Badges for Donar Recognition
NATIONAL GUIDEBOOK
ON
BLOOD DONOR MOTIVATION
MINISTRY OF HEALTH AND FAMILY WELFARE
NATIONAL AIDS CONTROL ORGANISATION
GOVERNMENT OF INDIA
NEW DELHI-110 001
First Edition
- 1990
Second Edition - 2003
Published by:
National AIDS Control Organisation
Government of India
36 Janpath, Chandralok Building, 9th Floor
New Delhi - 110 001
Compiled, Prepared and Edited by;
Association of Voluntary Blood Donors, West Bengal,
20A, Fordyce Lane, Koikata-700 014, India
Printed at :
Nabapress Private Limited
66 Grey Street
Kolkata - 700 006
Contributors:
Text and Research - Debabrata Ray with assistance from:
Arunabha Chattopadhyay, Ardhendusekhar Dutta,
Arunangshu Sarkar, Dipak Bose, Satyabrata Roy, Subrata Ray.
Reviewers:
AVBDWB:
Bhaskar Bhattacharya, Jayanta Kumar Bhattacharjee,
Ram Ram Chattopadhyay, Samir Kumar Gupta,
Sujit Kumar Datta.
NACO:
P Salil, Viswa Nath Sardana, Zarin Soli Bharucha.
Language Desk:
Amal Kumar De, Paramita Chowdhury, Ramaprosad De,
Sati Chatterjee - School of Language Management,
National Council of Education, Bengal.
Design, Setting and Layout:
Thoughtshop Communication Private Limited, Kolkata.
Photograph:
Dhiman Ghosh, Rathindra Chandra Poddar,
Subir Sen, Subrata Ray
FIRST BLOOD BANK IN INDIA
Established in March, 1942 at the All India Institute of Hygiene & Public Health, Calcutta
Table of Contents
Preamble
Basic Concept of Blood Transfusion Service
7
9
History of Blood Transfusion
History of Blood Donation Movement in India
11
32
Estimating Blood Need and Planning
36
Blood Bank
Commercialisation in Blood Banking
40
43
Blood Donor
Blood Donor Motivators
46
50
Basic Blood Science for Motivators
53
Indications of Blood Transfusion
65
Hereditary Blood Disorders
71
Transfusion Transmitted Infections
Donor Selection
76
78
Theory of Donor Motivation
86
Principles of Donor Recruitment
92
Donor Recruitment Strategies
95
School Education Programme
Women in Blood Donation Movement
Blood Donation Camp
101
105
107
Donor Counselling and Care
116
Donor Recognition
Donor Retention
Panel Donors
120
126
130
Law and Transfusion Service
132
Ethics in Transfusion Service
137
Public Relations in Transfusion Service
141
Communication in Donor Recruitment
IEC Materials for Donor Recruitment
145
156
Use of Mass Media
159
Donor Records
170
Quality Management in Donor Recruitment
173
Community Based Organisations
176
Leadership in Voluntary Organisations
181
Handling Errors and Complaints
186
Evaluation of Blood Donor Motivation Programme
Research in Blood Donor Recruitment
Modern Technology in Donor Motivation
190
192
195
Land and People
197
Common Questions and Answers
References
199
207
Annexures
National Blood Policy
212
National Blood Transfusion Council
State Blood Transfusion Council
225
226
Drug Rules
227
Adverse Donor Reactions
239
Licensed Blood Banks in the Country
247
Training Modules for Blood Donor Motivators
248
Slogans on Blood Donation
259
Important Dates for Blood Donation Drives
263
State AIDS Control Societies
Glossary
267
271
Name Index
279
Preamble
ndia happens to be the first country in the world to produce and publish
Ian official National Guidebook on Blood Donor Motivation as far back as
1990 as a WHO supported programme of the Directorate General of Health
Services, Ministry of Health and Family Welfare, Government of India.
On the basis of the recommendation of the first ever National
Seminar and Workshop, exclusively on Blood Donor Motivation held at
Calcutta on January 23, 24 and 25, 1985 with the participation of blood
bankers and donor motivators from all over the country, along with a few
experts from abroad, Director Emergency Medical Relief, Government of
India under the auspices of the Directorate organised a few meetings and
workshops at Delhi, Suraj Kund, Jamshedpur and Calcutta to prepare the
National Strategies for voluntary blood donor recruitment. As a result of
these exercises and the collective wisdom of many people, the first National
Guidebook on Blood Donor Motivation saw the light of the day in June
1990. The whole work was coordinated by the Association of Voluntary
Blood Donors, West Bengal.
Indian blood banks, since inception, mainly depended on commercial
blood sellers barring the periods of war and battles. Voluntary blood
donation movement was launched by well-meaning individuals only in a
few cities and towns in a sporadic manner. In 1980, the first attempt to
tackle the social problem in an organised manner by actively involving the
community as a whole — was planned on a regional basis.
On a public interest litigation, the Supreme Court after appointing
two expert committees and after hearing the advocates of all the parties at
full length, delivered a historic judgement on January 4, 1996. The
Judgement, inter alia, directed the Union Government to ban the buying
of blood from commercial blood sellers in any blood bank of the country
with effect from January 1, 1998. World Health Organisation directed that
replacement blood donor system be phased out and abolished by 2005.
With the formation of the National and State Blood Transfusion
Councils, the health planners and the voluntary organisations are eager to
achieve the much cherished dream of blood transfusion services dependent
totally on voluntary blood donors to ensure safe blood transfusion.
In the days of blood communicable life-threatening infections, all over
the globe, efforts are being made to ensure safe blood transfusion by
recruiting and retaining real voluntary blood donors.
[7]
he voluntary blood donation movement in India is at different levels
in different states. In some states, blood transfusion service is totally
dependent on replacement blood donor system; in some states, the
movement is at its zenith, while in a few states it is still at its embryonic
state.
Blood donor motivation is an art based on science and should be
practised with conviction and dedication either from within the transfusion
service or from outside. In both the cases, there would be requirement for
a large number of trained motivators who would be needing a guideline
containing strategies and techniques based on experiments and experiences
in advanced regions. The newcomers in the field instead of starting from
datum level can start from the ground prepared by others earlier.
The first edition the National Guidebook being out of stock, National
AIDS Control Organisation entrusted the Association of Voluntary Blood
Donors, West Bengal to prepare the second revised edition of the Guidebook
for the donor motivators of the country.
The Association, after consulting experienced motivators and
organisations of the country, decided to rewrite the book suitable for the
twentyfirst century with four sections: (1) Text (2) Annexures (3) Pictorial
and (4) References, so that those who don’t have enough time or scope to
do the library work or undergo training in any advanced center can get
everything in between two covers.
Opinion and materials were collected through exhaustive correspondence, email, meetings, workshops, research and library work. These
painstaking efforts continued for little over two years.
The second edition of the book is the work of many people from all
over the country. Materials from different sources have been used freely,
acknowledging the sources.
The Association and its volunteers would have a sense of fulfillment if
the current edition of the book which is the product of their untiring efforts,
help people working for the promotion of voluntary blood donation to lead
the country to a unique plateau where there would be no buying and selling
of blood. Gift of love would flow from the healthy to the ailing as a natural
social process to maintain the river of life flowing with all its glory singing
the songs of sharing and caring as a real manifestation of humanism.
Kolkata
December 10, 2003
Debabrata Ray
[8]
Basic Concept of Blood
Transfusion Service
In the course of seventy five years, blood banking has developed from a
bench in a corner of clinical pathology into a speciality of Transfusion
Medicine. Beautiful, well-designed buildings with glow-sign and
sophisticated plant, equipment, instruments, furniture and fixture manned
by trained doctors, technologists, nurses, supported by modern computer
and information technology cannot ensure the desired service in time of
need of any ailing or dying patient unless blood is readily available.
Replacement of ancient glass-bottles by modern poly-bags, introduction of gamma ray-sterilised disposable transfusion sets, extended shelflife of blood, use of blood components and plasma products, technology of
pheresis and modern laboratory technologies have changed the quality of
blood banking and blood transfusion service. But one thing that has not
changed since the dawn of first blood transfusion of modern era, is the need
of human volunteers to donate blood.
Modern medical science is very
service. Without blood there can be
human blood donors, there can be
regular flow of real voluntary blood
keep blood bank shelves full, delivery
at the right time can never be ensured.
much dependent on blood transfusion
no blood transfusion service. Without
no blood for transfusion. Without a
donors who have no axe to grind, to
of good quality blood in right quantity
But, all over the world blood donors belong to a minority community.
India is no exception. It should be accepted and appreciated that:
• Nobody is born as a blood donor.
• There are several myths, misconceptions and fear complex arounds
blood donation.
• People do not donate blood unless they are asked to do so.
• People are generally not self-motivated to donate blood.
• There are more than enough potential blood donors in the country
in respect of blood need.
• People have to be motivated to donate blood to keep the blood
bank shelves full.
Naturally, to motivate people to donate blood is a fundamental task
for any transfusion service. Awareness has to be generated for regular
voluntary blood donation in the community. Misconceptions, fear complex
and prejudices have to be removed scientifically by rationally emphasising
[9]
that blood donation is harmless to the donor; a social necessity and a friendly
gesture of caring and sharing for the human society crying for compassion
and respect.
Philosophy and science of blood donation together with blood need
for transfusion have to be propagated in a sustained, systematic and scientific
manner in a listener-friendly language in the community.
For this task, a large number of trained, dedicated blood donor
motivators and recruiters are needed for this vast country with so much
diversities in language, culture and religion.
The work of blood donor recruitment would need scientific planning,
careful organisation, rational outlook, pragmatic and appropriate direction,
control and coordination.
To many, even among the doctors, blood transfusion service is just
another discipline of medical science or at best an emergency medical
service. But, in fact, ideally, this service should be a highly coordinated and
organised social service, linking the healthy with the ailing through a host
of intermediaries like donor motivators, doctors, technologists, nurses and
clinicians integrated into the system.
Starting point of the service is blood donor recruitment through
education and motivation.
Every year a large number of young adults are attaining the age of
blood donation. Every year regular blood donors are moving out from
donor base owing to old age, ailment or change of residence. Blood donor
motivation is, therefore, an ongoing process to change the behavioural
pattern of non-donors. The work has no scope for respite.
[10]
History of Blood Transfusion
The story of blood begins long before the days of written history when
people used to live in caves. The primitive people knew nothing about
blood. But they saw their own blood when they had cuts on their body.
Some of them saw people bleed to death. They realised that their lives
depended on blood. Why blood is red and what blood does was a mystery
and magic to them. These people were mostly hunters. When they killed
animals, they saw blood and discovered the heart and figured it out as
important. This is known from the detailed paintings of animals on the
walls of caves. The animals1 hearts were shown in some of these paintings.
Of course, these primitive people didn’t know what the heart was for or
how it moved blood inside the body.
The earliest written medical records that mention blood, comes from
people called the Sumerians, who lived thousands of years ago in the fertile
crescent, in the land between the Tigris and the Euphrates rivers in middle
eastern Asia. Ancient Sumerian doctors thought that blood was the seat of
life. They thought that the liver controlled blood.
A little later, in the same area, Babylonian priest doctors wrote about
two kinds of blood: Day blood and Night blood. When they described day
blood, they were actually talking about the bright red blood carried by
arteries to feed oxygen and nourishment to all parts of the body. Night
blood was the darker blood in the veins that took wastes like carbon dioxide
to be expelled from the body through the lungs or bladder.
Over 5000 years ago, in ancient Egypt, the physicians were learning
more about blood. In a document written at the time, the heart and the
circulating system — the blood moving system — were described. This
document also tells about the pulse for the first time: “If a doctor puts a
finger on the neck, head, hands, arms, feet or body, the doctor will find the
heart there; for the heart reaches out to every part of the body and speaks
in the blood vessels of every part.”
At about the same time, 4500 years ago, on another part of the world,
a Chinese Emperor named Hwang-Ti (builder of the Chinese Wall) wrote a
surprisingly accurate description of the circulatory system and of the blood’s
role in carrying food to all parts of the body. The early investigators were
doctors who combined medicine with magic and religious rituals. They
had to fit what they learned about the body into the religious ideas of their
time, failing which, no one would listen to them.
[11]
The investigations were carried forward by the Greek philosophers
at the zenith of Greek civilisation 2500 years ago. In the third Century B.C.
a Greek doctor called Erasistratus recognised heart as a pump forcing blood
in the system. He also figured out that the pulse could tell about a person’s
health. Greek doctors trained in Greek schools carried on research when
the Romans came to power in the Mediterranean world over 2000 years
ago. They carried this research without instrument or equipment.
Experiments on living animals were not done. They had strange ideas about
blood vessels. While examining enemy bodies after death, these researchers
came to a strange conclusion. They noted that one half of blood vessels
contained blood, while the other half was empty. These early researchers
thought that the empty vessels carried air. Today we know that these
researchers were seeing arteries empty of blood some time after death.
Born in 130 A.D., Galen, the famous Greek doctor who was also a
philosopher and scientist wrote more than 400 books amidst his busy practice.
About one hundred books have survived. Some of them deal with anatomical
studies including blood vessels.
