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What could a lady giving birth, a child with thalassemia, and a person injured in a road traffic accident have in common?
Ask their caregivers and they will tell you – many of them have been asked to arrange for blood donors to ensure that their loved ones can get a blood (or blood parts) transfusion when they need it.
They will also tell you how difficult it is to arrange for this.
If you look up “blood request” on a any social media platforms, you will find multiple unanswered tweets or posts on the lines of “urgent requirement for blood.”
In India, the guidelines for blood donation, despite a recent update in 2020, continue to categorise all gay men and sex workers as 'high risk'.
While certain types of sexual activity do carry more risk of infections, it is neither useful nor fair to defer people belonging to these categories permanently. The guidelines are not only misleading, they are also vague and lead to considerable variation in actual practice.
Many willing donors are deferred in this way, often without adequate discussion regarding the reason for deferral.
The examples of this are plenty. After all, health care workers are people.
Even when they might be well intentioned, some biases remain – especially if they remain unchallenged in medical institutions.
For instance in the UK, deferral policy has changed over the years as screening modalities improve. The risk related deferrals are temporary and based on sexual activity rather than profession, gender, or sexuality.
After professionally donating blood was banned in 1998, addressing the blood shortage has been an uphill task.
Even today, most settings rely on family/replacement donors for replenishing and maintaining blood banks. Often, blood banks do not provide blood to patients until a “replacement” unit is donated by the family.
While the aim noted in most government guidelines is to shift to a 100 percent “voluntary” donation, where the replacement donor is not needed in times of crises, this is still a distant dream.
Let us picture this, you need a healthy blood donor. If you are a person with adequate nutrition, have slept well the previous night, with no drinking habits, no recent illnesses, no tattoos, or no new sexual partners, and your blood group is suitable for your loved ones (or a blood group that the blood bank needs) – congratulations! The likelihood of your loved one getting the blood they need is high.
However, if you are a person struggling to make ends meet with poor nutrition, or cannot sleep because of the weather, or you drank recently, or got a tattoo, or are gay – you need to beg around for a “replacement” unit.
So how many people are really even capable of donating blood?
Even when there are people willing to and capable of donating blood, misconceptions and distrust is rife – “donating blood will make me weak” is a statement nearly all healthcare providers have heard, especially from men.
This weakness often carries the connotation of both reduced virility and reduced capacity to work. Surprisingly, these ideas are prevalent across different sections of society.
In such a situation, finding a voluntary and fit donor is a heavy burden to carry for the caregivers.
The forms still ask if the donation is voluntary and the donor does say 'yes' if they hope to donate blood, yet often donations happen in lieu of receiving blood for someone.
Even online repositories of voluntary donors like friends2donate.org need to be used to bring in replacement donors rather than timely, voluntary donors.
We must remember that all of these issues are preceded by another obstacle – the sheer availability of a blood bank at an accessible distance!
While knowledge is certainly power, it is important to update the knowledge of experts too. It is high time that the blood donation guidelines caught up with the needs of the country.
It is also important to make these guidelines accessible. There are well written protocols for blood transfusion that encourage blood bank officers to discuss any reasons for deferral with potential blood donors.
There is also a need to build and strengthen blood banks or at least better referral and transport chains at the primary care level so that people can access life saving care.
Better screening, counselling, storage, and rational use are some other important aspects that need priority.
Even as we fight for more inclusive and evidence based strategies, we need to remember the aim of switching to voluntary donations – we must (continue to) volunteer for blood donation!
(Dr Shivangi Shankar is a medical doctor and public health researcher. She writes about mental health, doctor-patient relationships, caregiver health, issues concerning healthcare workers, and public health in India. This is an opinion piece and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for the same.)
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