Organization of Blood Transfusion Services

BloodTransfusion Services (BTS) is the vital part of modern health care system without whichefficient medical care is impossible. The aim of blood transfusion services should be to provide effective bloodand blood products, which are as safe as possible, and adequate to meet patients need.

A BloodTransfusion Service is a complex organization, requiring careful designing and management.

BASIC GUIDELINES FOR THE ORGANIZATION OF BTS

The development of blood transfusion service should be based upon the following recommendations of the International Society of Blood Transfusion and Immunohematology (ISBTI), and the World Health Organization (WHO),

  • The development of blood transfusion service should base on voluntary and non-remunerated blood donations. Reliance on family/replacement donors should be phased out.
  • The development and implementation of national strategy for the screening of all donated blood for transfusion-transmitted infections, using the most appropriate and effective assays to test for HIV 1 & 2, hepatitis B and C viruses. syphilis and malaria.
  • To enact effective legislation governing the operation of blood transfusion service so that it meets the prescribed standards.
  • Develop good manufacturing and laboratory practices in blood bank in order to protect the health of both blood donors and recipients of blood and its products.
  • To provide safe and adequate blood and its components to meet patients need. An adequate service includes availability of at least whole blood, red blood cells, platelets, fresh frozen plasma (FFP), cryoprecipitate (Factor VIII) and plasma.
  • The maintenance of a register of voluntary non-remunerated blood donors.
  • To establish a voluntary blood donation unit within the blood transfusion service, with an officer responsible for the blood donation programme and designated as donor recruitment officer.
  • The training of staff responsible for donor education, motivation, recruitment and selection.
  • The training of staff of blood transfusion service for safe blood collection procedures, including donor selection and donor care.
  • To train laboratory technical staff in all respect of blood screening, blood grouping, compatibility testing, components preparation and the issue of blood and its products for transfusion.
  • To develop good laboratory practice, including the use of standard operative procedures, in all respect of blood screening, blood collection and processin.
  • Monitoring and evaluation of clinical use of blood.
  • To promote cooperation between the blood transfusion services, health services and hospitals, educational institutes, religious, social and industrial organizations, mass media and the general public.
  • To ensure adequate and separate budget for blood transfusion services.
  • Blood Transfusion Service in a country may be centralized, regionalized, hospital based or some combination of them. Once a system has been established in a region it is difficult to change. The size, history, culture, political structure, level of economic
    development and administrative control effect the evolution of blood transfusion services. So in a developing country of big size the development of centralized or regionalized blood transfusion services at the level of metropolitan and big cities, states and/or district
    levels is more practical.
  • Estimation of donor requirement is essential for the development of blood transfusion services. Estimates of need may be based on fixed percentage (5 % recommended by WHO) of the population. But this assumption ignores the disparity between the size of population and the number of hospital beds in an area. Estimate of blood needs on the number of hospital acute beds is more realistic. The figure may vary from 5-15 units per bed per year. The lower ratios apply to hospitals where blood is needed in the management of bleeding as a complication of pregnancy or trauma or simple surgery. The higher ratios apply to hospitals with more specialized facilities like oncology, open-heart surgery,

2 Organisation of Blood Transfusion Services

renal dialysis/transplant or replacement therapy in thalasseamia, hemophilia, leukemia, and other blood disorders.

DONORS RECRUITMENT STRATEGIES

Donor’s recruitment is critical to the success of supply of safe and adequate blood and its products to meet patients need.

Donors Recruitment Strategies Are:

• Pure voluntary-based recruitment.

• Social persuasion-based recruitment.

• Remunerated-based donations.

The first two types of strategies result in voluntary blood donation, because they do not rely on monitory remuneration and the information of their health provided by these donors can be trusted. Remunerated based blood donation is done by blood sellers, who conceal the facts about their health and diseases which they may carry, about their last donation and their identity. Their blood is not safe.

Pure Voluntary Recruitment strategy:

It depends on the internally generated sense of altruism or community responsibility. A voluntary donor donates the blood on his/her own free will without distinction of caste, creed, religion, color and status of recipient and does not expect any monitory benefit from the collecting facilities or other sources at the time of donation or in future.

However, most donors do not donate blood as often as they can but small incentives like pins, badges and plaques given to donors who have donated blood to a specified numbers express appreciation to regular donors and enhance their feelings of altruism and encourage more frequent donations.

Social Persuasion-based Recruitment Strategy:

It is associated with persuasion and pressure of friends and colleagues, heads of religious organizations and political leaders to donate blood. Such donations are often associated with outdoor (mobile) blood donation drives at the work place like colleges, schools, factories, offices, or at some other place where a group of individuals collect as a social, political or religious unit.
In many cases, group or organizer promises the recruiter a minimum number of donations of blood units and the social pressure on individual member of the group is quite effective to encourage donations and to meet the promised target.

In second form of social persuasion-based strategy are replacement donors also who donate blood for specific patients, usually close friends or relatives without any monitory reward. These donors may feel an expression of their caring and concern for the recipients. The replacement donors can be easily motivated and persuaded to become regular voluntary donors. There is often undue pressure (coercion) upon the family/friends of the patients, which force them to pay professional paid donors to serve as family surrogates and donate blood resulting in unsafe supply of blood. Reliance on replacement donations may be phased out.