Galen believed in the two blood systems in the human body. One
system, he believed was filled with bright red blood, while the other system
was full with darker blood. This false idea was akin to the early Babylonian
belief. He thought blood was formed in the liver, where it picked up food
and took it to the right side of the heart. Some of this blood seeped into the
left side of the heart and was mixed with air pumped into the heart by the
lungs. The movement of blood. Galen decided, was caused by a pumping
action of blood vessels. He believed that this pumping action sucked blood
from the heart and sent it on its way to the brain and through the nervous
system to all parts of the body. The blood itself just disappeared into the
body and was replaced by new blood that was manufactured in the liver.
The popularity of Galen helped these false ideas to sustain for 1400 years.
It was dangerous to doubt anything that Galen had written.
On the other hand, in the dark ages no ‘witches brew’ could have
been effective without its complement of human blood. The Romans are
said to have drunk the blood of slain gladiators in order to rejuvenate
themselves. The queens of Egypt used to bathe in human blood to become
beautiful by slaying the slaves. In the Mahabharata, it is found Bhima took
an oath to kill Duhsasana to drink his blood, which he actually did later.
There was a popular belief that human characteristics like vice and virtue
flow with the blood. Attempts were made in medieval Europe to change
the character of the prisoners by injecting blood from noble people.
[12]
Transfusion techniques and
equipment, as pictured by German
surgeon J. S. Elsholtz in 1667.
Elsholtz believed that mutual
transfusions between a husband and
his wife could transfer personality
traits, thereby easing marital discord.
Even as doctor began to
understand the benefits of infusing
blood, the ancient practice of
blood-letting persisted. In this
illustration. The Blood-letting, by
the French artist Abraham Bosse
(1602-1676), a barber-surgeon
treats his wealthy patient.
13
Three illustrations from a
1679 treatise “concerning
the Origin and Decline of
Blood Transfusion.” The
author of the work
maintained that animal-to
man transfusions, depicted
in the top panel, had been
“shown to be wrong,” while
those from man to man,
shown in the bottom two
panels, should be “left to the
test of experience.”
[14]
`
Blood bath
To become
beautiful
IntheMahabharata
drinking of blood
of Duhsasana
Bhima
Drinking of
blood
by Roman and
Greek
Speculation about injecting blood to bring about rejuvenation or t
cure disease continued over the centuries. The dying Pope Innocent VIII in
1492 was injected with blood taken from three healthy boys; the donor
died, so also did the Pope.
1000 years after Galen’s death, Pictro d’Abano, a gifted Portuguese
teacher, was put to trial because he dared to question Galen’s ideas. The
famous anatomist Vesalius had to resign from teaching at a university of
Italy for contradicting Galen’s theories. As late as 1553, Miguel Serventus,
a Spanish doctor, was actually burned alive because he said publicly that
Galen was wrong. Because people believed Galen, medical science of blood
circulation was kept at stand still until 1616.
1616\
Dr. William Harvey
discovered
circulation
of blood
in human body
On April 17, 1616 Galen’s hold on medicine was finally broken by an
English physician named William Harvey, who had his medeical education
15
Man receiving blood
from a lamb. This
fanciful illustration,
from a 1692 German
medical textbook,
depicts the
experiments of those
who attempted to
transfuse lamb’s
blood for the
treatment of insanity.
in Italy. In a public speech to a group of doctors, Harvey discussed what he
had learned through research about the circulation of blood. It was the first
accurate description of the way blood moves through the body. He talked
about only one circulation system, where blood is forced through arteries
by the beating of the heart and comes back to the heart through the veins.
Harvey also disproved Galen’s idea that new blood was made from food
each day and disappeared in the body. Harvey measured that the amount
of blood that went through an adult body every minute was about 3.78
litres. He noted that if Galen was right, the body had to make 1,440 gallons
of blood every single day! This was impossible. Harvey reasoned that the
same blood had to be circulated through the body over and over again.
Harvey knew that he was right, yet he was slow to tell the world at
large about his ideas. He was afraid that everyone would be up against
him. It took great courage in 1616 for Harvey to talk about his findings and
research. He had to pay the price. His patients left. He was jeered in the
streets of London. He was considered a crank.
Gradually some listened to him. Harvey regained his good name. In
1628, he published his findings in a book. His book was banned in many
parts of Europe.
Not everyone scoffed at Harvey. In secret, many taught Harvey’s
idea. One such teacher was Bartolomeo Massari of Italy. His student was
Marcello Malpighi who was born in the same year when Harvey’s book
was published. Malpighi, after his medical education, became a teacher at
Pisa. He started teaching Harvey’s findings. In no time most of his students
left as they would not listen to Harvey’s ideas. Malpighi persisted and some
scholars and thinkers began attending his lectures. One scholar who thought
Malpighi correct was a man named Borcelli. From him Malpighi learned
about a new tool, named microscope, used in Holland. He procured a
microscope and proceeded to study the only missing link of Harvey’s
observation — a crossing over of blood from arteries to veins. With the
help of the microscope, Malpighi could see the tiny blood vessels in which
the cross over from artery to vein took place. He named these tiny blood
vessels as capillaries, from the Latin word capillus, meaning hair. He declared
his findings in 1661 just four years after Harvey’s death. With the discovery
of capillaries the focus shifted from the circulating system to the blood itself.
Long before the days of Harvey, blood letting originated in the ancient
civilisations of Egypt and Greece, persisted through the medieval renaissance
and enlightenment periods, and lasted through the second Industrial
Revolution of modern era. It flourished in Arabic and Indian medicine. In
terms of longevity no other practice comes close. Germ theory, basis of
[16]
James Blundell successfully
performed human to human
transfusions. His equipment
was rudimentary as this
contemporary illustration shows.
William Harvey (1578-1657)
demonstrated the circulation
of
the blood. The lower
illustration
i
’
d
i
f
Jean Baptiste
Transfused blood from
animals to humans
A collection of blood-letting
instruments. Blood-letting as
therapy endured for millennia,
although there was no evidence
to show that it worked.
A transfusion at La Pitie
hospital in Paris, 1874. This
illustration is at least partially
imaginary. It is doubtful that
the blood would have
fountained so neatly into the
cup, or that it would have
reached the woman’s vein
before clotting.
[18]
modern Western medicine, was formulated about 130 years ago. The modern
practice of transfusion is about seventy five years old. The path was paved
by Harvey nearly 385 years back. But blood letting was faithfully and
enthusiastically practised for more than twentyfive hundred years. This
practice resulted in loss of many lives including the legendary Robin Hood
and President Washington. In 1833 French doctors imported 41.5 million
leeches for blood letting therapy.
Harvey worked in Oxford among a group of brilliant scientists who
called themselves Experimental Philosophy Club. His colleagues were so
impressed by his methods that they undertook their own circulation work,
even if they had been trained in completely different fields. Sir Christopher
Wren, the legendary architect and Robert Boyle, the founder of modern
chemistry, dabbled in circulation using hollow quill and bladder to inject
opium and antimony into dogs and then milk, honey and wine in the human
circulation system. This paved the path of intravenous injections.
1665
Dog to Dog Blood
Transfusion by
Dr. Richard Lower
In 1665 a talented young doctor Richard Lower attempted to transfuse
blood from one dog to another. He tried vein-to-vein transfusion which
railed. After a series of experiments, Lower was successful by connecting
the artery of one dog with the vein of another dog. This simple advancement
became useful to transfusionists in centuries to come till the preservation of
blood in the bottle. On November 23, 1667, Dr Lower and Dr Edmund
King transfused blood from a sheep to one Arthur Coga who received 20
shillings for his cooperation and gave an address in Latin to the Royal Society
on his experiences.
[19]
On the other side of the English Channel at France, Dr Jean-Baptiste
Denis started transfusing animal blood to human beings from 1667. He
used the blood of calf and lamb. There were many deaths due to transfusion,
resulting in court cases. French Parliament officially banned all transfusion
involving human beings. In 1678, the Pope banned the practice throughout
Europe. So, there was not much work for nearly 150 years.
1667 Lamb to Man Blood Transfusion
On December 22,1818 in London Dr James Blundell, having shown
that the blood to be transfused must come from the same species, performed
the first transfusion of human blood in cases of haemorrhage after child
birth by using an instrument designed by him. It was a direct transfusion.
By these means he was able to save lives of a number of his patients.
Dr Blundell made two pivotal recommendations after a series of experiments:
• Only human blood can be transfused to human beings.
• Transfusion,could not be used for curing madness or change of
character. It should be only to replace blood.
However, progress was still slow. Transfusion of blood was not always
successful and at times caused death due to lack of sterile procedure, clotting
of blood in the needles and tubes and absence of knowledge about blood
groups. Polish doctor F Gesellius compiled statistics about transfusion in
1873; he found that the death rate due to transfusion was 56 percent.
Eminent doctors in Germany and Austria denounced transfusion as a
showpiece that brought attention to the clinic at the expense of the patient
By the end of the nineteenth century, the brief resurgences in transfusion
[20]
was causing so much human suffering and death that the procedure
threatened to slide into another long eclipse.
In those days it was not known how much blood a donor could part
with. There were cases when the donors collapsed and almost died.
Dr Alexis Carrel, a French researcher, an immigrant to USA,
introduced a technique of suturing the artery of a donor to the vein of the
patient to make a continuous vessel to prevent blood from coming in contact
with air and the clotting process to begin. This, of course, was done without
the knowledge of compatibility of blood type. The surgeon’s fee for such
transfusion was a handsome $500. There were many deaths too.
Dr Carrel became a celebrated man for ‘one of the most remarkable
surgical successes ever achieved in the USA’. In 1912 he got the Nobel
Prize. Next year the French acknowledged his brilliance and made him a
Knight of the Legion of Honour but his genius was not utilised in France
during the Second World War.
In 1875 Dr Leonard Landois, a German scientist, mixed human and
animal blood and observed the result under a microscope to find that red
cells swelled up and burst. He found that a second reaction was possible.
The transfused red cell would stick together in the patient, forming plugs
that blocked the capillaries and the complex network of blood vessels in
the kidneys. The same reaction happened in some human blood when
mixed with other human blood.
1901
‘A’ ‘B’ ‘O’ Blood
Group discovered by
Dr Karl Landsteiner
1940
Rh factor
discovered along
with Dr Wiener
A Group B Group O Group
[21]
These deadly reactions were explained 26 years later by an Austrian
pathologist Dr Karl Landsteiner at the Institute of Pathological Anatomy in
Vienna. In 1900 while mixing blood samples taken from different persons
in a test tube he noticed that under certain conditions the blood cells would
clump. He decided to explore with a series of experiments. In 1901, he
carried on the experiments in a straightforward way. He withdrew blood
samples from himself and his associates and allowed the blood to settle
until the red cells separated from plasma. In a series of test tubes, he mixed
plasma from each person with the red cell of every other. Sometimes red
cells would clump or even burst, other times nothing unusual would happen.
He recorded the results of 22 tested specimens. He found blood seemed to
fall into three distinct groups. The plasma from one group which he called
‘A’, caused the red cells of another group which he called ‘B’ to clumpand
burst. Similarly the plasma from ‘B’ group clumped the red cells of Group
A. Neither caused the red cells of a third group to clump. He first called this
‘C’ and later he designated it as ‘O’ Landsteiner himself belonged to ‘O’
group. There was no one in the laboratories belonging to AB group. In
1902 two of his students Dr Struli and Dr Decastello discovered a fourth
group in Germany which reacted to both kinds of plasma. They labelled it
as ‘AB’ group. Dr. Landsteiner migrated to the USA in 1922. He got the
Nobel Prize in Medicine for the discovery of ABO grouping system in 1930.
In 1910, Moss discovered that the plasma i.e. the liquid part of blood, also
contains some chemical substance which interacts with the chemical
substance present in the envelope of the red cell.
DΓ Reuben Ottenberg of the USA after studying Landsteiner’s work
in 1907, introduced cross matching of blood. It took thirteen years before
cross matching became a standard practice in 1920, and that too after
campaigning, experimenting and a few accidents. In the earlier days blood
groups were much used in forensic and legal work. In 1920 Dr Leone Lattes
in Italy developed reagents to determine blood grouping after a bloodstain
had dried. The heritability of blood group gained legal standing. From 1924
blood grouping evidence of paternity exclusion and also baby swapping
incidents in hospitals was accepted by extending Mendelian theory of
inheritance.
In the early years of the twentieth century doctors were learning
transfusion by trial and error method. Nobody asked the transfusion - not
the patient or the donor, not even the doctors. The procedure of direct
transfusion was complicated and costly. Donors were difficult to find even
from the near relatives. The doctors had no choice but to buy blood from
sellers on payment of $50.
[22]
In 1913 Dr Edward Lindman of New York, USA eliminated the need
of artery-to-vein transfusion by introducing multiple syringe method. The
needle was put into the arm of the donor and kept in place for quite some
time. The doctors shuttled back and forth from donor to recipient
withdrawing and reinjecting blood with a syringe. The surgeons used to
work quickly to avoid clotting of blood. In 1914, Dr Lester J Unger of
Mount Sinai Hospital designed a stopcock that eliminated the need of
multiple syringe. Needles in the hand of the donor were connected with
rubber tubing and a four way valve. By changing the position of the
stopcock, blood could be drawn into a graduated cylinder and then direct
it to the recipient. Clotting of blood was delayed by spraying the apparatus
with ether which kept it chilled.
But the donor had to come to the hospital and face the inconvenience.
