AOn May 14, 2014, Mahima Bhoi, a 17-year-old girl from Chirmiri in Chhattisgarh, was just another name in the long list of obituaries of Indians who fell victim to a rarely addressed problem. On her way to the weekly evening market, she was hit by a speeding motorcycle. She sustained serious injuries to her head. The hospital in the small town where she lived sent out for two units of AB blood group to a private blood bank. The hospital’s blood bank had run dry. There were too few donors. As Mahima’s relatives raced against the clock, she was losing dangerous amounts of blood. The stock of AB had run out weeks ago at the private blood bank too. It had not been replenished. Mahima died the next day.
There are many like Mahima. While India celebrates National Blood Donation Day on October 1, the life-giving liquid is in acute short supply in the country. According to the World Health Organization (WHO), India— with its population of 1.2 billion—needs at least 12 million units of blood a year, but is able to collect only 9 million, which is a 25 per cent deficit. BBC reports that in summer, the shortfall goes up to 50 per cent, which encourages the black market in blood.
Blood management is a neglected health sector. India doesn’t have a centralised blood collection agency. In rural India, the taboo against transfusion of blood is caste-based due to the misconception that one may get contaminated with impure blood from a lower caste. Delhi’s Rotary Blood Bank president Vinod Bansal points out that in Karachi in Pakistan, there is separate categorisation of Muslims and non-Muslims.
The nexus of professional blood donors, blood bank officials, hospitals and black marketeers compounds India’s blood crisis. Professional donors operate at blood banks in and around Delhi. The going rate per unit of blood is between Rs 1,200 and Rs 1,600. They are available from 8 am to 12 noon, and 7 pm to 11 pm.
Posing as the kin of a thalassemia patient, we scoured Safdarjung Hospital, a super-specialty government establishment in Delhi, looking for blood touts. Within minutes, we were guided to gate number 2, where we were asked to meet the guard. After a few minutes of whispered exchanges, we were asked to come the next day at 8 am sharp. “Your work will be done, but be sure to not mention this to anybody. I’m on duty in the casualty ward. I’ll take you to the right person,” he says. Reluctant to share his number, he asked for ours instead. “These days, you cannot trust anybody,” he says. Our experience was no different outside G B Pant Hospital. Sharmaji, who can be found outside one of the side gates, is the messiah for those in urgent need of blood and are willing to pay. The modus operandi here, too, was the same. The guard, though first reluctant to share information, soon gave in when he saw our seemingly distressed condition. “Wait here,” he says comfortingly. In 15 minutes, a short, scrawny man in his 50s walked in and exchanged pleasantries with the guard. We told him of our need. After some persuasion, he was ready to help. “Shift your patient to G B Pant Hospital and I will take care of the rest. I will get you blood for as long as you need. I have a wide network of young professional donors willing to sell blood,” he says.
Professional donors can be identified by the patterns of needle pricks on their arms. We met one hovering outside Kasturba Hospital in Daryaganj, Delhi. Suresh Jhadev, 32, sported at least three fresh needle pricks. He negotiated the price. “I can be your replacement donor. Nobody will get to know,” he says, seeking Rs 1,800 per donation. Completely oblivious to regulations, he lets us know he had donated blood just 25 days ago but assured us he was in good health. “Some doctors are aware of this illegal practice. Some are even a part of the mafia as they get a cut,” he says. Another regular donor, Suresh (name changed) says, “We donate blood and bring others, especially students from colleges, and make sure blood is donated.”
The promise of a few thousand rupees is all that’s needed to trap a person into becoming a commercial blood salesman. The demand is so high that the blood is sold to unscrupulous blood banks without testing. The lack of screening is the most common route to infect a patient with life-threatening diseases like HIV, hepatitis B and C. According to AIDS Action, this is not just an Indian problem, the illegal red market is a worldwide, multi-million dollar racket in Bulgaria, Africa, China, Russia and others. The ones lured into the trade are often the poor. “If we promise Rs 1,000 to the donor, we give it. Many agents give a pittance after promising more,” says Gangam Shah, a blood agent. He operates from the seat of his motorcycle outside Sir Ganga Ram Hospital, Delhi. He adds, “It’s a lucrative business both for us—agents and donors. It’s an individual’s choice to sell their blood. The money runs their homes. If there is such a problem with the commercial sale of blood, the government should encourage voluntary donation. Why come after us? We’re helping meet the deficit in the country.”
