This encourages professional donors to become more active, reducing the safety of the supply.