So the medical world was on the lookout for anticoagulants to prevent
the inevitable blood clot which after 3/5 minutes halted the blood transfusion
directly from the donor by blocking up the needles and tubes. After blood
grouping and cross matching, this was the third hurdle of blood transfusion.
In 1860 the English obstetrician Dr John Braxton Hicks was the first to
experiment with an anticoagulant and lost three patients as a result. Some
other doctors tried hirudin, a chemical found in leeches. That also proved
toxic to humans. Others used oxalates, bicarbonates and phosphates, all of
which delayed the blood clot but were toxic or poisonous. Simultaneously
in Belgium, USA and Argentina, experiments were made to use sodium
citrate to prevent blood clottinq.
The discovery of a satisfactory anticoagulant made indirect blood
transfusion relatively simple. Dr Albert Hustin in Belgium on April 24, 1914
demonstrated the use of sodium citrate to prevent coagulation of blood in
a glass jar and on November 14, 1914 at Buenos Aires in Argentina Dr
Agote carried out the first successful citrated indirect blood transfusion. In
January 1915 this was also done independently by Dr Lewison in the USA.
He also improved upon the technique and standardised the amount of
citrate to preserve donors blood. He wrote in his notes “Technique requires
no special apparatus any country physician could use it”.
But doctors raised several ‘ifs and buts’ to prevent the use of this
technique for quite some time.
Sodium citrate gave surgeons the time they needed to bleed a donor
into a flask and slowly infuse blood into the patient after mixing with
measured quantity of sodium citrate. But transfusion remained a laborious
affair. No one was storing blood. Doctors viewed citrate as a short term
anticoagulant to keep the blood liquid, long enough to complete transfusion.
When a patient needed blood, the doctor had to recruit a compatible donor,
[23]
Bring him to the hospital and use the blood right away. True, transfusion
had become an ‘indirect’ procedure; blood no longer had to flow directly
from donor to recipient.
Storing of blood had to wait till 1932 when in Russia Dr Andre
Bagdasarov demonstrated the system of storing blood for 21 days at 4°C by
adding a measured quantity of dextrose to the sodium citrate as a nutrient
of red cells.
1914
Dr. Hustin discovered
Blood preservation
in bottles
Now a days
Blood in a bag
is preserved
for 35 days
1932
Andre
Bagdasorov
introduced
Blood
preservation
for 21 days at 4°C
In the thirties of the twentieth century, Hitler used serologists like Dr
Otto Reche, Dr Ludwing Hirszfeld to establish his racial theory by causing
a wrong interpretation of blood groups from predominately ‘A’ group among
the white Europeans and ‘B’ group among the coloured Asians but carefully
avoiding the incidence of ‘O’ and ‘AB’ groups among both white and
colouredpeople.
In 1926 Dr Alexander Bogdanov established the world’s first centre
for Transfusion Research “Central Institute of Haematology” in Moscow. A
lot of work on cadaver blood was undertaken in Russia. Even attempts
were made to establish a cadaver blood bank. Scientists in Canada, India
and the United States quietly experimented with cadaver blood.
On March 23. 1930 Dr Serge Yudin at Skilifosvsky Institute named
after the Russian pioneer of emergency battlefield surgery, transfused
cadaver blood with success. He used the blood of a just dead person. Dr
Yudin never understood why the blood of sudden death victims remained
unclotted whereas the blood of those who suffered lingering death did not.
Haematologists subsequently learned that only in cases of sudden death
the body releases enzymes that dissolve blood clots. The attempt to use
[24]
By the 1930s arm-to-arm transfusions were becoming common. Above, a
depiction of Dutch doctors transfusing blood directly from a nurse into a patient.
During the Spanish Civil War, Dr. Norman Bethune. a Canadian surgeon
and revolutionary, took blood transfusion to the Republicans in Spain. He
ran a mobile transfusion service, speeding along the front lines delivering
blood to the wounded. He is shown here assisting refugees during the 1937
evacuation of Malaga.
[25]
During World War II the Allies
mobilised blood and its
constituent parts on an industrial
scale. Here, an American medico
administers plasma to a wounded
soldier in Sicily.
Dr Charles Drew pioneered the
industrial processing of plasma
during the early years of World War
II. He was lionised by the governmet as an exemplary Black
American, at a time when blood
donations were segregated by race.
[26]
cadaver blood was abandoned for logistical and legal reasons.
The first blood bank of the world was established by Dr Norman
Bethune during the Spanish Civil War at Madrid on December 10, 1936.
Immediately thereafter, another blood bank was established at Barcelona
by Dr Federico Duran Jorda by storing only ‘O’ group blood on the concept
of universal donor. Having collected, processed, stored and distributed nine
thousand litres of blood at his Blood Transfusion Center, he had no choice
but to abandon the enterprise at the end of the civil war. He moved to
England and was received by Dr Janet Vaughan who also took part in a
British physician’s group that supported the Republicans in the Spanish
Civil War. In doing so she became familiar with Duran Jorda’s work and
became convinced” that like Barcelona, London must have stocked blood if
it ever went to war. Together they established War Blood Transfusion Service
in Britain. Britain entered into the war with only fifty bottles of blood but
developed the transfusion service readily which after the war was converted
into National Blood Transfusion Service. In 1937 Dr. Bernard Funtus, a
doctor at the Cook County Hospital in Chicago, after reading about the
work in Russia and Spain established a blood bank at his hospital, where
he bled the donors into a flask containing a small amount of sodium citrate
with dextrose, tested it, sealed it and stored it in a refrigerator. Funtus called
the facility ‘Blood Preservation Laboratory’ but given the system of deposits
and withdrawals soon came up with a snappier name immediately became
part of the popular vocabulary. He, called it a ‘Blood Bank’. The date was
April 25, 1937. Never before were these words used, although, the world
had seen functioning of blood bank in some other name in Spain before.
In Russia, side by side with cadaver blood, efforts were made to store
blood drained from placentas and also from walk-in donors. In 1937, sixty
large blood centres and five hundred subsidiary ones started using ‘canned’
stored blood amounting to ten thousand quart.
Russians, in view of this pioneering work in blood transfusion and
storing, had dozens of research institutes and fifteen hundred transfusion
centres under the Health Ministry just before the war. Many of those institutes
and centres working efficiently and effectively under the leadership of Prof
- Andre Bagdasarov, the Director of Blood Transfusion Institute in Moscow,
were converted to war blood transfusion centres in four divisions. During
the first twelve months of the war, literally hundreds of tons of blood have
thus been applied to wounded men in all stages of evacuations and with
truly a tremendous success, wrote Dr Bagdasarov. Russians also produced
blood substitutes including ‘Petrov’s Solution , a suspension of salt in sterile
water and ‘Seltsovski’s solution’, a liquid designed to stimulate blood
[27]
producing bone marrow and the ‘Federov and VasUiev solution’, a gelatinous
liquid designed to maintain blood pressure. These prevented shock for a
few hours but none had the long lasting benefits of plasma or albumen.
Nothing would match the Russians’ bravery, resourcefulness and ability to
provide blood and transfusion fluids at the siege of Leningrad. At the height
of the blockade, more than thirty five hundred people were dying per day.
By the end of the “nine hundred day siege” more than 6,30,000 people
had died but amidst the appalling suffering and destruction the staff at the
Leningrad Institute of Haematology and Blood Transfusion carried on, often
without water, electricity or even food.
Britain did not have enough blood at the beginning of the Second
World War. From the other side of the Atlantic, Dr Charles Drew, who
invented the process of plasma separation, and whose famous thesis of
‘Banked Blood’ was of the thickness of New York Telephone Directory,
considered as authoritative work on the science of blood storage, organised
large scale shipment of ‘Plasma for Britain’ , as the first international medical
despatch of blood products.
In 1940, Dr Karl Landsteiner discovered the Rh factor in blood along
with Dr Alexander Weiner. Two disciples of Dr Landsteiner. Dr Philip Levine
and Dr Stetson proceeded to show along with Dr Weiner that Rh negative
woman could be immunised to prevent haemolytic disease of newborn by
injecting her with suitable immunoglobulin immediately after the birth of
her first Rh positive child. By the late 1960s this injection became
commercially available and with it began the era of ‘Exchange Blood
Transfusion’ of new born babies of Rh negative mother by ‘O’ Rh negative
or mother’s group specific negative blood.
During 1940-41, standards of glass bottles for preserving blood were
formulated. In the Second World War, glass bottles were the only containers
for storing blood, but had some disadvantage in respect of transport, air
dropping and storage space.
Prof Carl W Walter of Harvard Medical School invented in 1947 blood
containers made of PVC (Polyvinyl chloride) plastic resin. PVC containers
were suitable for air dropping. Subsequently. Dr Walter proceeded to convert
PVC bottles to bag by adding some plasticisers with PVC. These bags were
flexible, soft, pliable. In 1961 U.S. Govt gave permission for mass production
and marketing of poly bags. These bags, after further modifications are now
being used all over the world.
In the late eighties and early nineties of the twentieth century, further
technological advancement increased the shelf life of blood to 28 days with
[28]
CPD and 35 days with CPDA and CPDA1. Thirty five day’s shelf life of blood
is now in practice in India. But the western countries and some centres of
India are using SAGM, ADSOL, NETRICEL to increase the shelf life to 42
days. During the Vietnam war, U.S.A. used liquid nitrogen to preserve blood,
plasma and bone marrow for longer periods.
Since the days of Dr James Blundell, blood donors were paid. Even
when transfusion became indirect the doctors were depending on unreliable
donor supply, recruited from the patients family or their own personal
network, including individuals on payment. There were often no compatible
donors. There was a time lag, often fatal, between the need and the supply.
That was the situation Percy Lane Oliver confronted in London in
1921. Oliver, a balding bespectacled, bookish looking man, was the
Secretary of the Camberwell Division of the British Red Cross in Southern
East London. When a call came urgently requesting for blood with no other
resources from whom to draw, Oliver and three co-workers rushed to the
hospital. One had a compatible blood type and the patient survived. The
dramatic rescue gave Oliver the idea of a city-wide bureau of providing
pre-screened and pretested voluntary blood donors. He went on to maintain
a donors’ panel. In the first year, doctors called him thirteen times, in 1925,
428 times. Oliver ran the organisation from his home, where aided only by
his wife and a secretary, he worked 7 days a week recruiting, doing paper
work and phoning volunteers. In 1926, he had 2000 outgoing and 3500
incoming calls. The service was free. For one donor, an average eight
telephone calls were needed. Expenses for campaign, recruiting and travel
of these voluntary donors compelled Oliver to raise money. These blood
donors were known as ‘donors on the hoof. It had obvious limitations.
Inspired by Oliver’s example and compelled the by pressing need,
donor panels were established in Germany, Belgium, Australia, Russia and
even in Siam. In Japan, Dr H Ijima established the Nippon Blood
Educational Society with two hundred donors. In France, Dr Arnault Tzanck
established the Emergency Blood Transfusion Society. Donors received
small allowance to compensate for the inconvenience, most of which were
raised from the public. Dr Tzanck was actually the founder of the
International Society of Blood Transfusion. Dr Jean Pierre Soulier, one of
his disciples who headed the French Blood Transfusion Service for thirty
years wrote about Dr Tzanck that he was an incomparable motivator, who
always preached that ‘the man is truly poor who does not know how to give’.
If Tzanck represent the height of humanity and Oliver the epitome of
unselfishness, then the Americans with their practical and market driven
[29]
methods embodied cool professionalism in mobilisation of donors. They
saw nothing wrong in trading blood for money. Naturally, blood donors
‘bureaus’ were established by recruiting people who were selling blood fifty
six times in a single year. Some of them carried syphilis and other blood
communicable diseases.
Horrified at the situation, eminent doctors in the field like Dr Ottenberg,
Dr Coca and Dr Landsteiner in trying to raise the standard of professional
donation formed the Blood Transfusion Betterment Association. It was
actually a professional donors panel with rigorous standard of discipline,
hygiene and testing. Donors received $35 and the bureau got a commission
of $6.
During the Spanish Civil War, appeals over the radio brought hundreds
of donors. Patriotism prompted people to donate blood in U.K. Dr P L
Mollison was entrusted with the responsibilities of recruiting donors in 1943.
Unschooled in the art of recruiting donors, the great man and his colleagues
hired a theatrical impresario, who plastered several neighbourhoods with
posters for recruiting donors.
In Russia during the Second World War more than two thousand
people queued up in Moscow each day to donate blood. Donors received
food and money for their blood, although, many returned the cash payment.
All donors were women; most of the men had been called to the front. The
use of the woman’s name on the bottle of transfusion fluid sometimes led to
correspondence and friendship between the donor and the recipient, an
occurrence that increased enthusiasm among neighbouring donors.
In Calcutta the Britishers, the Anglo Indian community
organisations having British chiefs provided the blood to meet the war need.
and
After the war all the conferences and declarations from international
organisations recommended voluntary blood donation to ensure safe blood
transfusion. Associations and Federations of blood donors started coming
up. Red Cross joined in blood transfusion. An International Federation of
Blood Donor Organisations (FIODS) was formed at Luxembourg in 1955.
Not content with whole blood transfusion, advanced transfusion
centres are now using blood components and plasma fractions. The blood
of the patient is also collected before surgery to meet the blood loss during
surgery. This is known an autologous transfusion.
