I noted with interest a newspaper editorial of May 9 celebrating the return of the "chit" system for blood donation. This article discusses some of the issues raised, bearing in mind that T&T is a member of the World Health Organisation (WHO) and is obliged to observe its recommendations. As correctly stated, "blood donor chits" have been issued for decades as receipts to guarantee transfusion for an ill relative or as proof that blood used in an emergency has been returned (replacement blood donation). Nearly 90 per cent of blood is collected in this way in T&T.
Some people donate to trade these receipts for cash or other payment (remunerated or paid blood donation). Truly voluntary blood donors give blood freely and unconditionally. There is no "link with an intended recipient." They receive no token that could be converted to cash. In reality, the donated blood never goes to the "intended recipient" but into a blood bank for public use. What goes in could end up in any of our veins. It costs at least $2,000 of public money to collect, screen, process and store a unit of blood. It takes up to 48 hours for a donated unit to become available for use and it can be stored for only 28 days.
In 1975 the WHO recognised that voluntary blood donors were much less likely than the other types of donor to carry infections that could harm patients. On the grounds of public safety it recommended blood collection from voluntary blood donors only. Developed countries were the first to comply but with the discovery of the human immunodeficiency (HIV) virus, many developing countries began totally voluntary blood donation to keep their blood supply safe. What is the problem with collecting unsuitable blood? First, it costs millions of dollars a year to collect, process then discard infected blood.
Donor blood is tested very carefully in the laboratory after donation, not with the initial skin-prick test as suggested. Recently infected donors may have a negative test. This is much more likely with replacement and paid donation. Freezing blood for long periods is extremely expensive and is done in only a few specialised centres in extreme cases. It is not a substitute for regular donations from the public. The international code of ethics for blood transfusion services which was adopted by WHO states that blood is a public resource. Genuine clinical need should be the only entitlement to receive a transfusion.
This is because, done anywhere in the world, the transfusion of blood is a major clinical intervention which may cause complications. The "chit" system compromises adherence to this code. A person needing cancer surgery may have no relatives to donate blood on his behalf to entitle him to transfusion. A child born with thalassaemia major needs transfusion with two-four units of blood every month for life to stay alive and would not be able to generate enough "chits." Any of us could suddenly become one of the author's "unknown (apparently limitless)" recipients after a road traffic accident.
Most foreign visitors have no relatives here. The US Department of State through its travel advisory warns its citizens that, should they need a blood transfusion in T&T, they would be expected to have at least the equivalent amount donated on their behalf. People who have taken the trouble to find chits could demand transfusion whether they need it or not. There has always been a shortage of blood in T&T. Whereas the WHO recommends 65,000 donations a year, only 20,000 are collected. One of the main reasons is that we save our donations until a relative or friend needs a "chit."
This could be every five years or never. The service runs from emergency to emergency and it is difficult to increase donations in these circumstances. All that is needed is for three per cent of the population to donate once or twice a year without waiting for an emergency. The author writes of the Human Tissue Transplant Act of 1999 making the sale of blood illegal. In fact, section 21 (1) of the Human Tissue Transplant Act of 2001 goes much further. It is an offence to have blood taken for the purpose of trading it for valuable consideration for oneself or another person. Is special entitlement to a medical intervention considered valuable consideration?
The fine is $50,000 and six months imprisonment. The several suggestions for curtailing fraud in the chit system are valid but impracticable. For as long as a chit exists that is easily sold and "entitles" bearers to unconditional access to the public blood supply, ways to defraud the system would be found. The selling of chits in the street is but the tip of the iceberg. The chit system is unsafe, unethical, expensive, permissive of illegal activity and inconsistent international standards for public safety.
A blood transfusion service based on voluntary (no "chit"), regular (once or twice a year) by three per cent of the population solves all the problems caused by replacement or paid blood donation. As we approach World Blood Donor Day on June 14, I join the international community in thanking voluntary, unpaid blood donors everywhere.
Dr Kenneth S Charles