Dr Dharmakanta Kumbhakar
(drkdharmakanta1@gmail.com)
Blood is considered to be an essential element and the living force of human life with no substitute. Nothing is comparable to the preciousness of human blood. Safe blood/blood components transfusion is an important component of the modern healthcare system and most of the time, life-saving one. In many major surgeries, emergency care of trauma patients, women with complications during pregnancy, severely anaemic women and children, cancer patients and persons suffering from sickle-cell anaemia, thalassemia, haemophilia, etc., require safe blood/blood components transfusions. Safe blood/blood components transfusions improve life expectancy and quality of life of patients suffering from life-threatening diseases. In mass casualties like bomb blasts, gunshot injuries, road traffic accidents, natural calamities, etc., safe blood transfusions play a vital role in the life-saving process. Transfusion of safe blood/blood components helps to save millions of lives every year worldwide.
Patients who require blood/blood components transfusion as a part of their clinical management have the right to expect that sufficient safe blood/blood components will be available to meet their needs. Safe blood/blood components transfusion comes under legal protection also as it is both life saving and fatal. To transfuse the safest blood/blood components to needy patients, it is globally accepted that the best source of blood is from voluntary blood donations (VBD) and preferably from Voluntary Non-Remunerated Blood Donors (VNRBDs). A VNRBD donates blood or its components of his or her own free will and receives no payment, either in the form of cash or in-kind which could be considered a substitute for money. The only reward they receive is personal satisfaction, self-esteem and pride. The WHO advocates and recommends to its member states to develop national blood transfusion services based on voluntary non-remunerated regular blood donation in accordance with the World Health Assembly resolution, adopted in 1975. The WHO's goal was for all countries to obtain all their blood supplies from voluntary donors by 2020. But, as of today, in just 62 countries, national blood supplies are based on 100% VBD, with 40 countries, including India, still dependent on family blood donors and even paid blood donors. Even after 46 years of World Health Assembly resolution, the issue of blood safety, equitable access to safe blood/blood components and their safe and rational use are still remaining as major challenges in our country.
In India, safe blood/blood components are constantly in high demand. Maintaining a constant reserve of safe and sufficient blood/blood components all the time is a big challenge for most of the blood centres in our country. Most of the time, if a patient needs blood/blood components transfusion in India, a replacement blood donor from his/her family or friend needs to donate blood/blood components. In some conditions where blood/blood components transfusion is required off and on, sometimes more than 100 units to a particular patient, then how can the family or friends bring all the required number of replacement blood donors? This gives rise to the involvement of professional or paid blood donors disguised as replacement blood donors. It is well established that paid blood donors constitute a group with high-risk behaviour leading to greater chances of transfusion transmissible infections in the recipients. Indian Panel Code in chapter XIV, sections 269 and 270, provides protection against the spread of infectious diseases due to negligent and malignant acts respectively. The Supreme Court of India has banned professional blood donation since January 1, 1998.
To maintain a safe and sustainable national blood/blood components supply to all those in need, healthy VNRBDs must come forward for VBD. Without a regular flow of actual VNRBD to keep the blood/blood components stock sufficient, the delivery of safe blood/blood components in the right quantity at the right time can never be ensured. All we know is that, in spite of rapid and remarkable conquests of medical science today, there is no factory that can manufacture blood/blood components. It is only in human beings that human blood/blood components are made and circulated. For those who require blood/blood components for saving their lives, sharing the same from other fellows is the only means. If 1% of the blood donation eligible population of India donates blood/blood components voluntarily, then India can meet its basic requirements for blood/blood components easily. In India, any healthy person aged 18 to 65 years having normal blood pressure, normal temperature, weight more than 45 kg and haemoglobin level more than 12 gm/dL can usually donate whole blood, although other limits apply to donations of plasma and platelets. For safety reasons, users of injectable drugs, carriers of transmissible infections (HIV, HBV, HCV, Syphilis, Malaria, etc.), recipients of organ transplants or recent blood transfusions can no longer be blood donors. As a rule, at the interval of three months, any healthy person can donate blood up to four times per year. Plasma and platelet may be donated frequently.
For India, 100% VBD is not a magic figure. All the eligible blood donors of the country should come forward for VBD so that any patient who needs blood/blood components transfusion can get the required safe blood/blood component units from the blood centres without replacement. The most precious gift that we humans can give each other is the donation of blood/blood components, a gift that can save lives and give a new lease of life to many persons in need. There are many ways to be a better human being and to serve mankind. VBD is said to be one of the best services that a man can do. Donating blood/blood components is a noble work. If someone really loves oneself and other fellow beings, the only way to express it is to donate blood voluntarily. Voluntary Non-Remunerated Blood Donors are saviours of mankind. Today, on National Voluntary Blood Donation Day, the nation appeals to all eligible blood donors to come forward and join in this heroic act of giving the precious gift of life with a pledge to promote 100% VBD.