Red blood cells were first described in 1658. Vincenzo Menghini found
iron in the blood in 1746 and Dr William Charles Weslls in 1777 showed
that iron was in a complex substance subsequently named Haemoglobin.
[30]
In 1884 Russian scientist Dr Elie Metchnikoff found the role of white cells
to destroy germs, in 1877. Dr Earnest Newmann showed that red cells and
white cells were produced in the bone marrow. Dr Paul Ehrlich in 1879
established the basis of the differential count of the cell. Dr Emilvon Behring
(1857-1917) received the first Nobel Prize in Physiology or Medicine in
1901 for his work on serum therapy, which opened the way to blood
transfusion.
In 1940. Professor Edwin Cohn and Professor Blomback at Harvard
Medical School developed the process of plasma fractionation. Dr John
Elliot demonstrated the efficacy of albumen transfusion. In 1964
plasmapheresis .was introduced. 1965 saw apheresis in a limited way.
Professor Macforlaned in Oxford recognising that absence of the protein
(factor VIII) was the cause of haemophilia introduced transfusion of fresh
blood and plasma that laid the foundation for modern haemophilia therapy.
This, in turn, led to application of fractionation technique on a commercial
scale. Use of fresh blood for haemophilia patients was followed by fresh
frozen plasma in 1965. Cryoprecipitate, discovered by Dr Judith Grahan
Pool and her colleagues in Stanford, California and introduction of freeze
dried concentrates made home therapy and prophylaxis for haemophilic
patient possible. In 1971 Hepatitis B surface antigen (HBsAg) testing of
donated blood was introduced.
With the arrival of AIDS in the eighties, the panicky world of transfusion
medicine could get the screening tests to detect HIV only in 1985. These
tests were improved upon during the next fifteen years including some
kinds of confirmatory and rapid spot tests. None of the tests can totally
eliminate the window period but some costly sensitive tests available can
reduce the window period.
Thus altruistic genuine voluntary blood donors declaring truthfully
their history of past ailments and health habits are the base of transfusion
service to ensure safe blood transfusion. World Health Organisation had
rightly declared 2000 AD as the year of Safe Blood Transfusion with a
slogan ‘Safe Blood Starts With Me’. World Health Organisation, International
Federation of Red Cross and Red Crescent Societies, International federation of
Blood
Donor
Organisations
and
International
Society
of
Blood
transfusion have jointly decided to observe June 14 (birthday of Dr Karl
Landsteiner) as World Blood Donor Day from 2004 with a slogan “Safe
Blood starts with the blood donor” and thrust would be on youth
Programme.
[31]
History of Blood Donation
Movement in India
In 1925, the Imperial Serologist started a Transfusion Centre at the School
of Tropical Medicine in Calcutta. This was a service to draw blood from a
donor by syringes and transfuse to the recipient without any storage in
between. In 1939 the Indian Red Cross Society formed a Blood Bank
Committee to support the Transfusion Centre with equipment and donors.
By then the Transfusion Centre was collecting blood in a flask and
transfusing
to the patients, occasionally keeping the flask for a couple of hours in a
refrigerator. The war necessitated establishment of a blood bank with storage
for a considerable period. On March 6. 1942 under a Government order
of Major General W C. Paton, I. M. S., Surgeon General, Government of
Bengal, Calcutta Blood Bank the first real blood bank of the country was
established at the All India Institute of Hygiene and Public Health, 110
Central Avenue (now Chittaranjan Avenue) Calcutta to meet the war need.
The management of this blood bank was entrusted to the Blood Bank
Committee of the Red Cross.
To meet the blood need of the war casualties, the Britishers, British
managed industrial and commercial houses, government employees and
the Anglo Indian community came forward to donate blood. The blood
bank team collected 39050 units of blood between March 6, 1942 and
May 15, 1943 from Calcutta, its suburbs, including the railway head quarters
at Nagpur, tea gardens of Assam and Darjeeling. Only 5458 units of blood
were collected in the blood bank premises.
After the war, this blood bank was handed over to the State Govt.
and transferred to Calcutta Medical College campus. Nobody thought of
motivating and recruiting voluntary blood donors during peace time.
Professional blood sellers were accepted as the main source of blood to
meet the need of the day. Blood banks were established in metropolitan
cities of the country in the forties. In the fifties the district blood banks were
established. All these blood banks depended on professional sellers. Nonavailability of blood in these government blood banks encouraged a number
of doctors to establish commercial blood banks throughout the country.
In 1954, the son of Mrs. Leela Moolgaoker, housewife of the Tata
family met with a road accident in Bombay while travelling on a motorcycle. He was taken to St. Georges Hospital near VT Railway station. Blood
was needed to save his life. Hospital employees and the employees of Tata
House came forward to donate blood. The life was saved. But this incident
[32]
triggered off the need of oranising blood donation drives in the mind of
Mrs Leela Moolgaoker. Mrs Moolgoker carried on her mission till her last
day in 1992. In 1980 under the leadership of Dr H M Bhatia and Dr Z S
Bharucha, Federation of Bombay Blood Banks was founded.
In 1962, Dr V G Mavalankar an eminent surgeon of Ahmedabad,
finding difficulty in getting right type of blood at the right time took up the
cause of promotion of voluntary blood donation under the umbrella of
Red Cross along with Dr Vani and carried on his self-assigned task till his
death in 1984.
Led by Dr Triguna Sen, then Rector of Jadavpur University, students
and teachers organised first blood collection drive during peace time in
West Bengal on August 4, 1962. In a month long daily blood collection
drive, 301 students and teachers donated blood. Some of the donors of this
camp initiated the move to set up the Association of Voluntary Blood
Donors,
West Bengal in 1980 with eminent doctor and social, worker Dr Labanya
Kumar Ganguli as the president and established professional engineer
Arunabha Chattopadhyay as the secretary to build up voluntary blood
donation movement by involving the community and by using various
innovative techniques. Voluntary organisations in the districts and
subdivisions of the state were established and voluntary blood donation in
the state became a statewide people’s movement At the moment, there are
forty voluntary organisations working exclusively on blood donor
motivation, recruitment and retention for the fifty eight government blood
banks of the state.
In 1962 Dr ML Gupta Director Indian Red Cross Society Blood Bank,
Delhi initiated voluntary blood donation movement in Delhi by bringing in
other voluntary organisations.
In 1964 at Chandigarh, led by a housewife Mrs K Swaroop Krishen
and supported by the then in-charge of the blood bank at P G I Chandigarh
Dr JG Jolly, the Chandigarh Blood Bank Society was established to recruit
voluntary blood donors. From Chandigarh at their initiative Indian Society
of Blood Transfusion and Immunohaematology (ISBTI) was established
on October 22, 1971. This organisation introduced All India Voluntary
“blood Donation Day on October 1 in 1975. Since then, the day is being
observed throughout the country. National AIDS Control Organisation
(NACO) came forward to support the observance of this day from 1996.
ISBTI has chapters in some states of the country.
In 1967, patronised by the Tata House, Jamshedpur Blood Bank was
established to recruit voluntary blood donors and collect, store and distribute
[33]
blood. In 1985, Voluntary Blood Donors Association, Jamshedpur, Bihar
was established to work from outside the blood bank to motivate and recruit
blood donors.
In 1970, the students of Madurai Medical College, with the inspiration
from their teachers Dr S A Kabir, Dr T Dorairajan and Dr T Chelliah set up
Madurai Blood Donors Club to organise voluntary blood collection drive
for the hospitals of the city. In 1974, Dr T Subramanian took over the charge
and
the
club could do away with the professional blood sellers from
the medical college hospital in 1983.
In 1975, Mrs Shanti Ranganathan, a housewife of the TTK family,
established the Madras Voluntary Blood Bank to spread the message of
voluntary blood donation in the state. Subsequently, led by R Rajkumar, a
bank employee, the Association of Voluntary Blood Donors Tamil Nadu
was established in 1991 to function from the same premises to work for the
same cause for the whole state.
In 1985, the First National Seminar and Workshop exclusively on
blood donor motivation took place at Calcutta. This three-day meet enabled
field workers and the organisers working in the country to meet and share
their experiences and inter state contacts and communications were
established. The meeting after a whole night session, formulated a draft
National Policy on Blood Transfusion, which was printed and circulated
The proceedings of the said meet served as the hand book on blood donor
motivation for quite sometime. This prompted the Government of India to
constitute a working group and organise workshops and the National
Guidebook On Blood Donor Motivation came out in June 1990.
On the basis of the recommendations of the first-ever national meet
on blood donor motivation, a link quarterly bulletin “Gift of Blood” came
to be published regularly from Calcutta from October 1985. The bulletin
has now completed its eighteen years.
National meets on donor motivation were subsequently organized
by different organisations in Mumbai, Chennai, Chandigarh, Indore, Pune.
Jaipur, Tamluk, Bhavnagar at regular intervals. Even two International
meetings on donor motivation and recruitment were hosted at Calcutta
in1990 and 1995.
Other voluntary organisations to recruit blood donors were established
in Tripura. Assam, Madhya Pradesh, Orissa and Punjab between eighties
and till the publication of this guidebook.
[34]
On a public interest litigation, the Supreme Court directed the Union
Government on January 4, 1996 to abolish buying blood from sellers with
effect from January 1, 1998 and asked the Government to constitute
National and State Blood Transfusion Councils to promote voluntary blood
donation.
National AIDS Control Organisation established, in 1992, under
its Blood Safety Programme has been supporting voluntary blood donation
of the country.
National and State Blood Councils were set up in July 1996 under
the direction of the Supreme Court. The portions of the Drug Rules under
the Drugs and Cosmetics Act related to blood banking were thoroughly
revised and came into force from April 5, 1999 and subsequently modified
thrice. National Blood Policy, after processing through all levels, was
released
on April 2002. The Action Plan for Blood Safety was released by NACO in
May 2003.
NACO had his first phase of programme between 1992-99 and
entered in its second phase of the programme on November 9, 1999. The
second phase would continue upto 2004. Thirty percent of the project cost
is focussed on Blood Safety. The project finances HIV and other test kits,
technical assistance on blood safety, and up gradation of equipment in
government blood banking facilities. It also sponsors information, education
and communication (IEC) campaign at both national and state level to
generate awareness of potential danger of unsafe blood from unlicensed
blood banks and professional sellers, and promotes the voluntary blood
donation movement.
Every year, exercise by way of workshops, seminars, conferences are
being organised by National AIDS Control Organisation (NACO), World
Health Organisation (WHO), Department of Science, Technology,
Government of India (DST) and voluntary organisations to train up the
blood donor motivators to embark upon a journey to achieve total voluntary
blood programme for the country.
“If there is one place on the face of the earth where all the dreams of
living men have found a home from the very earliest days when men
began the dream of existence, it is India.
Romain
[35]
Rowland
Estimating Blood Need and
Planning
O
ne of the most important essential first move for blood donor recruitment is establishing clear goals by estimating pragmatically the blood
need of the Country/State/Region/ Blood Bank. For a well established
transfusion service, with a long history of success, knowledge of current
patterns of blood usage and data of changes from year to year, it is a
straightforward matter to project need into the future, to plan blood collection
and recruit donors accordingly.
The process is much more difficult at the beginning in regions or
states where no data is available for any estimation at all. It is, therefore,
quite natural that maiden attempts of donor recruitment may result in
insufficient blood collection in reality.
Surrounding every mountain peak, there are valleys and into these
valleys one must go before climbing the peak. There are joys. There are
disappointments. There will be success and there will be failure. Blood donor
motivators should have a mental makeup to accept both the rough and the
smooth. The journey of a thousand miles begins with the first step. And, a
beginning has to be made.
There may be three principal reasons for failure in the first venture:
•
Immature organisation
•
Lack of clear goals
•
Underestimation of blood need.
When there is no blood, suppressed need of blood would not come
to the surface. Blood need will increase with the availability of blood. Even
donor awareness campaigns may inculcate the sense of need of blood in
the minds of the clinicians and surgeons resulting in irrational use of blood.
That should be taken care of when blood would become easily available
from the blood banks.
There may be a number of approaches for the estimation of blood
need. Some are simple and some are complex in character. Some may
give an approximate idea and some may give a fairly accurate target. To
start with a goal, however approximate, a target is badly needed to set the
ball rolling.
[36]
There are four approaches to estimate how much blood is needed:
• In relation to hospital beds
• In relation to total population
• In relation to medical facility available in the region
• In relation to past blood usage.
Ideally, if 2% of population donates blood, it will be more than sufficient
to meet the need of a country like India. For a population of 100 crores
(1000 million), 2 crores (20 million) of intending blood donor would be
more than sufficient for the country by taking into consideration all
possible
allowances. The present estimated blood need of India is 80 lakh (8
million)
units.
In the first method the need of blood can be calculated as 3 to 15
units per hospital bed per year. It may also be calculated as 7 to 20 units
per acute hospital bed per year. In the primary health centres, the need
may be 3 units per bed per year, while at a super speciality surgical hospital
the need may be as high as 25 - 30 units /bed /year. The golden mean may
be worked out. With the introduction of open heart surgeries, liver
transplants and treatment for oncological disorders in the country, the need
of blood in different regions have increased.
The table below indicates the enormous variations of blood donor
per 1000 population between different countries.
