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.”
A study published in 2022 estimates that about 14.6 million units of blood are required each year in India and there is a consistent shortage of one million units. Yet, there are multiple hurdles for blood donation.
Blanket Guidelines, Donors Lost
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.
People with certain illnesses such as thyroid disorders are also often deferred despite being euthyroid (maintaining normal levels with medication). This is not to be blamed on the guidelines though, this is at the health providers' discretion and often deferral seems easier than making an informed decision.
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.
It is not that deferral protocols are unnecessary. These rules for blood transfusion are in place to ensure “safe blood” is donated to the recipients. However, the guidelines have not been updated even as knowledge progresses throughout the world.
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.
How Voluntary Is It Anyway?
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.
In my experience, even when patients were provided blood on an “emergency basis” without a replacement donor, they were hounded with repeated requests to arrange for a replacement later. Needless to say, vulnerable groups are thus made more vulnerable. Caste, class, sexuality, gender, and other social identities combine to decide whether you and your community can arrange this life-saving elixir for a loved one.
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.
And don’t forget, the situation of anaemia (the reporting of which is being compromised) is dire in India.
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!
This again raises the question of who can access such resources, especially in a crisis. Given the increased possibility of illness and injury, such situations add to the illness of those without privilege.
What Can We Do?
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.
There are no easy answers and blood transfusion pathways cannot be fixed overnight in a health system that struggles with everything else, yet it is important to remember that there are many healthy individuals who can, in fact, donate blood.
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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