Voluntary Non-remunerated Donors Research Articles

How expanding voluntary non-remunerated blood donations would benefit patients, donors and healthcare systems?

How expanding voluntary non-remunerated blood donations would benefit patients, donors and healthcare systems?

The challenges of meeting the blood transfusion requirements in Sub-Saharan Africa: the need for the development of alternatives to allogenic blood.

As a resource, allogenic blood has never been more in demand than it is today. Escalating elective surgery, shortages arising from a fall in supply, a lack of national blood transfusion services, policies, appropriate infrastructure, trained personnel, and financial resources to support the running of a voluntary nonremunerated donor transfusion service, and old and emerging threats of transfusion-transmitted infection, have all conspired to ensure that allogenic blood remains very much a vital but limited asset to healthcare delivery particularly in Sub-Saharan Africa. This is further aggravated by the predominance of family replacement and commercially remunerated blood donors, rather than regular benevolent, nonremunerated donors who give blood out of altruism. The demand for blood transfusion is high in Sub-Saharan Africa because of the high prevalence of anemia especially due to malaria and pregnancy-related complications. All stakeholders in blood transfusion have a significant challenge to apply the best available evidenced-based medical practices to the world-class management of this precious product in a bid to using blood more appropriately. Physicians in Sub-Saharan Africa must always keep in mind that the first and foremost strategy to avoid transfusion of allogenic blood is their thorough understanding of the pathophysiologic mechanisms involved in anemia and coagulopathy, and their thoughtful adherence to the evidenced-based good practices used in the developed world in a bid to potentially reduce the likelihood of allogenic blood transfusion in many patient groups. There is an urgent need to develop innovative ways to recruit and retain voluntary low-risk blood donors. Concerns about adverse effects of allogenic blood transfusion should prompt a review of transfusion practices and justify the need to search for transfusion alternatives to decrease or avoid the use of allogenic blood. These strategies should include the correction of anemia using pharmacological measures (use of antifibrinolytics to prevent bleeding and the use of erythropoietin and oral and intravenous iron to treat anemia) use of nonpharmacologic measures (preoperative autologous blood transfusion, perioperative red blood cell salvage and normothermia to reduce blood loss in surgical patients). All these strategies will help optimize the use of the limited blood stocks.

Attitude to blood donation in Saudi Arabia

Background and Objectives:The blood donor system in the Kingdom of Saudi Arabia depends on a combination of voluntary and involuntary donors. The aim of this study is to explore the attitudes, beliefs and motivations of Saudis toward blood donation.Materials and Methods:The study was conducted at the Donor Centers at King Khalid University Hospital (KKUH) Blood Bank and King Saud University Students Health Center, Riyadh. A self-administered questionnaire was distributed to donors (n = 517) and nondonors (n = 316), between February and June 2008. All were males.Results:Ninety-nine percent of the respondents showed positive attitude toward blood donations and its importance for patients care, and object the importation of blood from abroad. Blood donors: Ninety-one percent agree that that blood donation is a religious obligation, 91% think no compensation should be given, 63% will accept a token gift, 34% do not object to donating six times/year and 67% did not mind coming themselves to the donor center to give blood. Nondonors: Forty-six percent were not asked to give blood and those who were asked mentioned fear (5%) and lack of time (16%) as their main deterrents. Reasons for rejection as donors include underweight and age (71%) and health reasons (19%). Seventy-five percent objected to money compensation but 69% will accept token gifts and 92% will donate if a relative/friend needs blood.Conclusion:These results reflect an encouraging strong positive attitude toward blood donation. Further future planning with emphasis on educational/publicity programs and careful organization of donor recruitment campaigns could see the dream of total voluntary nonremunerated blood donations should not take long to be true.

Partnerships for blood safety in Africa: the U.S. President's Emergency Plan for AIDS Relief

Partnerships for blood safety in Africa: the U.S. President's Emergency Plan for AIDS Relief

Attitudes towards blood donation in Trinidad and Tobago

The aims of this study were to determine the factors that influence blood donation in different demographic groups in a multi-ethnic, multicultural community, and to devise a strategy for a national campaign to increase voluntary non-remunerated blood donations. The majority (87%) of blood donations in Trinidad and Tobago are replacement donations. Seventy per cent of the country's transfusion needs are not met. In 1998, the World Health Assembly recommended that reliance on replacement donations should be phased out due to their association with an increased risk of transfusion-transmitted infections. An observer-administered questionnaire was completed by 1423 respondents in a multi-ethnic borough in central Trinidad. Respondents were classified as donors or non-donors and grouped by age, race, religion, employment status and highest level of education. The prevalence of a history of blood donation and the factors that encouraged donation or conversely discouraged donation in each demographic group were recorded. A total of 1146 (81.2%) respondents had never donated blood. Of the 277 (18.8%) who had previously donated, replacement for a family member or friend was the most common reason (86.9%). The prevalence of donation was low in all racial, religious, gender, educational and age groups. However, there were significant demographic variations. The majority (71.3%) of non-donors cited a lack of information as a major reason for non-donation and expressed a willingness to donate if access to information and donation facilities were improved. Voluntary blood donation in Trinidad and Tobago could be greatly increased by a national education campaign and increased accessibility to donation centres. This would ensure a safer and more reliable blood supply.

