Investigating the impact of blood transfusion services in the developing world

Transfusion of blood and blood products saves millions of lives each year. However, with a global increase in diagnosis for cancers and blood disorders, the demand for blood is also on the rise. Whilst 80% of the world’s population live in developing countries, they also only account for 40% of the blood donated each year (WHO). This has pushed developing countries into a chronic blood shortages crisis. One of the reasons for this chronic blood shortage is the levels of annual fluctuations in blood donations, as well as an inability to store blood for a significant period of time. The current shelf-life of blood (red blood cells) is only up to 42 days when held at 1-6°C. If we could increase the shelf-life of donated blood, it would lead to an improved stability in blood supply.

The technology that thei-Team was investigating referred to different storage solutions for blood. Frozen blood has a shelf life of up to 10 years, and can be thawed and ready to use in minutes. Freeze-dried blood has a shelf-life of up to 2 years, and can be stored at room-temperature. It requires a solution for resuspension, but then can be ready for use in around 30 minutes. These two methods provide alternatives to refrigerating blood that might be pertinent to developing countries where access to blood is neither consistent nor reliable.

The team looked at what these blood transfusion services needed, and therefore where they might best be implemented. They established that the technology requires a good donor base of voluntary non-remunerated blood donors, and will not work in countries that rely primarily on replacement donors. Given this initial requirement, the team then looked at countries across the world whilst exploring various barriers to voluntary blood donation. These barriers might be religious, oppositions to technological implementation, or the legal framework. Donor fears of HIV are particularly relevant, as are the costs of the technology itself. Based on working around various criteria, the team chose Kenya, Malawi, Vietnam, Iran, and India to look at in more detail.

Each method seems better tailored to a particular scenario. Countries with better infrastructure (Vietnam, Iran, and India) have improved storage capacities and distribution that might benefit more from the frozen blood technology. This is because it is ultimately less costly, and has a longer shelf life. Countries with a less developed infrastructure (Kenya and Malawi) with less developed blood donation organizations would likely not be able to store frozen blood, so might benefit more from the freeze-drying technology. However, the latter requires finding external funding sources as this technology is potentially more costly.

The team finally recommended investigating and addressing other considerations. These include the need for education, logistics of supply chain, international drug approval, clinical trials, and applicability of technology for blood components.

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Investigating the impact of blood transfusion services in the developing world