Many donors openly advertise their service on the Internet. Google ‘sell blood in India’, and you'll find a bunch of websites advertising details of prospective donors. Most of them have Facebook accounts with phone numbers. Ashish (name changed), a young college student in Mumbai, donates blood often. “I sell 300 ml of blood for Rs 3,000 once in three months, because I need money to meet my expenses,” he says. He patronises a laboratory in Belapur, Navi Mumbai.
The crisis is largely caused by poor blood donation. “Not enough Indians make it a priority. People will give numerous excuses and justify their lack of participation, the most common being ‘others are donating enough’. The shelf life of a unit of fresh blood is just six weeks. Great quantifiers of blood expire every few weeks and more is constantly required,” says Dr Arvind Mehrotra, director of the blood bank at The Park Hospital in Delhi.
Blood donation continues to be an unregulated sector, with unscrupulous gangs operating in small towns. A horrifying exposé of migrant labourers being caged and their blood extracted thrice a week for over two years did not have any impact on the well-entrenched red market. The liquid of life was being sold to private banks and hospitals at 15 times the price. Corruption and collusion between health officials, government doctors and illegal blood suppliers was revealed. The captive donors were rescued from a blood farm in Gorakhpur along the Indo-Nepal border. The 1996 Supreme Court ruling banning paid donors and unlicenced blood banks have not been a deterrent to the existence of this medical underworld. Even state-of-the-art hospitals are not chary of making unscrupulous money off a desperate, life-saving need.
Needle phobia is a big deterrent for donating blood. “The thought of a needle piercing my body worries me. I’ve often thought about donating blood, but my fear doesn’t let me,” says Kanika Chhabra, a PR professional in Delhi. Similarly, needle procedures give Prateek Chhabra, a watercolour illustrator, the jitters. “I tried donating once when I was in school. I fainted, and I’ve not attempted it again,” he confesses.
Hence, it may be no surprise that between the age group of 25 and 44, only 28.38 per cent donate blood, according to data from blood donation camps over five years. One of the most common excuses is ‘my blood group is not in demand’, ‘I will catch a disease or ‘I’ll run out of blood’. “It doesn’t surprise me because they have no positive reinforcement. The government has a huge responsibility to disseminate information about serious social issues,” says Mehrotra.
Lion’s Club member A V Satheesh Kumar in Tamil Nadu’s Ramanathapuram says, “People think they will become weak by donating blood. We convince them by giving our own example saying that we are healthy even after donating blood 25 times.”
Sadly in India, it’s mostly about emergency donation as opposed to voluntary donation. Anybody between 18 and 60 years of age is a suitable donor, provided the screening process goes fine. There aren’t enough NGOs working on the voluntary blood cause. While India’s urban core still has a few drivers, the situation is worse in small towns and the countryside. When sporadic camps are organised, participation is abysmal. “Laziness is the main reason. I’ve been cleared to donate blood since March, but I still haven’t,” says Utkarsh Kawatra, co-founder of BloodConnect, which acts as a channel between voluntary blood donors and those who need it. Kawatra’s honest admission is a reality check for him and other youngsters.
“We must push ourselves and do it sooner or later. After all, your blood could save a life. What’s more important than that?” he asks.”
The government’s apathy has not helped blood banks over 40 years. Voluntary blood donation programmes were not given priority in any of the eight Five Year plans. “There was no manifestation of transforming this desire into reality through a serious national plan of action. With huge soft loans to the tune of $85 million from World Bank and funds from other international agencies, blood banking was engulfed within the AIDS prevention programme,” says Raju Chandrashekar, chairman and president of Karnataka Voluntary Blood Donors Association.
