Blood donation in India

The history of voluntary blood donation in India dates back to 1942 during the second world war when blood donors were required to help the wounded soldiers. The first blood bank was established in Kolkata, West Bengal in March 1942 at the All India Institute of Hygiene and Public Health and was managed by the Red Cross. The donors were mostly government employees and people from the Anglo-Indian community who donated blood for a humanitarian cause. The number of voluntary donors declined after the war and donors had to be paid for the blood.[1][5] Leela Moolgaonkar, a social reformer, initiated voluntary blood donation camps in Mumbai from 1954. The 1960s saw many blood banks open in different cities. Under his stewardship in 1975, J. G. Jolly, the president of the Indian Society of Blood Transfusion and Immunohaematology declared 1 October as the National Voluntary Blood Donation Day, which has been observed throughout the country ever since.[6]

The HIV pandemic in the 1980s led to the government setting up the National AIDS Control Organisation in 1992 to oversee the policies in preventing the spread of AIDS. Subsequently, the National AIDS Control Programme was launched which led to drastic improvements in patient screening and hygienic transfusion procedures. A public interest litigation was filed in the Supreme court in 1996 to abolish the practice of selling blood which became effective on 1 January 1998.[5] Selling or donating blood in exchange for money is illegal under the National Blood Transfusion Services Act 2007 and those found convicted may face a prison sentence of up to three months with fine.[7]

There are several parameters that determine the eligibility of an individual to donate blood. Guidelines laid down by the Ministry of Health, Government of India have to be followed by blood banks and organizations conducting blood donation camps.[4][8]

• Overall health- The donor must be fit and healthy, and should not be suffering from transmittable diseases.
• Age and weight- The donor must be 18–65 years old and should weigh a minimum of 50  kg.
• Pulse rate- Between 50 and 100 without irregularities.
• Hemoglobin level- A minimum of 12.5 g/dL.
• Blood pressure- Diastolic: 50–100 mm Hg, Systolic: 100–180 mm Hg.
• Body temperature- Should be normal, with an oral temperature not exceeding 37.5 °C.
• The time period between successive blood donations should be more than 3 months.

Individuals under certain conditions are deemed ineligible to donate blood:[8]

• A person who has been tested HIV positive.
• Individuals suffering from ailments like cardiac arrest, hypertension, blood pressure, cancer, epilepsy, kidney ailments and diabetes.
• A person who has undergone ear/body piercing or tattoo in the past 6 months.
• Individuals who have undergone immunization in the past 1 month.
• Individuals treated for rabies or received Hepatitis B vaccine in the past 6 months.
• A person who has consumed alcohol in the past 24 hours.
• Women who are pregnant or breastfeeding.
• Individuals who have undergone major dental procedures or general surgeries in the past 1 month.
• Women who have had miscarriage in the past 6 months.
• Individuals who have had fits, tuberculosis, allergic disorders in the past.
• Individuals who currently have asthma with active symptoms, and severe asthma patients.

Human blood is covered under the definition of drug under the Drugs and Cosmetics Act, 1940. Blood bank activities are regulated under this act and they are required to obtain timely renewal of the license from Drug Controller General for operation and have to comply with the terms presented in the license. It specifies accommodation, manpower, equipment, supplies and reagents, good manufacturing practices, and process control to be followed in Indian blood transfusion services.[9]

The National AIDS Control Organisation (NACO) was formed in 1992 following the outbreak of AIDS. Following public interest litigation, a verdict by the supreme court in the case of Common Cause vs. the Union of India in January 1992 led to the establishment of the National Blood Transfusion Council (NBTC) at the federal level and State Blood Transfusion Councils (SBTC) for all the states to review the status of blood transfusion services in the country and conduct annual monitoring visits to blood banks.[10] While the regulatory authority is entrusted with the task of drug regulation, NACO and NBTC are the main technical bodies that frame guidelines for the practice of transfusion medicine.

The Government of India in 2002 published the National Blood Policy (NBP) to reiterate the commitment to safe blood and blood components. It documents the strategies for making available adequate resources, technology, and training for improving transfusion services apart from outlining methods for donor motivation and appropriate clinical use of blood by clinicians. It has also taken steps for research and development in transfusion medicine.[10]

India has several blood donation organizations, both governmental and non-governmental. Some major organizations operate in many regions throughout the country while others are regional and operate with local support. Along with conducting blood donation camps, these organizations also raise awareness on voluntary blood donation and public health. Most of the organizations have an online portal where donors can register their details and get updates when camps are organized. Some of the major organizations that conduct blood donation camps are enlisted below.

Despite a huge population, the demand-supply gap for blood units persists in many healthcare facilities in the country. According to a 2012 report by the World Health Organization, only 9 million blood units are available annually, whereas the demand is 12 million units.[16] Disparities in access of donors in different areas have led to wastage of blood stock in some parts of the country, while at the same time creating a shortage of blood in some other parts.[17] Due to substandard medical facilities and practices in many parts of the country, there have been cases of transmission of infective diseases like AIDS.[18] A study conducted between 2009 and 2013 concluded a high rate of non-compliance on the part of blood banks on the quality and safety of transfusion services.[19] Voluntary blood donation comprises about 70% of the blood demand, with the rest coming from replacement donors, whereas 62 nations in the world fulfill their blood demands through voluntary donations.[20][21] A study conducted in 2011 reports that a mere 6% of women donate blood, mostly due to physiological problems and low hemoglobin count.[22] Other hurdles in increasing voluntary blood donation include the fear of pain and weakness after the procedure, and illiteracy.[23]

Forced donation

Documented instances of forced blood extraction have occurred in India, among other countries, owing to its disproportionate ratio of available supply of blood and high poverty rate. One such ring gained national attention in 2008 when an emaciated man escaped from his captors near the city of Gorakhpur, in Uttar Pradesh.[24][25]

Blood donation camp in New Delhi

October 1 is celebrated as the national voluntary blood donation day.[11] Blood donation agencies often organize workshops to educate people about the benefits of donating blood.[26] With a huge population of youth, blood donation camps are regularly organized by hospitals and organizations at college campuses.[27][28] Blood donors and their family members are often given priority in case of emergency or accidents. In 2016, the government launched an initiative called E-RaktKosh, a web-based mechanism that integrates all blood banks in the state into a single network, providing information about blood camps and the availability of blood in hospitals throughout the country.[29]

• List of blood donation agencies

A) Sant Nirankari Charitable Foundation Blood Bank at Vile Parle, Mumbai