|Blood Safety and AIDS: UNAIDS Point of View (UNAIDS, 1997, 8 p.)|
Educate, motivate, recruit and retain low-risk donors
WHO, together with the International Federation of Red Cross and Red Crescent Societies and the International Society of Blood Transfusion, strongly recommend that the principle of voluntary, non-remunerated donations should be accepted and practised.
Getting people to give blood for no remuneration - whether in money or something that can be exchanged for money - is difficult. It needs an effective and ongoing campaign to persuade large numbers of the public to give blood voluntarily, out of public spirit, and regularly - that is to say, motivating and recruiting them.
Educating people about what being a blood donor means is also important, so that prospective donors can self-select and self-defer. Self-selection means excluding themselves from giving blood if they know or think they may be infected. Self-deferral is putting off, perhaps only temporarily, blood donation if there are reasons to do so - because of a recent illness, perhaps.
When donors present themselves at blood donation centres, they need to be interviewed by trained staff, so that those who appear to have a high risk of being infected are excluded. Selecting donors is thus an important part of the process.
And retaining voluntary, non-remunerated blood donors in the system is a key step on the way to achieving a safe and sufficiently large blood supply.
Such an operation needs good guidelines and operating procedures. For instance, the confidentiality of the donors must be guaranteed. The staff who are going to recruit donors and to counsel and select them before taking their blood need themselves to be appointed and trained. Donors need educational materials about what it means to be a blood donor and about the transfusion system. And a good recording system for donors has to be set up.
Screen blood and blood products
It is essential that all countries move quickly towards screening all blood and blood products -and for all the main diseases that can spread through transfusions, including HIV. This involves using the most appropriate and effective tests and adhering to internationally-approved guidelines to ensure the quality and safety of blood. Often, more than one type of test is recommended for a particular disease. In the case of HIV, WHO has testing strategies to help countries decide how to screen blood.
A national screening programme presents considerable logistical problems, which can only be overcome through good organization. Such problems include the distribution and storage of reagents and other materials used in testing blood, and storage of the blood itself. Donated blood, for instance, can be kept for a maximum of 35 days if special anticoagulants are used, but needs to be stored at a constant temperature of between +2 °C and +8 °C. And plasma - after being separated from whole blood - must be frozen within a few hours and kept at a temperature of -20 °C or lower. But while facilities may often exist in large cities, suitable refrigeration may not be available in rural or remoter areas - perhaps because electricity is lacking. Or it may be difficult to obtain or store materials used in blood screening, or anticoagulants.
Reduce unnecessary and inappropriate transfusions
Blood transfusions save many lives - but they should also be used with care. There is a risk of infection as well as of other adverse reactions from transfusions. And inappropriate transfusions waste precious blood that could be used elsewhere. Shortages of available blood encourage paid donors to appear - something that one definitely wants to avoid.
· Doctors and other medical staff should be educated to avoid prescribing inappropriate transfusions.
· Blood substitutes should be used where appropriate. Simple alternatives to blood, such as crystalloids (that is, saline solution) or colloids, will not transmit infection and can be obtained at a fraction of the cost of whole blood.
· The underlying reasons for blood transfusions should be addressed. A condition for which blood transfusions are often given is chronic anaemia - a lack of red blood cells that carry oxygen to the tissues. Chronic anaemia can be caused by malnutrition, slow loss of blood, and infections such as malaria. If we attack the root causes of chronic anaemia we can reduce the condition itself. We can do this by improving nutrition and giving supplements; controlling malaria; and raising health standards generally in society. Another condition where blood is often needed is complications in childbirth. By ensuring proper care for women before and during delivery, we can again decrease the need for transfusions.
A national blood transfusion service
A national blood transfusion service means making all transfusion centres and blood banks part of a national network, accountable to the government or else to a government-appointed nonprofit organization.
Having a national service makes all the other measures for ensuring safe blood much more possible. Such systems exist in some developed countries, and in several developing ones. It is no coincidence that in places with a good national service, the blood supply is considered safe. As an example from southern Africa, South Africa, Zimbabwe, Namibia and Zambia have national blood transfusion services, while most of their neighbours do not. The blood supply in these countries is regarded as safe.
The service must be developed within the framework of the country's health service and have an adequate budget and trained staff. For it to be successful, there has to be a national system of regulations. Regular independent monitoring of the blood transfusion service is highly important.
The charge for blood should be agreed in annual negotiations between the government and the blood transfusion service.
This is a recovery fee for the service provided, and covers items such as testing, staff salaries, other running costs and capital spending. However, the blood or blood product itself should be free for those receiving transfusions, or paid for by a health insurance scheme, for example.
One can never be 100% sure that blood is free of HIV. But with political commitment, good organization, sufficient funding, and donation of blood from low-risk, voluntary, non-remunerated donors, a national blood supply can be made so safe that the chances of becoming infected through a transfusion are extremely minute.
UNAIDS acknowledges the kind assistance of Dr Jean Emmanuel, Chief of the Blood Safety Unit at WHO, in preparing this publication.