Switzerland
113 Japan
70
Australia
58
New Zealand
56
Canada
55
UK
40
Greece
33
Singapore
24
Macao
23:
Hongkong
27
Korea
22
Spain
21
Jordan
17
Malaysia
13
Zimbabwe 10
Mexico
10
9
Fiji
9
Philippines
7
New
Guinea
China
4
Brazil
2
Vietnam
2
Sudan
2
Ethiopia
0.4
[37]
In India, this figure at the moment is 4 per thousand population with
some regions/states at a higher than the national average and some below
the national average.
If this national average can be raised to 8 voluntary blood donor per
1000 population, there would not be any shortage of blood for the country
and none would die for want of blood for transfusion.
The ideal simple method of estimating blood need at the beginning
would be to make a list of hospitals together with the details of bed strength
of a region for which a particular blood bank or transfusion service is
supposed to cater. This data is available with the health authority of the
state. From this data, by counting the actual bed or acute bed, by using
rule of thumb, blood need can be calculated by multiplying by the
appropriate factor between 3 and 20 depending upon the standard of the
health service
.
Another method may be to collect data about the requisitions received
and served by the blood bank / transfusion service over a period of not less
than three months. If such study had been conducted in the past, the results
should also be studied. While computing such data, care should be taken
pragmatically to:
• Express all data on annual basis (if information availability covers
only three months, it should be multiplied by four).
•
If data are not up-to-date, there should be interpolation and or
extrapolation to allow for changes during the intervening period.
• It should be ascertained that information collected is, in fact,
complete.
• Inconsistency between blood collection and blood usage should
resolved before interpretation.
It will be difficult to get data in many states due to poor documentation and
improper record keeping system. Still a survey has to be undertaken. The
survey may be based on the following questionnaires:
•
How many units of blood are collected by the hospital in day/
week/month/year? (any one)
• How many requisitions are received in a day/week/ month/year?
(any one)
• How many units are asked for on an average per requisition?
• Whether blood for the patients are obtained from other sources?
• If so, what is the quantum?
With these data, blood need can be estimated for the state/region/
blood bank for the year
[38]
The motivators have to collect another set of data i.e. actual storage
capacity of blood bank(s) or transfusion service for which blood donor
recruitment is being planned.
The blood donor motivators should remember that the donor
recruitment target should always be higher than the estimated blood need.
The reasons are:
• Recruited donor may not turn up on the day of blood collection.
• Intending donor may be temporarily deferred on medical reasons
at the time of actual blood collection.
• Collected blood after testing may be discarded for containing
blood communicable parasite/virus.
Further, to meet each and every blood need, the services will have to
stock blood more than the estimated requirement. As it is not known from
which blood group patients would come, blood of all groups including rare
groups is to be adequately stocked.
There may be some marginal periodic so-called ‘wastage’ due to out
dating of blood of some groups. A question can be raised: which is better,
some one dying for want of right group of blood or some blood bags being
discarded after the prescribed expiry period for want of requisition of that
particular group? How do we feel if the unfortunate victim, whose blood need
could not be met, is our near and dear one?
A small portion of the collected blood, about 5%, may be outdated,
another portion of about 1% may be discarded after testing, for various
reasons. Some of the intending donors may be deferred on medical reasons;
some intending donors may not turn up on the date and time of blood
collection. Considering all these allowances and adding a blanket allowance
of further 10%, the target of donor recruitment may be planned for the
year and computed for month or week.
Target of donor recruitment, annually, monthly or weekly should be
at the finger tip of donor recruiters. A portion of blood would be collected
in the blood bank but a goal has to be set. The goal should be pragmatic
Estimation of blood need and planning the target of blood donor recruitment
are the initial steps to identify the goal. The donor motivators/recruiters
should assess, review and reset the goal from time to time by generating
data from different sources.
[39]
Blood Bank
O
n April 25, 1937 Dr Bernard Fantus at Cook County Hospital in
Chicago coined the word “Blood Bank” for the blood preservation
laboratory equipped with the system of deposit and withdrawal. But blood
banks had been established even before the nomenclature was coined.
Blood transfusion service does not exist in isolation. It is an integral
and indispensable part of the health care system. Today no hospital can
function effectively without blood. Blood has to be provided to the patient
in need in right time and right quantity. A stock has to be maintained. Only
well planned and efficiently managed blood banks can meet the requirement
of health care service.
An Ideal blood bank has the following functions:
• Blood donor motivation, recruitment and retention
• Blood collection
• Blood processing and storing
• Blood distribution
• Record keeping
• Human resource development
• Post blood transfusion follow up and research.
The first task of any blood bank is blood donor motivation, recruitment.
and retention. Without blood all other functions of blood bank become
non-existent.
Only the blood banks depending on voluntary donors motivated
through education of self-exclusion can ensure safe blood transfusion by
preventing transfusion transmissible infections. There should be steady
supply of blood from voluntary blood donors throughout the year. There
should not be any flush or lean season. Hence blood donor motivation in
a scientific, systematic and sustained way is a demanding task.
Some of the blood banks wrongly depend totally upon the ‘family
donor’ or replacement donor system. There are, however, several reason
why such blood banking system is unsatisfactory and dangerous. It may
not be possible for the patients’ family to find a suitable family donor. Some
may feel obliged to donate even if they know that they have some health
condition which prohibits donation of blood. Moreover, since this blood
meant for a particular patient, it is not easily made available to other patients,
who may have a greater need. It is not possible, therefore, to utilise family
donations effectively for running a blood bank with adequate stock of blood,
ensuring its availability at right time of right group.
[40]
In addition, this system may ultimately lead to professional bloodselling system in disguise, has the potential to corrupt the personnel working
in the blood bank. Since these are the people who have first access to the
family, there is great temptation to accept pay offs for referring the family to
the professional seller syndicate. Corruption of this kind thus introduces
further dangers for the patient by subverting the professional integrity of
the transfusion service staff.
Systems of this kind are undesirable and should not be allowed to
develop. The solution is to create a viable, ethical voluntary blood
programme which succeeds in providing the required services. Paid donor
system cannot succeed if something better is already in place.
Blood banks, therefore, must have their own donor motivation,
recruitment and retention programme, or may entrust one or more
respectable voluntary organisations with the responsibility of undertaking.
the job for them.
There are four different models of blood banking service which have
been tried successfully. These are:
• Centralised
• Regionalised
• Coordinated hospital services
• A coordinated mixed system.
In India there are three types of blood banking service:
• Government blood banks
• Private non-profit making blood banks run by trust/society or
snon-government organisation
• Commercial blood banks.
Government blood banks run on tax payers money from the public
exchequer and therefore, they donot have to depend on total cost recovery
from the patients. Non-profit making blood banks have to be funded from
different sources including cost recovery from the patients.
Commercial blood banks trade in human misery. Often their blood
banking practices are unethical. Commercial blood banks have a high price
for blood to meet the salary bills and the profit of the owners.
Ideally, there should be a National Blood Transfusion Service (BTS)
based on the existing model of National Health Service (NHS) in the United
Kingdom (Britain).
[41]
Blood procurement
Donor motivators
procurement in time
rules for providing blood.
have to
of need.
face questions about procedures for blood
Different blood banks may have different
Some blood banks work round the clock and some work during
daytime only. Even in 24-hour blood banks different services may have
different working hours. Some have fixed hours for issuing blood for cold
cases.
Donor
motivators
must
be
conversant
with
all
these
working
procedures so as to answer all such questions.
One may have donated blood hundred times in camps. But the donor
may not have visited any blood bank in quest of blood for his/her near and
dear ones. This may be necessary once in a blue moon. So, the procedure
of blood procurement is an important ingredient in awareness talk or
campaign. This also helps in donor retention.
For procuring blood, proper requisition is always required. Requisition
from the attending clinician or surgeon and blood samples of the patient
should be presented at the blood bank counter. While bringing blood from
a blood bank the cross match slip must be obtained from the blood bank
and made available to the attending doctors. The cross match slip certifies
that donor’s blood and patient’s blood are compatible. In case the distance
between blood bank and the place of transfusion is considerable, suitable
container with ice-packing would be needed.
Blood bank personnel have a great role to play in donor motivation,
recruitment and retention. The best motivational exercise may go in vain if
blood bank personnel do not reciprocate with donors with equal earnestness
and respect. On the other hand a well meaning, courteous and sincere
blood bank team may inspire many around a camp to become blood donor.
Tender loving care and empathy from the blood bank personnel across the
counter to handle patients’ relatives in agony with requisitions for blood for
their near and dear ones help in donor motivation and retention. In fact,
they are the ambassadors and public relations people of the transfusion
service. They carry with them the immense possibilities of being the best
motivators if they mean their job with sincerity, devotion and credibility
born out of compassion for the ailing patients whose lives rest on a fraction
of hope in quest of this vital life saving fluid which has no substitute as yet.
[42]
Commercialisation in Blood
Banking
Forall
many years, monetary inducement of blood donation was
over the world barring a couple of countries. In India all
banks started functioning depending on poor paid blood sellers.
relied on
the blood
Transmission of infection is a serious complication of blood.transfuion
In spite of sophisticated laboratory techniques to screen blood from donors,
safe blood transfusion cannot be ensured unless the quality of donors is
assured at the source. Blood donors recruited in lieu of payment would be
untruthful about their history of past ailments and sell blood by suppressing
their health status particularly when they should exclude themselves. A
global study has revealed that prevalence of infectious diseases in paid‘
donors’
is
higher
than
in
voluntary
donors.
Naturally,
incidence
of
transfusion transmitted infections from commercial* blood banks is higher
than those from non-profit making blood banks.
To ensure blood safety, a move towards a totally voluntary blood
donor service for all blood products has long been advocated at the
international level. As already indicated, under the directive of the Supreme
Court buying blood from blood sellers has been officially banned in India
from January 1, 1998.
But many transfusion centres or blood banks of the country, in view
of banning of buying blood from professional blood seller have switched
over to replacement donor system. They put the responsibility of bringing
donor for the blood bank on the patient or their friends/relatives instead of
going out to motivate and recruit voluntary blood donors. This has resulted
in patronisation of blood seller system where money is not officially paid at
the blood bank but unofficially outside the blood bank door by the patients’
relatives.
The most serious danger of family donor system is that the difficulties
described
above
may
create
entrepreneurial
opportunities
for
the
blood
sellers to pose as family surrogates, on payment in an organised manner.
Such systems have the ability to make the sellers dependent upon this
activity for their livelihood. The resulting deep corruption may be difficult
to eradicate, yet so dangerous to both the donor and the patient. The
professional donor is tempted to give blood too frequently; stories are
common of professional donors admitted to hospital in shock after several
donations in one day. Moreover, it is not possible to rely upon health history
[43]
information provided by the professional donor because such ‘donors’ often
come from economically and socially deprived sections of society. Therefore,
there is a greater likelihood that the ‘donor’ will be anaemic and in poor
general state of health. They will be less likely, out of financial need, to
reveal any medical condition.
In India, hospitals particularly specialised ones are in the metropolitan
cities or in state capitals. Rural people coming to these hospitals cannot
bring donors of required group with them. Naturally they fall prey to blood
sellers.
These blood sellers are poor people themselves who sell their blood
for want of money caring little for their own health. They suffer from various
ailments and are often drug addicts, alcoholics and carriers of blood
transmissible infections. Their only concern is to earn money. It makes no
difference to them whether the recipient suffers or dies because of the poor
quality of blood. They often sell their blood at short intervals in different
names to different blood banks. Often, their blood is poor in respect of
haemoglobin content in view of their frequent blood letting. They hoodwink
the haemoglobin test prior to donation in different ways such as by taking
iron tablets orally.
From the point of view of social values, buying and selling of human
blood is a positive insult to humanity and can be compared with trading in
human slavery. To the sick, counting days for a bag of blood, the community
has a moral and social responsibility. Refusal to donate blood when one is
fit to do so takes away one of one’s right to expect that somebody would
donate blood in time of one’s need.
There is another angle which must be emphasised.
not a merchandise; it is a collection of living human tissues
body the cells must be ‘fed’ to continue living). Trading in
organisms cannot be legally permitted. And blood cannot
market-mechanism. Awareness is also growing all over
requirement of ‘safe blood’ is an “entitlement” under
Rights” which cannot be denied to any individual.
In
Human blood is
(Outside a donor’s
such living human
be priced by the
the world that
universal “Human
some blood collection drives, donor-organisers lure donors by costly
gifts having monetary value. The gifts do not ensure real voluntary blood
donation. If enticements truly motivate people to donate blood, they have
the same potential danger as ‘selling’. It brings in people who are not
supposed to donate blood. Quality of blood collected from ‘donors’ with
enticements having monetary value does not ensure safe blood. Thus,
enticement serves no useful purpose. Instead, it adds the unnecessary.
[44]
costs and logistic complications. In a study at Kolkata it was revealed that
costly gifts attracted more first time donors, who had a higher prevalence of
viral blood transmissible infections but did not attract more repeat donors.
Regular donors feel insulted by such gift.
Real
non-remunerated
altruistic
voluntary
blood
donors
have
the
following advantages over the paid, replacement or directed donors:
• Voluntary donors are not under any pressure to donate blood and therefore would be
truthful about their health status.
• They would meet the natural criteria of low risk donors.
• They can be easily converted into regular voluntary donors.
