In a detailed response to an editorial carried in another newspaper that "celebrated" the return of blood chits to the systems at the National Blood Transfusion Service, Dr Kenneth Charles makes some compelling points about the issues with that system. Charles, who ran the Transfusion Service until recently and is now Senior Lecturer in Haematology at UWI, certainly knows his way around the scientific issues regarding blood and its role in saving lives through transfusion. Among the key points he raises in his statement, excerpted in today's Guardian, is the vulnerability to abuse inherent in a system that commoditises blood donations.
Among the key reasons for the removal of the chit system at the end of 2010 were problems with blood being sold, after donation, with the chit used as an illegal form of tender and the practice of paying people to donate blood for a specific patient. The incidence of infected blood also rises among donations taken either directly or indirectly for money, since donors living in situations of greater risk are most likely to sell blood for money. As Dr Charles points out, blood almost never goes directly from donor to recipient despite the wishes of someone giving blood.
Blood must be tested extensively and prepared for donation through several processes, which cost the State up to $2,000 per unit and adds 48 hours to the preparation process. Whole blood remains viable for just 28 days. It's worth noting that the reason for the discontinuation of the chit system represented only a part of the Transfusion Service's refreshed focus on delivering blood based on medical merit instead of emotional drivers. The service, colloquially known as the Blood Bank, provides blood for emergency victims, but it also must provide blood for persons who need continuing transfusions of blood. While Dr Charles' statement is a valuable addition to the relative lack of information about the realities of blood transfusion, the goodly haematologist must also acknowledge that the Blood Bank has done a poor job in the past of explaining the issues at stake in blood donation.
The sudden shift from a decades old and readily understood system of blood donation based on banking metaphor to a completely new procedure based on altruism represented such an abrupt shift in perception that the sharp drop in blood donations was inevitable. Most donors found out that their chits were useless when they came to give blood and that's an inexcusable lapse in public communication. By failing to articulate these critical changes clearly with the public, its most essential resource, the Ministry of Health missed a critical window of positive engagement with the community most critical to a continuing blood supply at the Blood Bank. After the sharp drop in donations, the Ministry of Health managed to put itself in the position of both having to explain its new position while trying to win donors back to the Transfusion Service.
Desperation, misinformation and ill-will were the first harvest of this error in judgement and fundamental misunderstanding of human nature and it's an error that the Ministry will be wrestling with for some time to come. The reintroduction of the chit system may have brought some temporary relief to the situation that the Blood Bank found itself in, but it's also put the service in the position of having to engage in an uphill reselling of its plan to move to voluntary, unpaid blood donors who give to a key national service rather than to a person or investing in a "bank." With a goal of three per cent of the public giving blood twice a year, the Ministry of Health must open the doors of the Transfusion Service to greater public understanding of its mission critical service. On World Blood Donor Day, June 14, the Ministry should declare its commitment to a national programme of education and engagement that will have as its goal the encouragement of a committed local culture of blood and eventually, organ donation as cornerstones of a 21st century public health system.