Developing an administrative plan for transfusion medicine—a global perspective

Throughout the world blood services aim to provide a life-saving service by ensuring an adequate supply of safe blood. However, across the world blood services are at very different levels of development. Consequently, the actions taken in one country or region would not be appropriate in another. This paper aims to identify how suitable solutions can be developed to match the different prevailing circumstances of an individual country or region. In trying to do this it is important to look at the whole of the supply chain within a blood service and identify the part where a change could make the biggest impact. Four key areas are identified that are integral to this. These are the donor, testing of blood, hemovigilance, and overall management arrangements. Whilst the first two have largely been addressed in highly developed countries, there is still much work that could be done in these areas in developing countries. In particular, a move to voluntary nonremunerated donors worldwide would significantly improve overall safety. Hemovigilance systems are identified as a powerful tool to influence policy development, yet these are largely under developed throughout the world. In order to make high impact and sustainable changes it is important that those in the blood industry across the world work together to improve education and training, to share experience of best practice, and to move to develop agreed standards in transfusion medicine. It is imperative that developed countries recognize the importance of working with developing countries if the safety of the global blood supply is to be maintained and improved.

Blood supply protection: how much is enough?

The delivery and maintenance of a safe blood supply are imperative for Australia?s security and medical advancement. Practices such as the use of voluntary nonremunerated donors (1927), and early coordination to identify optimal testing regimes, e.g. for Hepatitis B virus (HBV) 1975, Human Immunodeficiency virus (HIV) 1985 and Hepatitis C virus (HCV) 1990, have ensured the Australian public are at minimal risk of exposure to unsafe blood. However, the AIDS epidemic did reveal significant flaws and weaknesses in our delivery of a safe blood supply, unfortunately with some devastating ramifications. Since that time, public tolerance of adverse events following receipt of infectious donations is very low. Does Australia now have a safe blood supply, and is safety assured against future potential catastrophes?

Comparative analysis of national regulations concerning blood safety across Europe

In October 2001, representatives of 17 European countries (Albania, Bosnia-Herzegovina, Bulgaria, Croatia, Czech Republic, Federal Republic of Yugoslavia, Finland, France, Germany, Greece, Italy, Macedonia, Romania, Slovenia, Spain, Turkey and UK) met in Sarajevo at a course organized by the European School of Transfusion Medicine to discuss their countries' regulations concerning different aspects of the safety of blood transfusion. Results are summarized in tables to facilitate comparisons. Most countries (13/17) have specific transfusion laws and 9/17 have hospital-based systems as opposed to national organizations. Quality assurance is common among investigated countries (14/17). Voluntary associations are responsible for donor promotion in the majority of countries (13/17). Exclusively, voluntary non-remunerated donors are found in 5/17 countries, whereas in the remaining ones, incentives, family replacement and remuneration are mechanisms stimulating blood donation. Medical doctors using official selection criteria are checking donor suitability in virtually all countries, which also perform main microbiological testing. Regulations on good clinical use of blood and derivatives are present in most countries but applied only in some. Although the data presented need to be interpreted with some caution, this preliminary analysis shows that, although some significant differences still exist, the majority of countries studied are moving in the same direction to ensure safety of their blood supply.

Recruitment of voluntary non-remunerated apheresis donors: the second five years' experience in Shenzhen

The voluntary non-remunerated blood donation campaign in Shenzhen, China, was launched in 1993 and the smooth change from paid donors to unpaid took only a decade. In the first half the volunteer donation system and a sufficient blood supply was promoted and this paved the way for further development in the second half during which the non-remunerated donation system became substantial and integral due to recruitment for plateletapheresis and peripheral stem cells donation as well as whole blood donations. Ninety percent of the donors registered for plateletapheresis do donate and none of the twenty-three non-related donors with matched HLA genotypes broke their promise to donate their peripheral stem cells.

Organizational changes in Estonia.

The situation of the blood transfusion service in Estonia is analyzed since 1991. Considerable changes towards the establishment of a cost-effective on a cost-efficient system providing self-sufficiency of good quality blood products in future have been made. National blood transfusion service based on voluntary nonremunerated donations is under development.

Self-sufficiency and blood transmitted diseases.

The Council of Europe and the EEC Council of Ministers have strongly promoted self-sufficiency for plasma products on the basis of voluntary non-remunerated donors. Several European countries have a programme of self-sufficiency with plasma products, either with national fractionation plants (e.g. Belgium, Finland) or based on contract fractionation (e.g. Norway, Slovenia). Advantages of national self-sufficiency includes epidemiological factors, economical factors and also ethical and moral issues. Self-sufficiency is one of the basic conditions for reducing the hazard of transmission of infectious diseases. Norway has been self-sufficient with coagulation factors since 1981. Price mechanisms and market forces have been important factors in ensuring the necessary plasma volume, and fractionation methods rendering high yields of factor VIII are initially preferred. This policy has resulted in a low prevalence of antibodies against human immunodeficiency virus (6%), hepatitis B virus (28%) and hepatitis C virus (41%). No Norwegian haemophiliacs have been infected with hepatitis A through FVIII concentrates.

Investigation of an Outbreak of Hepatitis A in Irish Haemophilia A Patients

Since 1990, Irish haemophilia A patients have been treated with solvent-detergent(SD)-treated virally inactivated high-purity factor VIII concentrate prepared from plasma from Irish voluntary non-remunerated donors. In 1992, 13 haemophilia A patients developed clinical hepatitis A and a further 17 patients showed serological evidence of recent infection by hepatitis A. All but 3 of these patients had had recent exposure to SD-treated product. A case-control study is underway to determine whether these cases represent transmission through product or environmentally acquired hepatitis A.

Investigation of an Outbreak of Hepatitis A in Irish Haemophilia A Patients

Since 1990, Irish haemophilia A patients have been treated with solvent-detergent(SD)-treated virally inactivated high-purity factor VIII concentrate prepared from plasma from Irish voluntary non-remunerated donors. In 1992,13 haemophilia A patients developed clinical hepatitis A and a further 17 patients showed serological evidence of recent infection by hepatitis A. All but 3 of these patients had had recent exposure to SD-treated product. A casecontrol study is underway to determine whether these cases represent transmission through product or environmentally acquired hepatitis A.