Blood Bankruptcy

Ask the relative of any patient in need of blood and you'll hear the harrowing tale of running in desperation from blood bank to blood bank. According to one estimate, India has an annual shortfall of 20 lakh units of blood. Even in Delhi, which boasts of the country's best blood bank infrastructure, the supply falls short by 50,000 units when the annual requirement is 3 lakh units. The scenario is worse in other metros and severe in rural areas.

Government-run banks meet only a limited demand for blood for transfusion; the rest is met by blood banks run by private or voluntary agencies like the Red Cross. The government has fixed Rs 500 as the maximum processing charge for a unit, but private banks—many run by upscale private hospitals—charge anywhere from Rs 900 to Rs 2,000 per unit. Scarcity or rarity of the blood group pushes the price even higher.

And things could only get worse with the new blood policy cleared by the Union cabinet. It focuses on phasing out replacement donors from the blood transfusion programme and collecting blood only through voluntary non-remunerative donations. The current practice is for a patient to source blood from a bank, pay for it, and get relatives or friends to donate an equal amount of blood to replenish stocks.

The new policy, according to NGOs, will severely affect blood collection. In 2001, replacement donors contributed 16.6 lakh units, while 13.4 lakh units were collected through voluntary donation camps. The huge gap of replacement donors will now have to be filled by voluntary donors which, say transfusion experts, is next to impossible and will worsen the scarcity and fuel a spurt in blood prices. It will also increase the import of blood products. Purushothaman Mulloli, convenor of NGO JACK-India, calls it an artificial scarcity, "meant to benefit MNC market forces in the blood products business". If the fear of replacement blood being infected was real, it could always have been tested, say others.

In fact, the controversy over replacement donors has triggered off a demand for an overhaul of the blood transfusion and banking system. Under severe attack is the National Blood Transfusion Council (NBTC), the nodal regulatory body set up subsequent to a Supreme Court directive in 1996. Meant to streamline blood bank functioning, the council's own members say the body hasn't met since October 2000 and done precious little. Says council member J.G. Jolly: "Even if meetings are held, nothing seems to move. Many decisions have been taken but most have remained on paper for want of action."

More serious allegations pertain to the NBTC being reduced to an adjunct of the National AIDS Control Organisation (NACO). For example, two of its top posts—of chairman and director—are held by NACO officials. From administration to purchase and distribution of machinery, NACO is the agency that does everything. "Even the blood policy released recently is prepared by NACO, not the council," says Mira Shiva of the Voluntary Health Association of India.

And NACO's blood policy, according to those in the health sector, is driven solely by HIV/AIDS considerations. For example, until now, in rural areas not served by blood banks, the practice in an emergency was to source blood from a local donor, test it for infections—including HIV—before use. The new blood policy does not approve of this Unbanked Direct Blood Transfusion (UDBT). Blood can now be sourced only from blood banks after mandatory tests. "While denying UDBT, the blood policy has put enormous faith in the blood banks," says Anant Phadke of Cehat, an NGO in primary healthcare in Pune. "What is the guarantee that they religiously follow guidelines?"

Finances apart, it's blood bank administration that's also attracted flak.The dispute began with the granting of regional transfusion centre (RTC) status to a blood bank owned by Rotary International in Delhi. By convention, only government-run blood banks or those run by voluntary agencies like the Red Cross are granted this status, which allows them to organise blood donation camps. In turn, the RTCs have to adhere to government-determined service charges for providing blood. Private banks are barred from organising camps and can collect blood only through donation at their premises. But then there's no government control over their service charges.

Problem is, the Rotary blood bank will enjoy both RTC status and have its own rate list. This blood bank provides a unit of whole blood for Rs 900, inclusive of cross-matching charges, while the Red Cross charges Rs 350 per unit. The latter even lodged a protest at the last meeting of the Delhi State Blood Transfusion Council. Says Bharat Singh, its member-secretary: "We've told Rotary that it should coordinate with other regional blood centres and also reduce prices of blood and blood components. If not, we can withdraw their RTC status." But Sudarshan Agarwal, president of the Rotary blood bank, dismisses the allegations. "We recover only 60 per cent of the cost incurred from the price we charge for providing blood. We don't get any funds from the government, nor do we ask for replacement donors." Call it a system error. But to rectify it, the government needs a serious infusion of good sense.