Remunerated-based Donations:

Remunerated-based donations are done by blood sellers (paid professional donors) who are poor people and give blood for money. It is recognized all over the world that their blood is mostly of poor quality and may carry infection of many diseases like hepatitis B virus (HBV), human immune deficiency virus (HBV), hepatitis C virus (HCV) and syphillis etc. It is not safe blood and may be hazardous to the recipients. This system survives due to the inefficiency of voluntary blood transfusion service and apathy of the general public. It should not be encouraged and stopped.

MOTIVATION AND PROPAGANDA

Effective and wide propaganda is imperative for the recruitment of voluntary blood donors. The following enumerated available means and methods of communication for voluntary blood donation should be followed

Oral Communication

This is the most effective method of recruiting donors. Talk on need of blood, shortage of blood, ease of donation and myth about blood donation, possibly illustrated by films is very effective. The speakers/recruiters must have the persuasive power to appeal to the humanitarian feelings of the audience. Time should be available in the end of talk for the audience to ask questions and to
give precise answers.

Personalized Communication

Personalized communication is achieved through circulars from professional and religious associations, clubs newsletters, and school magazines or by direct mail.

Printed Communication

Brochures, posters and informative leaflets are valuable forms of communication. Material must catch the’ eye’, and be easy to understand. Publicity materials e.g. posters, television advertisements, jingles, cartoons etc. should be prepared by professionals. Greeting cards on Birthday, Marriage Anniversaries, New Year’s Day or other auspicious days carrying motivational slogans for voluntary donations are also effective.

National or Local Mass Media

The awareness of the need of blood and voluntary blood donation and urgent appeal can be made by the announcements on radio, television and through news papers, magazines and other influential reading materials.

Educational Institutions

Education among the young is useful to remove superstition and myth connected with blood donation. It is important to introduce the subject of blood donation into schools as part of science and civic studies. The young are potential donors.

Recruiters

The importance of the contribution made by recruitment officers, who may be social workers or often blood donors themselves, should not be under estimated in recruiting donors. Their enthusiasm and empathy with new donors is invaluable.

Recruiters are the conduits to the general public and they should have all information about voluntary blood donation, scientific and technical advances relating to transfusion medicine, so that they can give precise answers to donors. There should be meetings for the recruiters at which they can express and exchange views about their work.

Motivating relatives and friends of patients

Hospital staff specially clinicians can actively contribute in motivating the relatives and friends of patients, who had or will need blood transfusion, to donate blood. Patients’ relatives and friends who have donated blood can be easily motivated to become regular voluntary blood donors.

DONORS RETENTION STRATEGIES

Blood Collection Facilities

Public image building and the retention of donors are more successful if static and mobile blood collection centers are attractive and all facilities for the comfort and convenience to donors are available. The donation must be made a pleasant and rewarding experience for the donors.

Static collection centers

There should be attractive reception area and adequate seating arrangement at the collection center. The likely waiting time should be indicated to donors. Donors must be comfortable during the blood donation.

Mobile collection venues

Mobile collection venues are very convenient for many blood donors, and also attract people to donate first time on impulse. About 80% of voluntary blood donation (excluding replacement donations) is received in mobile (out door) blood donation camps and they have some advantages.

• Camps are organized at convenient locations for the donors e.g. shopping centers, sports stadium, banks, factories, colleges, schools, offices or any open public place.

• It has a very congenial atmosphere and provides a festive look.

• Blood donors and organizers can interact with each others and the public.

• It attracts the people who want to help others or do some social service.

ORGANIZATION OF OUT-DOOR BLOOD DONATION CAMPS:

• Blood donor organizer identifies a ‘key’ person amongst the target group who can act as chief donor recruiter within that group.

• In consultation with the contact ‘key’ person, a talk on a date convenient to the organizer may be arranged, if desired by the organizer.

• The date, time and venue of blood donation camp convenient to the organizer are fixed.

• Informative posters, brochures etc. are given to the contact person to display at the venue of blood donation camp.

  • Blood collection team should reach at the venue of out door blood donation camp in time and should stay till the organizer wants.
Dealings with donors

It is of prime importance to dispel donor’s fear. If a new donor is convinced by personal experience that blood donation is painless and harmless, he or she will usually return to give blood again.These are effective to motivate public to be regular blood donors.

Staff

The staff personnel should be courteous interested, cheerful and friendly, as well as professional and efficient. If the donors encounter ill-tempered or in-civil staff and badly run, disorganized, or dirty collection centers, they are unlikely to return to donate blood again.

Incentives

Incentives like pins, badges and plaques for specified number of donations help in repeat donations. Other incentives or awards, simple and attractive of minimal commercial value, are useful in retaining donors.

Post donation strategies

Donors are bled skillfully, treated well, given the light refreshment and donors cards. The donors should be thanked for the contribution and encouraged to donate again. Simple letters thanking donors/organizers for their donations are important.

Special ceremonies

Annual award ceremonies should be held to acknowledge and congratulate the people who have donated blood many times or assisted in promoting the voluntary donations. These occasions should be widely publicized and prominent citizens should be invited to address the donors and organizations/institutions for their valuable and outstanding service to the community. Donors, recruiters, institutions and organizations should be given cups, trophies and shields for their contributions in voluntary blood donations.

Greetings

Greetings on special occasions like Birthday, Marriage Anniversary, New Years Day etc. to voluntary donors increase repeat donations.

CONCLUSIONS

There is no short cuts to effective recruitment programming. The only way to achieve good results is to approach the task systematically and professionally. The work of voluntary blood donor recruitment is essentially progressive and active. The challenge is ever present.