Demand-supply gap in blood donation

 Hundreds of blood donors, a large number of them women belonging to self-help groups, turned up in a few hours in Odisha to donate blood to over 900 passengers injured and admitted after the Balasore train mishap, reflecting the growing awareness of blood donation in India. Ground realities, however, present a mismatch between demand and supply of blood for transfusion in India. Taking stock of the existing blood collection, storage, and transfusion infrastructure to find out if these are adequate to meet the growing demand for blood transfusion can help get a clearer picture of whether the gap is persisting due to inadequacy in the system or awareness levels not reaching the desired level. The World Health Organisation estimates that one percent of a country’s population needs to donate blood regularly to meet the country’s demand. Based on the WHO criteria, the country’s requirement for blood is estimated at 13.1 million units. The National Estimation of Blood Requirement in India carried out by the National AIDS Control Organisation (NACO), India, the U.S. Centres for Disease Control and Prevention (CDC), New Delhi, the National Institute of Medical Statistics, India, Christian Medical College, Vellore, and the Christian Medical Association of India (CMAI), India, provides a reality check. The estimation report defines current clinical demand for blood as the total number of units of whole blood and components requested or demanded to meet all blood transfusions for emergencies and elective procedures at a defined number of health facilities over a defined period of time (usually one year). Based on medical needs, the clinical demand for the country was estimated to be 14.6 million units, which would address the whole blood and component demand. Of the total demand, the demand for medicine was 6 million (41.2%), followed by surgery at 4.1 million (27.9%), obstetrics and gynaecology at 3.3 million (22.4%), and paediatrics at 1.2 million (8.5%). The study revealed nutritional anaemia contributed around 39% of the population’s need, followed by oncological conditions (21.3%), gastrointestinal bleeding (12.9%), hemolytic anaemia (8.2%), end-stage renal disease (8.1%), bone marrow transplant (2.5%), plasmapheresis (1.9%), and leukaemia (1.6%). Adult cardiac surgery contributes the most, accounting for 17% of the total population need, followed by transplant (16.1%) and oncology surgeries (13.7%), while the least contributing condition is head and neck elective surgeries (0.2%), preceded by neurological conditions elective (0.5%), neurosurgical procedures emergency, and urology with 1.6%, highlights the report. A key highlight of the estimation is that the quantum of blood needed to cater to the paediatric needs of the population is estimated at 5.6 million units. The estimation found that 32% of the adult population (42.5 crore) in India is eligible for blood donation, and in order to meet the population’s need for blood, 62.3 per 1,000 eligible population (6.23% of the eligible population) should donate once a year. “The need is converted into a demand only when the person seeks healthcare services in a health facility. The conversion of the need to demand depends on geographic, socio-economic, and cultural factors that affect access to health services,” states the estimation report. According to this study, 34.3 per 1,000 eligible people (3.43% of the eligible population) must donate blood once a year to address the estimated clinical demand. The proportion can be reduced in the event of promotion of repeat voluntary non-remunerated blood donation. It states and emphasises that addressing the clinical demand is the most critical aspect, as it reflects the current demand that is experienced in the health facilities. Failure to meet the current clinical demand indicates that the blood transfusion services in the country experience shortages, it warns. According to this study, the country was able to supply around 93% of the whole blood and 92% of the red cell concentrate requirements. And estimates that assuming 93% of the demand was supplied, supply per 1,000 population was 31.9 per 1,000 eligible population (3.19% of eligible population), which indicates a gap between demand and supply. An additional 3 per 1000 people donating blood may address the actual clinical demand of the country, according to the estimation. The report reveals that in 2017, the annual collection of blood in India was 11,094,145 (11 million) and adds that if this data is assumed to be supply, then the actual supply was 26.1 per 1,000 eligible population, which indicates a significant gap between demand and supply. This larger picture of the gap between demand and supply revealed by the national estimation shows that there is no room for complacency over the growing awareness of voluntary blood donation and that there is a need to intensify the campaign to bridge the gap. Besides, distribution of blood donation infrastructure and region-, state-, or district-wise actual collection of blood and availability are crucial for the benefits of blood donation, which benefit people in every corner of the country.