• Regular voluntary donors are more likely to be free from transfusion transmitted
diseases. This is time tested.
• They would self exclude themselves whenever not fit to donate in view of their
education.
• These voluntary blood donors would easily respond to the call
for rare group donor or ‘on call’ emergency donors in view of
their high level of motivation and commitment to voluntary blood
donation.
Therefore,
elimination
of
commercialisation
in
blood
banking
can
ensure safe blood transfusion. The starting point is recruitment of voluntary
blood
donors
through
education
to
meet
the
national
need.
Through
awareness programmes common people should be motivated not to accept
blood from commercial blood banks. There should be no coercion to get
replacement donation. All government blood banks should provide blood
to private hospitals and nursing homes. Conviction, dedication, enthusiasm,
perseverance
among
the
donor
motivators
and
organisers
within
the
transfusion
service
or
from
outside
can
eliminate
the
commercialisation
in blood banking, of course, with adequate support from the government.
[45]
Blood Donor
Blood
India
donor base is the foundation of any blood transfusion system. In
any able-bodied individual between the age of 18 and 60 years
can donate blood upto 168 times.
After the historic directives of the Supreme Court officially, there is
theoretically no paid blood seller in India from January 1, 1998. So, at the
moment, blood donors are of two types:
• Voluntary Blood Donor
• Replacement Blood Donor.
Voluntary
Blood
Donor:
A
voluntary
blood
donor
donates
blood
out of his/her free will without expecting anything of monetary value from
the blood bank or patients” relatives or any other source at the time of
donation or in future.
Acceptance
of
voluntary
blood
donor’s
certificates,
badges
or
cards
is permissible according to the law of the land. Such recognition of donor is
universal.
Replacement
Blood
Donor:
Replacement
blood
donor
is
a
member
of the family or a friend of the patient who donates blood in replacement of
blood needed for the particular patient without involvement of any monetary
or other benefits from any source.
Normally, blood bank or transfusion centre provides the right group
of blood for the patient and replacement donor belonging to any other
blood group replaces the supply in quantity. But whenever blood is donated
by a relative donor for a particular patient, it is called Directed Donation.
Directed donation from relatives is not always safe. Husband’s blood given
to wife can lead to antibody formation causing problems to the foetus in
future. Blood from any blood relative such as father, mother, son, daughter,
brother, sister can lead to serious medical complications. Even for transfusion
transmitted infection, the close relation who had been socially pressurized
to donate, are at times not able to disclose their risky sexual behaviour.
Such donation should be avoided as far as possible to maintain ethical
code of anonymity between the donor and the recipient and to avoid many
future complications — social, legal, emotional.
It has been proved universally and accepted
non-profit blood is statistically less contaminated
obtained from commercial or other sources.
[46]
all
by
over the world that
diseases, than blood
So, in the days of blood communicable infections, which are often
fatal any ideal transfusion service should depend on real voluntary blood
donors recruited through education. In view of the city based health care
service in a predominantly agricultural country with a very low national
income, rural people coming to city based hospitals are unable to organize
replacement/relative donor to meet their blood need.
More than half the population of the country is medically fit to donate
blood. But 4 out of 1000 of the population in India are blood donors. So
the reasons for not donating blood should be studied by blood donor
motivators to convert the non-donor to donor.
The reasons for not donating blood are:
• Fear of the needle
• Fear of pain
• Fear of sight of blood
• Fear of future weakness
• Fear of possible ill effects
• Objection from the elders
• Apathy
• Indifference
• Social taboo
• Medical excuses
• Story of wastage of collected blood
• Ignorance and illiteracy
• Blood is sold at a high premium
• Inconvenience due to location and timing of blood collection
• Apprehension of post donation reaction
• Has never been asked personally.
Motivators should also know the reasons for
present microscopic minority. Reasons for donating blood are:
• Altruism
• Service to the community
• Sense of social duty
• Gaining experience
• Personal obligation
• Personal appeal
• Social pressure
• Group pressure
• For helping friends or relatives
• For blood donor credit card
• For recognition and awards
[47]
blood
donation
by
the
•
•
•
•
•
Checking up health
Reciprocity to pay back the social debt
For- knowing blood group
Seeing others donating blood
Celebrities appealing to donate blood.
Motivators should appreciate that in the materialistic
the donor has some expectations. Expectations are:
• Cordial reception
• Painless bleeding
• Clean and hygienic environment
• Blood group and credit card
• Proper utilisation of blood
• Availability of blood in later time of donor’s need
• Transparency of blood transfusion service.
world
of
today
It is well known that in the corner of every human heart there is a
desire to do good to others without causing any harm to oneself and be remembered for the
service,
therefore,
donors
and
non-donors
should
be
handled keeping in mind the eternal human psychology.
The donors have a right to know many things. Donor motivators
should equip themselves to satisfy the quest of the donor for knowledge
about blood and blood transfusion service, which includes basic blood
science, blood group, its inheritance, principles of selection of donors, blood
need of the state or region and present supply, procedure for procuring
blood from blood banks in time of need.
It should be borne in mind by the donor motivators that blood donors
are not mere numbers in statistics but are human beings in flesh and blood
and should be handled with tender loving care.
Blood donors are the ambassadors of blood transfusion service. They
can become donor-recruiters too, in course of time. The word of mouth
from blood donors may bring credit or discredit to any transfusion service.
Identifying Low-risk Donors
The
donor
recruiter
must
appreciate
that
to
ensure
safe
blood
transfusion, identifying and recruiting low-risk donors is absolutely essential.
Selection of low risk donors may be based on the following considerations:
1. Regular,
voluntary
non-remunerated
donors
or family replacement donors and commercial donors.
are
2. People who give blood under pressure or for payment are less
[48]
safer
than
family
likely to reveal
blood transfusion.
their
unsuitability
as
donors.
They
are
3. Potential donors may be unsuitable to give blood because of:
• their own poor health
• they are not giving blood voluntarily
• risk behaviour.
4. It is not possible to detect HIV antibodies
period’.
therefore
during
a
the
risk
to
‘window
5. HIV seroprevalence is generally higher in blood sellers and even
in the so called replacement or relative donors than amongst regular
voluntary donors.
6. Every
blood
transfusion
service
and
hospital
blood
bank
should
be aware of national criteria for identifying low risk donor groups and, therefore, potentially
safe
donors.
They
should
concentrate
on
finding
donors from amongst low risk groups by:
• Avoiding unsuitable donors
• Recruiting regular voluntary non-remunerated donors.
7. Potential donors who
are in poor health should
is only possible if potential
bank staff should always
confidential unit exclusion.
be maintained.
have engaged in high risk behaviour or who
be encouraged to self-exclude or self-defer. This
donors are made aware of risk behaviour .Blood
provide opportunities for donors to ask for
In such cases, strict confidentiality must always
8. Donors should be asked questions in
donors who approach blood banks should be deferred.
9. Considering history-taking
of units of blood is a great mistake.
as
a
[49]
barrier
a
private
in
area.
collecting
Result
seeking
large
number
Blood Donor Motivators
Toare motivate,
needed.
recruit, and retain voluntary blood donors, dedicated people
In whatever name we call them- donor motivator/donor
organiser/donor
recruiter/social
worker/donor
managertheir
need
is
great
for any transfusion service. They may work from within the transfusion
service or from outside, to extend their voluntary service as labour of love
individually or in an organised manner.
Anybody
having
empathy,
compassion
and
respect
for
the
ailing
patients in their quest for a new lease of life can become a donor recruiter
or
motivator.
He/she
should
be
appropriately
motivated
and
enthusiastic
enough regarding blood donation.
The donor recruiters may be of three types:
• Those who would like to organise blood donation camps in their
place of work or their locality once or twice a year.
• Those who would work as full-time staff within the transfusion
service.
• Those who would work closely with blood transfusion service as
honorary trained volunteers on their own of on behalf of any
social welfare organisation.
The tasks of donor motivators are:
• To
build
up
a
general
awareness
campaign
message
of
voluntary
blood
donation
deep
community.
• To recruit new donors and expand the donor base.
• To retain donors and make them regular donors.
• To organise outdoor blood donation camps.
• To maintain a panel of rare group and on call donors.
• To maintain liaison with donors, donor organization and blood
banks
• To assist in relieving emergency and shortage blood..
An effective donor motivator must
with good public relations skill and stamina.
be
a
blood
The following are considered as qualities of Donor Motivators.
• Compassion and Empathy
• Understanding
• Patience
• Polite and pleasant personality
[50]
and
spread
down
in
donor,
good
the
the
organizer
•
•
•
•
•
•
Imagination and Innovation
Enthusiasm
Strong motivation, conviction and dedication.
Knowledge of blood, donation and transfusion service
Competence in public relations
Communication skill.
The task of the donor motivator
service in:
• Donor recruitment
• Donor retention
• Donor recognition
• Donor counselling
• Organising camps
• Record keeping
• Planning IEC materials
• Evaluation of programmes launched.
would
be
to
assist
Knowledge of the land and the people, ability to
psychology of non-donors and knowledge of blood and
practice are essential for blood donor motivators.
blood
transfusion
understand the
blood banking
Motivators can develop themselves by self study or library work or
through observation in blood bank and blood donation camps. Those who
have neither time nor facilities to develop themselves may avail themselves
of the facilities of the structured workshop/training programme.
It is not difficult to develop faculty members for such training
programmes of any region through training and workshops by inducting
people from different disciplines, having good communication skill. They
should be blood donors and must have seen recruitment programme /
blood donation camps. They must have direct knowledge of local blood
bank (s) through visits and interaction. people from the field of bioscience,
social
science,
management
science,
transfusion
medicine,
blood
banking,
haematology,
pathology,
medicine,
surgery,
education,
journalism,
public
relations, theology, history, philosophy. literature may be groomed for this
work
through
orientation
programmes
and
teachers
guidebooks
prepared
by experts in the field.
After training, the motivators should be able to:
• Have an understanding of the basics of blood science and science
of blood donation.
• Gather correct information and facts about blood donation and
other related matter of the region.
[51]
• Learn the techniques of motivating people to donate blood.
• Earn
competence
in
conducting
motivational
meetings
organising blood donation camps.
• Develop skills in preparing materials for blood donor recruitment.
• Apply all knowledge and experience so gained for the cause.
They must acquire a good concept on the principles and strategies
donor recruitment appropriate for the region. They must be competent
answer all possible questions that may crop up in donor motivation sessions.
and
of
to
Curricula or the training modules have to be designed to meet all
these needs. Designing curriculum requires expertise. Each curriculum must
have clearly spelt out objectives and duration of the programme would
depend on the background of the trainees, their assimilation power and
depth of the content. All training modules should be evaluated and modified
with time to meet the need of the era.
Pretested training modules for blood donor motivators used by the
Association of Voluntary Blood Donors. West Bengal appended in the
annexure may be used for training of donor motivators. However, this is
just a guide line. This may be modified to suit the need of the trainees.
“A student acquires a quarter of his knowledge from his teacher, another
quarter from his own intelligence, the third quarter from his co-students
and the last quarter in course of time from experience”.
-MAHABHARATA
“Knowledge is not something to be packed away in some corner of our
brain, but what enters into our being, colours our emotion, haunts our soul,
and is as close to us as life itself”.
- Dr Saruapalli Radhakrishnan
[52]
Basic Blood Science for Motivators
is made up of minute elements
Blood
yellow fluid known as plasma. Each
called cells suspended in a pale
drop of blood contains primarily
three types of cells - about 250 million red corpuscles, 400, 000 white
corpuscles and 15 million platelets. Each of them plays a part in keeping
the body healthy.
Blood is red in colour. This red colour comes from red blood cells.
Those cells contain a substance called haemoglobin, a combination of iron
and other materials that give them the red colour. Haemoglobin makes it
possible for red cells to pick up oxygen from the lungs and to carry the
oxygen to all parts of the body. The trillions of cells that make up the body
need oxygen to survive. As such, the red blood cell distributes its load of
oxygen, it picks up carbon dioxide waste from the body cells and takes it to
the lungs to be breathed out. Red blood cells have no power to move on
their own. They must be pumped throughout the body in the blood stream.
The red cells are manufactured in the bone marrow of the larger bones of
the body. The red cells are continuously at work and they have an average
life span of 120 days. New ones are made constantly at a rate of millions
per second.
[53]
Blood carries Oxygen, Water and
Food to all cells
[53]
Old blood cells are sent to an organ called spleen, where they are
taken apart. The wastes are disposed of and iron is recycled to go into new
red blood cells. Certain food such as red meat, cereals and green vegetables
provide the body with iron. For donating blood one must have at least 12. 5
gm. of haemoglobin per 100 ml of blood.
There are several types of white blood cells. Together these cells provide
an active defence to protect the body when it is invaded by bacteria, viruses
or other harmful substances. 60 to 70 percent of the white cells have a very
simple mission. Their job is to attack and literally eat up bacteria and other
harmful substances. They are the body’s first line of defence against infection
and many illnesses.
Another very important group of white blood cells protect the body
against catching the same disease over and over again. These cells are
especially effective against many diseases that are caused by bacteria and
viruses.
Many common diseases, such as chickenpox, are caused by viruses.
