Death by blood

This is a country with an estimated 4 million HIV-infected persons (according to UNAIDS, the United Nations HIV/AIDS programme). As many as 600 blood banks out of the total 1,400 in the country are unlicenced. Still, the recentlytabled national blood policy (NBP) just does not fix the responsibility of the blood transfusion system (BTS) in India.

The Government’s apathy towards this field is evident in the fact that BTS receives only a drop of the budget allocated for health care. “Where is the money going to come from for whole-sale supply of blood in the country? There is no great budget even for the health system in the country. Whatever little we are getting is from the National Aids Control Organisation (NACO), when the issue of blood safety was brought under its purview,” says Dr Zarin Bharucha, head of department, transfusion medicine, Tata Memorial Hospital, Mumbai.

Despite the Supreme Court banning the commercialisation of blood and the NBP recommending that blood banks in private hospitals be run on a non-profit basis, scrutinised by the Drugs Controllers office, there seems to be nobody in particular to curb the selling of blood.

Today, the only professional body in existence is the National Blood TransfusionCouncil (NBTC), an advisory body which lacks any form of implementation authority.

Dr Ambika Nanu, additional professor, department of transfusion Medicine, All India Institute of Medical Sciences, New Delhi, says: “Since I gave the government the idea of forming a national and state level blood transfusion council, no one is more astonished and disgusted than me, at how the NBTC has been derailed and made totally effete by NACO. Not one worthwhile decision has come out of it in almost three years of its existence.”

Though NBTC is a registered independent body, it appears to be NACO by another name, since the Supreme Court directive states that the project director of NACO will also head NBTC. “Therefore, it is inextricably enmeshed with NACO. There is no need for an advisory body,” says Nanu.

In the absence of an authority, commercialisation is flourishing. “Permission has been given by NACO to the private blood banks, to conduct voluntary blood camps. The result: private blood banks are regularlyconducting voluntary camps and selling that blood,” says Nanu.

Today, there is no uniformity in the activities of blood banks in the country, with no laid-down operating procedures. Each blood bank operates according to its own exclusive rule book. There are no uniform standards for donor screening especially in the cases of deferral periods for history of jaundice, history of malaria and for diabetes. For example, the estimation of haemoglobin in donors, one of the musts’ in donor screening, is carried out by most blood banks only in cases of suspected anaemia.

Another major discrepancy is that some commercial blood banks possess valid licenses but not the infrastructure needed for obtaining one. Many blood banks instead of maintaining a strong universal donor base retain a data base of only rare blood groups.

Variation in service charges for a bag of blood seems to differ from hospital to hospital, depending on overhead costs. Questionnaires used to detail the medical and sexual history of apotential donor are all in a convenient state of flux while in certain states like Andhra Pradesh its usage is highly restricted. Counselling or educating the donor seems to be last on the list of priorities for most blood banks in the country.

“Why can’t we be centralised like the American or Canadian Red Cross? In the West they have identical donor cards, identical donor questionnaires, identical donor protocol and ideal ways of counselling and education,” says Dr Chandra Vishwanathan, director, National Plasma Fractionation Centre, K.E.M Hospital, Mumbai.

In the absence of a proper mechanism where blood donors with infection cannot be identified or traced, a system of donor application’ can be adopted says Vishwanathan. Costly investments in machinery and tests can simply be avoided by drawing the blood of a willing donor which is tested and kept on record with all confidentiality assured to him.

And experts say the draft National Blood Policy does not do anything to make things better. Says Nanu:“The draft NBP will not serve any purpose, as it makes general statements that could be applied to any BTS anywhere in the world. The blood policy for the Indian blood transfusion system must be tailor-made to prevailing Indian conditions.”

What is also missing is a time-frame for implementation. “It seems almost impossible to accomplish unless the blood policy is implemented in a phased manner. A supervisory body is also necessary to control all its activities,” says Vishwanathan.