India’s 2,708 blood banks are not evenly distributed in 687 districts of the country. The scene is dismal in blood banks at government hospitals. “They are under-staffed, lack commitment and enthusiasm, and never reach camp sites on time,” says Chandrashekar.
Lack of transparency among blood banks makes it worse. There is no central database to track units available in blood banks. “Data should be shared so that people know exactly which blood bank has how may units and blood groups. Prices should be mentioned too,” says Kawatra. This way, the needy won’t have to run from one blood bank to another. He adds, “There is no coordination between blood banks or exchange of units. No transfer services are available.”
Odisha has seen a rapid rise in voluntary blood donation camps by private agencies. Last year, it met the annual target of 4.20 lakh units. But the administration is struggling against illegal trade practices by private hospitals and nursing homes. Citing a shortage of blood, private operators demand money from patients to arrange blood of poor quality, which is capable of transmitting dangerous diseases. Swaraj Mishra, secretary of Aama Odisha, which popularises voluntary blood donation, claims that sometimes the blood bank staff create an artificial shortage of rare blood types like AB (negative) for money. Also, blood banks are poorly maintained.
Apart from storage problems and shortage of skilled staff, sources say the state also lacks blood separation units. It has only seven of them at Capital Hospital, BMC Hospital and Central Red Cross in Bhubaneswar besides three medical colleges and hospitals in Cuttack, Berhampur and Sambalpur. However, Director of State Blood Transfusion Council Gyanabrata Mohanty refutes the claim. “There is no such shortage. We are encouraging camp organisers to collect blood in a phased manner throughout the year,” he says. In summer, demand is the highest. While plans are afoot to introduce nucleic acid amplification testing method in all blood banks across the state, Mohanty says work is on to establish blood separation units at Koraput, Bargarh, Balangir, Keonjhar, Rourkela, Balasore and Baripada.
A PIL filed in Ahmedabad in 2014 exposed local blood banks, which were selling blood collected from voluntary donors to private hospitals instead of sharing them with hospitals catering to the poor. Their profit on the sales ran into crores of rupees.
Bansal is critical of the blood collection policy of private hospitals across the country. “Why don’t big private hospitals organise voluntary blood donation?” he asks. Despite them having the wherewithal and infrastructure, he doesn’t understand why they don’t help fill the deficit. “They practice coercive replacement of blood. It’s a profitable venture that serves only them,” he says. Bansal has experienced situations when officials in big hospitals have refused to take blood from Rotary or reputed blood banks as it would prevent them from making an illegal profit. “Some of these hospitals charge Rs 3,000 or more per unit. What we charge for processed blood is Rs 1,600. Such hospitals are exploiting patients. They insist on replacement donors because then they get the blood for free, the screening cost is very little, and hence the profit is great,” he says.
Lying in bed number 81 in the gastrointestinal ward of SCB Medical College and Hospital in Cuttack, three-year-old Tazeen Parween is paying the price for a mistake by blood bank officials at Balasore District Headquarters Hospital in Odisha. A thalassaemia patient since she was six months old, Tazeen was allegedly administered infected blood during a transfusion. She was detected with Hepatitis C as part of her annual checkup. “The hospital authorities had assured me that they would bear the cost of the treatment, but haven’t come forth yet. Such callous handling of blood is unacceptable,” says Tazeen’s father S K Sujut Alam.
In June this year, VSS Medical College in Burla in Sambalpur grabbed headlines after two patients were allegedly transfused with HIV and Hepatitis-infected blood. Hospital authorities admitted the blood was administered after rapid tests and no ELISA tests were conducted. The government suspended the in-charge blood bank officer Dr Rajendra Patnaik and fired two staff members for negligence. A probe was ordered by Revenue Divisional Commissioner in both the incidents. Official reports show contaminated blood has infected 2,234 people with HIV through transfusions in the past 17 months in India.