The first time one of these diseases is caught, it triggers an immediate reaction
from these special white blood cells. They begin to produce a substance
called antibody meant to fight the virus. The antibodies are produced too
late to prevent the first occurrence of the disease. However, the antibodies
are stored away available to prevent the disease from occurring a second
time. A different type of specific antibody is produced for each type of virus
that causes disease.
The white blood cells use the blood stream as a highway in order to
rush to the site of an infection or illness. White cells are larger than red cells.
They also have the ability to change shape in order to pass through the
narrow twisting capillaries. White cells can get through some tight spots.
Pus formed is actually the dead bodies of white cells.
Platelets are tiny irregular shaped cells and. like red blood cells, are
made in the bone marrow. Platelets are sticky. They can and do stick to
each other and to the inner surfaces of blood vessels. When a blood vessel
cut or punctured, platelets begin to gather at the site of the injury. The
platelets stick to each other and to the edges of the injury, forming a plug
that reduces the loss of blood. As the plug gets bigger, it becomes more
solid and firm. It becomes a clot or scab, stopping the flow of blood and
providing a foundation upon which the healing process can take place.
The fluid part of blood called plasma carries all cells.
consists of plasma while cells constitutes 45% of the blood. Out of the 55%
[54]
55%
of
blood
of plasma, 92% is water. The balance 8% of plasma consists of proteins,
sugar, fats, vitamins and minerals that are needed by the body cells. In
addition,
plasma
contains
antibodies
and
hormones.
Hormones
are
chemical messengers that regulate growth, physical responses to emotions
and other body functions.
Circulation of Blood
Circulation is a movement, starting from a
the same point. To maintain the movement,
otherwise it becomes static, i. e.. circulation fails.
point
force
and
has
coming back to
to be applied,
BRAIN
PULMONARY
ARTERY
LUNGS
.
SUPERIOR
VENA
CAVA
RIGHT AURICLE-
PULMONARY
VEIN
AORTA
LEFT AURICLE
INFERIOR VENA CAVA
CAPILLARIES
RIGHT VENTRICLE
LEFT VENTRICLE
Circulation System in Human Body:
In the human body the smallest living unit is a cell. To live, it must be
fed and nourished. This process is achieved by blood. Irrespective of size,
shape, function and location of the cell, blood must reach each individual
cell. The bulk of the nutrients is derived from the food we take, which passes
from the intestines to the blood in a fashion which is readily utilisable by
the cell. For proper utilisation of the nutrient, another essential substance,
oxygen is required. This is also carried by blood. But as we do not eat
oxyen, the source of its supply is different. The source of supply of oxygen
is the lungs. We breathe in air containing oxygen and this oxygen passes
from the lungs to the blood, to be carried along with other nutrients to each
cell of the body.
[55]
While oxygen is being utilised by a cell, it gives out a waste productcarbon dioxide. This is a harmful product and must be thrown out of our
system. This process of throwing out is carried out by the lungs during
breathing. The vehicle of carriage from cells to lungs is blood.
Thus we see that blood, carrying nutrients, oxygen and carbon dioxide
must be continuously moving from cells to the lungs and back to cells again.
This is, therefore, circulation.
Nature wants that once blood gets its oxygen from the lungs, it should
not get mixed up with blood carrying carbon dioxide. So the human body
is provided with two distinctly separate set of channels. The set of channels
which carries oxygenated blood is called artery while another set which
carries blood rich in carbon dioxide is called vein (There are of course two
exceptions - pulmonary vein and pulmonary artery. The classical definition
is vessels carrying blood away from the heart are arteries and vessels carrying
blood towards the heart are veins. ). The arteries are linked to the veins by
very tiny vessels called capillaries which are invisible to the naked eye.
The movement of blood
by a pump, which is the heart.
through
the
arteries
and
veins
is
maintained
The Heart
As has been described, oxygenated blood and carbon-dioxide carrying
blood must not come in contact with each other, the construction of the
pump - the heart - conforms to this rule.
I 24 hours
heart pumps
out 36,000
litres of Blood
through a
distance of
20,000 km.
[56]
The heart is a muscular organ divided into two compartments – the
right and the left by a muscular partition. There is no connection (normally)
between the two compartments. The right side is meant to receive and
pump out venous blood and the left side is to receive and pump out
oxygenated blood. Each compartment is again divided into an upper and
lower chamber. Upper chamber of each compartment, called the atrium
(plural atria), is to receive blood and then push it into lower chamber called
ventricle. The opening in between the upper chamber and the lower
chambers is guarded by valves, so that when pumping action takes place,
the flow of blood remains unidirectional (one way traffic).
The right upper chamber receives venous blood from each cell from
the scalp to the toe. Once it is filled, it pumps its content into the right lower
chamber, which then pumps blood into the lungs to get rid of carbon dioxide
and to be oxygenated.
The left upper chamber receives oxygenated. blood from the lungs,
and this blood passes into the left lower chamber, which in turn pumps the
contents (oxygenated blood) out to reach every cell of the body.
Actually, therefore, the heart is a ‘2 pump’ organ.
The heart in a healthy adult beats (i. e., pumps) at the rate of about
72 per minute. At each beat it pumps out about 70 ml of blood. Through
its rhythmic contraction and dilation the heart maintains the circulation of
blood.
Distribution of oxygen by blood flow through the body
[57]
Blood Volume
The amount of blood content in any human body can be easily derived
from the empirical mathematical equations:
V (Men) - 0. 3669H3+0. 03219W+0. 604l
V(Women) = 0. 3561H3+ 03308W+0. 1833
Where, V is volume of blood in litre, H is height in metre and W is
body weight in kilogram. Since most of us know our height and weight, the
amount of blood stored in our body may easily be computed.
Computation from the above formula reveals that normally a healthy
man has roughly at least 76 ml of blood per kilogram of his body weight,
whereas this amount is 66 ml per kilogram of body weight in case of a
woman. Though blood content is generally proportional to body weight,
yet fat in the body account for much less quantity of blood. Body fat accounts
for only 11 to 22 ml of blood per kg whereas in other components of the
body it is about 92 ml per kg.
Blood Volume:
No harm in
Donating 8 ml.
of Blood per kg.
of Body Weight
Men
76ml.
per kg. of
Body
W i ht
Out of the total quantity of blood (76 ml/kg or 66 ml/kg as the case
may be] contained in the body, at best only 50 ml of blood per kg of body
weight in the circulation system is more than sufficient for performing normal
[58]
routine work. Hence, the automatic deduction is that men have 26 ml/kg
and women have 16 ml/kg, of blood in the circulation system as surplus or
factor of safety.
From this surplus, it has been scientifically established that if one slowly
parts with 8 ml of blood per kg. of one’s own body weight, no harm is done
to the body mechanism in any way. For donating blood in India one must
have a body weight 45 kg. or more.
Anybody having a body weight of 45 kg can donate 45x8=360 ml.
In India not more than 350 ml of blood is collected from a donor. Those
having higher body weight can donate more blood. But in a blood bank
storing different quantities of blood in different blood bags would cause
much problem at the time of distribution. So the quantity that can be collected
from a 45 Kg. body weight person can also be collected from persons having
higher body weight. For collecting 450 ml of blood it is desirable that the
donor should have at least 55 Kg body weight.
The liquid part of the donated blood is made up automatically within
2 days, and cells are completely replenished within 21 days. Still one is
allowed to donate blood not more than once in 90 days i.e., three months
after donation.
For recuperation of the donated blood, which is only a fraction of the
surplus amount, no additional nutritious food, rest or any medicine or tonic
is needed. Normal diet is sufficient to make up the donated blood.
Blood Group
The blood of all human beings can be grouped or classified on the
basis of presence or absence of particular chemical substances in the
envelope of the red blood cells (known as antigen). Chemical substance
present in the plasma (commonly know as antibody) interacts with the
antigen and if incompatible causes the red cell to agglutinate. The plasma
of a particular group will not contain any chemical substance which will
cause injury to the red ceils of the same group. To elucidate, in the plasma
of ‘A’ group blood, there will be no A’ cell destroying substance. On the
contrary it will contain ‘B’ cell destroying substance known as anti ‘B’.
Similarly, the plasma of ‘B’ group contains no anti ‘B’ but it contains anti
‘A’. The plasma of “0’ group contains both anti ‘A’ and anti ‘B’, while the
plasma of ‘AB’ group contains none. The whole thing may be represented
as follows:
[59]
Determination of Blood Groups
The presence of ‘A’ and ‘B’ antigen in the red cell membrane forms
the basis of determination of blood groups. Anti ‘A’ will be present in the
plasma of ‘B’ group individuals and anti ‘B’ will be present in the plasma of
‘A’ group individuals. Blood from a ‘A’ group and from a ‘B’ group individual
are allowed to clot. Afterwards the sera from the respective groups are
collected and marked ‘B’ and ‘A’ respectively. A drop or two of anti ‘A’ and
anti ‘B’ serum are placed on two different glass slides. 2 ml blood to be
tested for groups is drawn in a syringe containing 0. 4 ml of 3. 8% sodium
citrate solution and subsequently transferred to a container. A drop or two
of the blood is placed on each of the slides containing anti ‘A’ and anti ‘B’
sera and slightly tilted for mixing. Agglutination can be observed under the
microscope. The results interpreted on the basis of agglutination are as
follows;
If the red cells of the test blood are agglutinated by anti ‘A’ serum only,
then the blood belongs to group A: if agglutinated by anti ‘B’ serum only it
is group B; if agglutinated by both anti ‘A and anti ‘B’ it is AB group and if
no agglutination takes place it is O group. Now a days tube method is
preferred and mostly used.
The main significance of blood group is for the purpose
transfusion of compatible group. In other words. A group blood should be
[60]
of
blood
transfused to A group persons, B group blood to B group persons and so
on.
In
transfusion
reactions,
the
recipient
suffers
due
to
the
donor’s
incompatible red cells. In limited transfusion the plasma of the donor is
suitably diluted and, therefore, has negligible effect on the cells of the
recipient. So, in case of emergency. ‘O’ group blood can be transfused to
persons of any other group as the red cells of ‘O’ group devoid of both ‘A’
and “B’ antigens will not be affected by the recipients plasma. On the other
hand, the plasma of ‘O’ group, which contains both anti ‘A’ and anti ‘B’ will
not affect the red cells of the recipient much. So, ‘0’ group is called universal
donor. Similarly, ‘AB’ blood group which does not contain any antibody
its plasma and as such can receive blood in emergency from all other groups
and is. therefore, called universal recipient. The whole thing can be
represented as follows:
Who can Donate Blood to whom ?
Donor
Recipient
A
B
A
But in all normal
should be transfused.
cases,
right
group
of
blood
after
cross
matching
Cross
matching
and
compatibility
tests
discovered
by
Dr
Reuben
Ottenberg in the USA. match serum of blood of the recipient with cells of
blood of the donor and serum of blood of the donor with the cells of the
recipient.
Serum
means
plasma
minus
fibrinogen
(protein
present
in
plasma).
[61]
Rhesus factor or Rh factor
Nearly 40 years after the discovery of the ABO blood groups, another
type of blood group was discovered by Landsteiner and Wiener in 1940.
They noted that reaction occurred in a large percentage of population when
treated with antisera derived from rabbit or gunie pig immunised by red
cells of a small monkey Rhesus Macacus. This is due to the presence of a
different type of antigen in the envelope of the human red blood cells.
Those individuals who possess this antigen are called Rh positive and those
without it are grouped as Rh negative. But unlike ABO groups, the Rhesus
group has no naturally occurring antibody. For transfusion purpose this
factor should also be taken into consideration.
Besides these two different systems of grouping mentioned, human
red cells can be grouped by detecting the presence or absence of a host of
different chemical substances in their envelope. To name a few, they are
the Kell. Duffy, Kidd, MNSs. Lutheran, Lewis, Diego and Sutter systems.
These are not taken into much practical consideration for transfusion
purpose, but their importance lies mainly in anthropological and genetical
studies.
Why one should know one's own blood group
Depending on the group, the blood of one individual may or may
not be compatible with that of another. While it is generally known that the
blood group typing of the donor and the recipient is a must before blood
transfusion, there are everyday life situations in which we need to know
our own blood group.
Before marriage, it is advisable to check the blood group and Rh type
of the couple. In case the Rh type of the bride is negative and the groom is
positive, special care of the would-be-mother and the foetus is needed.
Lack of prior knowledge of the blood type in such cases can lead to stillbirth or toxic conditions, resulting in loss of life.
In pregnancy, the would-be-mother's blood group must be checked.
During or after delivery, she may require blood transfusion, depending on
the extent of blood loss.
In the increasing pace of life, commuting day-to-day is becoming more
and more risky. Accident rate has increased, one can meet with an accident
whether one is driving a car or travelling in a public vehicle or even walking.
In such an emergency, every minute counts. A prior knowledge of the blood
group can save time and save a life.
[62]
Inheritance of Blood Group
All our features and characteristics are controlled by genes which exist
as the basic units of inheritance within our living body cells. These genes
are, carried by chromosome - a thread like structure, present in the nucleus
of living cells. Each gene has its own place in a particular chromosome and
is responsible for a particular characteristic ranging from the colour of the
eyes, hair to blood groups.
