Blood Donation & World Blood Donor Day
Blood donation is an important area of global health. According to the World Health Organisation (WHO), over 81 million units of blood are donated globally; however, only 45% of this blood comes from developing countries, which is home to about 80% of the global population. (1) Additionally, both developing and developed countries have issues with the security of their blood banks in their quest to safeguard the integrity of their blood supplies. In the developing world the main problem lies in the prevalence of paid or mercenary donors while in the developed world, the issue revolves around the exclusion of certain groups of potential donors, in particular, men who have sex with men (MSM).
Increasing Blood Donation & World Blood Donor Day
Most blood donations in the ‘developed’ world are voluntary and unpaid. However, the majority of blood donations in the ‘developing’ world are from paid donors or from family members of those who may require a transfusion. (1) This is not ideal, as voluntary unpaid donors are the safest source of blood and are the least likely to transmit blood-borne infections such as Human Immunodeficiency Virus (HIV) and the Hepatitis viruses. (3) Voluntary blood donors are not pressured into donating blood and are less likely to hide information about their health status or behaviour which would make them ineligible to donate blood.
In order to motivate countries to encourage blood donation from unpaid volunteers, World Blood Donor Day (WBDD) was set up on June 14, 2005, in commemoration of the birthday of Karl Landsteiner, who discovered the ABO blood group system. (3) The aims of WBDD are to increase awareness of the importance of voluntary blood donation, to encourage more people to become regular blood donors and to celebrate the individuals who voluntarily donate blood. (3)
This year, the fourth WBDD was celebrated in the United Arab Emirates (UAE). The UAE was the first gulf country to ban importation of blood in 1984, after the discovery of HIV/AIDS. (2) Within a few years, its Government established a national blood transfusion programme which encouraged voluntary unpaid blood donation. Within 16 years, the country managed to go from 0% voluntary donations in 1990 to 97.6% voluntary donations in 2006. (2) The programme has been successful because it incorporated a supportive culture of voluntary blood donation and used the media to raise awareness.
On WBDD itself, various speeches and activities were conducted at the Emirates Palace in Abu Dhabi and the Emirates Towers, Dubai. A list of the guest speakers can be seen in figure 1.
The day also involved the handing of awards to voluntary blood donors, governmental and private organisations supporting the aims of WBDD and the organising committee. The WBDD Flag was also handed over to the Australian Ambassador.
Protecting the Purity of Donated Blood
To ensure that only safe blood is donated, it is common practice to ban groups who are at high risk of carrying blood borne infections such as prisoners, prostitutes and individuals who have returned from travelling within malaria-infested zones. However, such policies have received criticism for their exclusion of MSM from donating blood. Most countries, e.g. UK, USA and most of Europe, have a lifetime exclusion of MSM. Others, e.g. New Zealand, Australia and Japan, exclude MSM donors for a defined period of time, ranging from one to ten years since their last sexual encounter with another man. (4,5) Consequently, it has been argued that the lack of uniformity with regard to MSM donors highlights that social and cultural values, rather than scientific evidence, form the basis of the ban. (5)
Critics of the restrictions on blood donation by MSM maintain that advances in testing and screening have reduced the risk of transmission of blood-borne diseases (notably HIV). (5) Initial tests for HIV involved looking for the presence of antibodies to the virus. However, there is a ‘window period’ of three to six months before the body produces these antibodies. This potentially allows some individuals to unintentionally pass on the disease even though they have a negative test result. More recently developed tests look for HIV itself and its genetic components, such as Nucleic Acid Amplification Testing (NAAT). These tests are more sensitive and have a window period of approximately twelve days. (6) As of 2007, the UK has implemented NAAT screening for HIV; however, it is not an effective test for other blood borne pathogens. Therefore, further tests are required to ensure donated blood is disease-free. (5)
Another criticism of the blanket ban on MSM donation is that it excludes men who solely engage in safe sexual practices (such as mutual masturbation or oral sex). These men are at a very low risk of contracting blood-borne infections. With blood shortages common within the UK National Blood Service, critics argue that such healthy donors should not be excluded from donating blood. (5) However, the UK National Blood Service maintains that to differentiate between MSM who engage in safe sexual practices and those with risky sexual habits would require identifying and taking detailed sexual histories from MSM donors, which would be difficult to implement with over 7000 donors a day. (4,5)
Various recommendations have been made by opponents to the MSM ban. One suggestion is that the UK National Blood Service implements a policy similar to Australia and allow MSM to donate blood one year after their last sexual contact. (4,5) Models used by the UK National Blood Service, estimate that such a policy would result in an increased risk of HIV-infected blood entering the blood service by 60% and an increase of less than 2% of non-infected donations. (4,7) However, this statistic was calculated five years ago and requires updating due to the development of more accurate blood screening.
Conclusion
The main issues with blood donation involve the security and quantity of blood donated. The quantity of blood in the developing world is a considerable problem because of the lack of voluntary donors. In addition, the security of blood is at risk due to the prevalence of paid or mercenary donors who have the financial incentive to be dishonest. The quantity of blood donated in the developed world is also problematic due to policies in place to maintain the security of blood donated, in particular the exclusion of MSM from blood donation. This, in a way, draws comparison between MSM and paid donors who are considered unsafe, and raises questions about the fairness of the exclusion of MSM from donating blood.
Shawn Ellis, 3rd year medical student
Brighton Sussex Medical School
S.D.P.Ellis@bsms.ac.uk
References
1. WHO. Blood Safety. [Online] 2008. [Cited: 05 07 2008.] http://www.who.int/topics/blood_safety/en/.
2. WHO. world blood donor day. [Online] 2008. [Cited: 05 07 2008.] http://www.thelancetstudent.com/wp-admin/www.who.int/worldblooddonorday/en.
3. Day, World Blood Donor. About World Blood Donor Day. [Online] 2005. [Cited: 05 07 2008.] http://www.wbdd.org/index.php?id=24.
4. Transplant, NHS Blood and. Exclusion of men who have sex with men from Blood Donation Position Statement. [Online] 2008. [Cited: 05 07 2008.] http://www.blood.co.uk/pdfdocs/position_statement_exclusion.pdf.
5. Does Blood Discriminate? K, Phillips. London : The Lancet, 2008, Vol. 371, pp. 1983-1984.
6. Detection of HIV-1 and HCV infections among antibody-negative blood donors by nucleic acid-amplification testing. Stramer SL, Glynn SA, Kleinman SH, et al. s.l. : New Eng J Med, 2004, Vol. 351, pp. 760-68.
7. Evaluation of the de-selection of men who have had sex with men from blood donation in England. Soldan K, Sinka K. s.l. : Vox Sanguis, 2003, Vol. 84, pp. 265-73.
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