On a Positive Note
India as one of the 193 member-countries of WHO is committed to achieving 100 per cent voluntary blood programme by 2020. In Tamil Nadu, where awareness about voluntary blood donation is high, paid donors are few. Over 99 per cent of donations are voluntary. Paid donors were banned a decade ago, says an official from the Tamil Nadu State Blood Transfusion Council. “Since the state collects 8.50 lakh units of blood per year, there is no acute shortage,” he adds.
In Kerala, 85 per cent of the yearly requirement of 1.25 lakh units of blood is arranged by relatives (around 20 per cent) and voluntary donors (65 per cent), according to K P Rajagopal, president of National Federation of Indian Blood Donors Associations. For the remaining 15 per cent, treatment or surgery is postponed or managed temporarily with available blood components. Rajagopal also affirms that there is no organised illegal trade of blood in Kerala. Till a few years ago, the IMA Blood Bank was the only centre, which catered to the needs of all patients in and around Kochi. Now, almost all hospitals have blood banks where an average of 1,000 units are in stock at all times. Besides blood donation, awareness about organ donation is very high in Kerala.
The average collection of blood per camp is 60 units in India. For achieving a total voluntary blood programme for the country, 200,000 camps per year are required—an over-three fold increase. Says Chandrashekar: “The Central government needs to learn from Japan. Its government controls all blood banks, and donors are motivated and patients receive blood free. All expenses of blood collection, transportation, testing and distribution are borne by the government. This system is in practice in the UK, Australia and New Zealand as well.”
Plan of Action
Apart from blood camps, awareness camps and campaigns have to be stepped up, say experts. They say the responsibility of collecting blood shouldn’t fall on only a handful of banks. “The guardians of the education system should motivate heads of the 360,000 post-school educational institutions in India to hold camps through National Service Scheme, National Cadet Corps and Youth Red Cross Units. Institutions should be graded using credit points in the National Assessment and Accreditation Council,” says Chandrashekar. Special efforts should be made to conduct camps in the evenings and not just during work hours. Female donors are fewer in number, and the government needs to educate and motivate them. Many are still under the misconception that because of their menstrual cycles, they cannot afford to lose more blood. Parents need to encourage their children to donate blood as well. Donating blood twice a year reduces the risk of heart attacks by 80 per cent because it reduces cholesterol.
Despite the shortage, there are scores of people who have gained from successful transfusions. Kumar S Rao is a hemophilic who benefits from the regular donation of 22-year-old college student Karan Bhargava, who had pledged to donate to Rao till he needs it. Doctors say it may take a few more years. Though Bhargava’s contribution may not suffice by itself, it certainly fills a big demand. “It benefits both the giver and receiver. After donation, the body immediately begins to replenish lost blood and as a result, production of new cells starts, which helps in maintaining good health. Blood donation is the biggest service,” says Bhargava.
Why is blood donation by anyone less than 18 years prohibited?
18 is the age of consent in India.
Why are 60+ people not allowed to donate blood?
Blood vessels start constricting with age. Giving blood may lead to physiological problems.
What is the ideal body weight of a donor?
Above 45 kg.
Why is three months stipulated though recuperation time is within 21 days?
It’s a precautionary measure for the donor’s health.
What physical tests are performed before blood donation?
Checking blood pressure, heart beats, liver, lung and spleen.
What lab tests are performed in blood banks for collected blood?
Hepatitis B & C, HIV, malaria and venereal diseases (STD).
Should the blood group of the donor be the same as his/her parents?
May or may not be. Blood group is inherited by a random combination of one gene from each parent. Dominant genes (A, B) prevails over recessive gene (O).
Why is blood preserved for 35 days?
Donated blood cells have a life span of one to 120 days. To keep blood’s living cells worthy of transfusion, a 35-day shelf life is optimum.
How long does it take to donate blood?
Around 20 minutes.
How much blood do blood banks take?
Is the blood donation process painful?
Not at all.
How long for a donor to return to a normal lifestyle?
After 30 minutes.
(Source Blood Search)
with inputs from Meera Bhardwaj, Sujitha J, Sindu D, Babu K Peter, Hemant Kumar Rout and Kiran Parashar