Every cell - with the exception of reproductive cells (sperm and ova)
- has 23 pairs of chromosomes, altogether 46, inheriting one set from each
of the parents. Of these, 22 have been given numbers 1-22 and are called
'autosomes'. The-23rd pair consists of the sex chromosomes: X and Y The
sexes are determined by females having two X chromosomes and males
one X and one Y chromosome. The sperms and eggs (ova) have only half
the number of chromosomes, one of each pair. During fertilisation, each
parent, therefore, contributes half of each pair in the cells of the resulting
embryo.
Amongst our inherited characteristics there is a gene in chromosome
No. 9 responsible for the specificity of our ABO blood group and another
gene in chromosome No. 1
responsible for Rh factor. In
other words, we inherit two
blood group genes, one from
each parent. For the ABO
blood groups, chromosome
from the mother carries one of
A, B or O gene. Similarly, the
other chromosome from the
father carries one of A, B or 0
gene.
A and B genes are
dominant over the O gene. O
is recessive gene. Thus a child
inheriting A from father and 0
from mother would be AO i. e.
A group. Similarly by inheriting
A from father and A from
mother the child will be AA i. e.
A group. The AO or AA is
called Genotype and A is called
phenotype. The genes inherited
[63]
from each parent which are present on the chromosomes are called genotype
and observable effect of the inherited genes i. e. the blood group itself is called
phenotype. The table shows the possible combinations of genes and the blood
groups they confer,
Genotypes
Phenotype
(Blood Group)
AB
AB
AA,AO
A
BB,BO
B
OO
The Rh system, unlike the ABO system, has six genes called c, C. d, D,
e, E. The genes travel in sets of three, with one set being received from each
parent. But it is the presence or absence of the D gene that determines Rh
positive or Rh negative. If
the child inherits d from
father and d from mother
then and only then the
child can be Rh negative,
although the parents are
positive with Dd, Dd
combinations. But the
child of Rh negative father
(dd) and Rh negative
mother (dd) must be Rh
negative.
83% of the world
population are Rh
positive and in the Indian
population 97% are Rh
positive.
I
n
h
e
r
i
t
a
Inheritance of the Rhesus factor
[64]
Indications of Blood Transfusion
T
ransfusion of whole blood from one individual to another is indicated
for two main reasons: firstly, when the volume of blood within the
circulation system of the patient is less than that required to sustain life and,
secondly, when the red blood cells are deficient either in quantity or quality.
If we have insufficient red cells, or if our red cells are abnormal, there will
not be enough haemoglobin to maintain the body efficiently and we are
then said to be anaemic.
Blood loss through accident, surgery, or haemorrhage at childbirth,
or from such a condition as the bleeding of a stomach ulcer, may reduce
the amount of circulating fluid in our bodies below safe limits and we may
die unless this loss is speedily replaced.
Blood Supply from Govt. Blood Banks [100% ]
Emergency
Situation [17%]
Post -operation Bleeding [9%]
N=10000
Non Emergency
Situation [83%]
Planned Surgery
[35%]
Obstetric Emergency including
exchange transfusion [6%]
Obstretie & Gynaecological
Cases[13%]
Road and industrial
Accident [1%]
General Surgery including
Tumour & Cancer [14%]
Burn. Case [ 0. 7%]
Malena[0. 3]
Cardiac and Thoracic.
Surgey [3%]
Orthopaedic Surgery
Haematological Case
[48%]
Thalassemia [20%]
Severe Anaemia [15%]
Leukaemia [7%]
Haemophilia [6%]
A study by AVBDWB at Kolkata
Indications of blood transfusion can be summed up as:
• Anaemia
• Major Surgical Operation
• Accidents resulting in considerable blood loss
[65]
• Cancer patients requiring therapy
• Women in childbirth and newborn babies in certain cases
• Patients of hereditary disorders like Haemophilia and
Thalassaemia
• Severe burn victims.
Components
In addition to being used as whole blood, blood can be separated into
its components: red cells, white cells, platelets, plasma, cryoprecipitate which
are used to treat certain conditions. One of the components, plasma, can be
further subdivided by chemical procedures into its constituent parts, the socalled (plasma fractions] anti-hoemophilic factor concentrate, immuno
globulins, plasma protein fraction and albumin etc.
BLOOD COMPONENTS
1 unit =
whole blood
Red Blood Cells
Platelets
Plasma
Cryoprecipitate
Main blood
products that can
be prepared from
one whole blood
unit: Red Blood
Cells, Plasma,
Platelets and
Cryoprecipitate.
Transfusion of whole blood has long been a well-recognised life saver
during and after major surgery and where there has been massive loss of
blood in an accident or in childbirth. There are, however, various conditions
which do not need whole blood replacement. For example, chronic anaemic
condition requires transfusion of only the red cells of blood, Indeed,
transfusion of unnecessary plasma may be harmful if the patient has a
weak heart. Separation of red cells from plasma can be achieved either by
allowing the container in which the blood is collected to stand for some
hours during which the red cells will separate themselves from the plasma
by gravity, or by spinning the container in a centrifuge, a machine which
spins the container around a central axis. Adjustment of the number of
revolutions per minute and the duration of spinning allow the different
cells, e. g. red cells and blood platelets, to be separated from each other.
Platelet transfusion
These cells circulate in the body with the red and white cells and play
an important role in the clotting process of the blood. Transfusion of platelets
separated from several units of blood is now an important part of the
treatment of platelet deficiency.
[66]
White cell transfusion
It is now established that successful transfusion of white cells can
assist patients to combat infections when, as it sometimes happens in certain
blood diseases, the patients' body is unable to produce its own white cells,
These transfusions involve the use of specialised techniques and cell
separation equipment. It is not possible to collect sufficient white cells through
conventional blood donation.
plasma and albumin
Plasma Protein Fraction (PPF) is a clear fluid containing approximately 5% albumin. This is an end-product of plasma fractionation, it is
widely used for the treatment of surgical shock and burns or, in remote
areas, to maintain the volume of fluid in the circulation until a patient can
be removed to a hospital with full transfusion facilities, or until compatible
blood can be provided. Thus, it is extremely valuable in small hospitals and
to ships, which traditionally carried dried plasma (which has now been largely
succeeded by PPF). A more concentrated solution of albumin, about 20
per cent, is also available.
Fresh Frozen Plasma
Fresh Frozen Plasma (FFP) is prepared from freshly collected blood
by spinning it in a centrifuge. On separation, the plasma is immediately
deep frozen and stored at minus 40°C. FFP contains all the proteins required
for normal clotting of blood, and is commonly used in clotting factor
deficiency usually caused by liver diseases.
Cryoprecipitate
This is prepared from Fresh Frozen Plasma by allowing it to thaw
under conditions so adjusted that the Factor VIll settles out as a solid
substance or precipitate. This can be separated by removal of the greater
part of the thawed plasma after spinning in a centrifuge, and then deep
frozen in packs. Cryoprecipitate also contains fibrinogen, another protein
essential for normal clotting of blood. In some conditions, this disappears
temporarily from blood and bleeding ensues. Transfusion of cryoprecipitate
rapidly corrects the deficiency of fibrinogen and stops the bleeding. It can
stored for one year at minus 40°C.
factor VIII Concentrate
This preparation has certain advantages over cryoprecipitate for the
treatment of haemophiliacs. In particular, it enables them to be treated at
It is also convenient for the control of bleeding when they
undergo major surgery. This concentrate is prepared by fractionation of
[67]
Immunoglobulins
These are substances carrying the antibodies which the body forms to
protect itself against infectious diseases and foreign materials
Immunoglobulins separated from the blood of healthy adults are valuable
in preventing or attenuating certain infectious diseases such as measles
and hepatitis. The blood of certain persons may contain particularly large
amounts of one antibody for example, antibody against chicken pox or
antibody against Rhesus factor D. The immunoglobulin prepared from such
blood will contain high level of the antibody and is called, for example,
anti-chicken pox immunoglobulin, or anti D immunoglobulin. Such specific
immunoglobulins are of great value, particularly in case of Rhesus
incompatibility between father and mother, which may lead to the birth of
a child affected with haemolytic disease, the mother at risk can be sensitised
with anti D immunoglobulins.
Autologous Blood Transfusion
In autologous blood transfusion, the patient serves as one's own blood
donor. The underlying principle is that one's own blood will certainly be
compatible and will not contain extraneous transmissible infections. The
assumption is that 'one's own blood is the safest blood. ' This is true, but it
should not be assumed that autologous blood can be used indiscriminately.
Even autologous blood should be transfused only when absolutely needed.
There are three basic forms of autologous blood use:
• pre -deposit
a) prior to planned (elective) surgery
b) long-term (frozen) storage
• pre-surgical haemodilution
• Intraoperative blood salvage.
Autologous Blood Collection Prior to Planned Surgery
Persons who require surgery, but are otherwise in good health and
able to donate blood safely, may reasonably donate blood for themselves
prior to surgery. It is generally possible for a patient to donate 2 to 6 units o
blood in this way, within a period of 2 to 4 weeks. A slight fall in haemoglobin
level (not below llg-l00ml) is acceptable. Prescription of iron supplement,
is usual which generally prevents the development of significant anaemic
Some centres treat such patients with erythropoietin (EPO), a powerfu
hormone drug which stimulates the production of red blood cells in the
bone marrow. The use of EPO in autologous donor/patients is stil
controversial because of the cost and the possibility of side-effects such a:
thrombosis.
[68]
Autologous donation has become well established in preparation for
certain orthopaedic procedures which are likely to require blood transfusion
(e. g- spinal fusion) and has been widely used in plastic surgery. More
controversial, but also widely practised, is the collection of autologous blood
prior to cardiac surgery or caesarean section. Some industrial and advanced
countries have active autologous transfusion programmes for paediatric
patients; others accept patients of any age (including above 90 years),
regardless of cardiac status. There are concerns about the potential risk of
such aggressive programmes.
Indications for Autologous Donation
Generally accepted
• Surgery will be required in the next 2 to 4 weeks
• Patient can safely donate blood
• Patient is likely to need blood during surgery
• Patient is willing to undergo autologous donation
Controversial
• Pregnancy
• Myocardial ischaemia, cardiac arrhythmias, cardiac insufficiency
• Children
• Donation of just one unit of blood
• Blood is not likely to be needed during surgery
Not acceptable
• Risk of bacterial contamination of donated blood
• Haemoglobin level less than llgm/100 ml.
Apheresis Donation
'Apheresis' refers to a type of donation in which the desired
component is selectively withdrawn from the donor while residual parts of
the blood are transfused back to the donor during the blood collection
process itself. Apheresis techniques are most commonly used to obtain
plasma and platelets. The principal factor limiting the amount of blood that
can be collected from a donor is the slow replacement of red cells after
donation. By returning the red cells to the donor, it becomes possible to
collect much larger amounts of plasma, platelets, leukocytes. Apheresis may
be applied therapeutically (therapeutic apheresis) as well as to obtain
Products for transfusion.
[69]
Plasmapheresis
Plasmapheresis is useful in three distinct situations:
• if the donor has some specific plasma factor which is required
(e. g., rare or valuable antibody).
• to obtain plasma products for regular patients from highly selected
donors;
• to obtain plasma for fractionation into specific derivatives (e. g.,
albumin, immunoglobulin, blood coagulation factors).
Establishment of a volunteer donor plasmapheresis programme is a
major decision. It is possible to develop large-scale programmes of this
type, as has been demonstrated dramatically in Belgium. Many other
countries have smaller but growing programme of this kind, for example
Canada, France and England. The decision to initiate such a programme
cannot be taken lightly because it requires a huge expansion in facilities,
investment in cell separators, training of staff and complete reorganisation
of the way the donors are recruited and organised.
Cytapheresis
Cytapheresis. or selective removal of specific cells like platelets, white
cells etc. from the donor, while returning red cells and plasma with the help
of machine known as cell separator. In case of platelet pheresis. sufficient
platelets can be removed from a single donor in less than two hours to
provide all the platelet needed for one patient. Naturally the donor has to
stay in blood bank for longer hours. This also needs motivation. The donor
recruiters have to be prepared to meet such requirement.
Voluntary Blood donor
Patient
Whole Blood
CENTRIFUGING
Pached Red Cells
plasma
CENTRIFUGING
Platelets
Plasma
FREEZING AND THAWlNG
Cryoprecipltata
Plasma
SERUM LABORATORIES
[70]
Hereditary Blood Disorders
T
halassemia and Haemophilia are hereditary blood disorders requiring
blood or blood product transfusion at regular intervals. There is no
permanent cure as yet. Life is only prolonged by blood transfusion.
Thalassaemia is a hereditary disorder, a kind of anaemia, characterised
by a deficiency of normal haemoglobin. The disorder is also known as
Cooley's anaemia. Mediterranean anaemia or Hereditary leptocytosis.
Modern research has revealed that there are various types of thalassaemia.
but the more prevalent is the homozygous beta thalassaemia, commonly
known as thalassaemia major. Clinical symptoms of the disease are observed
a few months after birth. These include anaemia, and later enlargement of
spleen and liver. At about the age of four, stunted physical growth is seen
accompanied by abnormally projecting upper jaws and prominent cheek
bones. Bone marrow expansion takes place in the long bones, ribs and
vertebrae and the bones become brittle leading to fracture easily. With
blood transfusion therapy and desferal, the lives of affected persons may
be prolonged.
Inheritance of Thalassaemia
A new life starts by the union of a male gamete (sperm) and a female
gamete (egg or ovum). Each chromosome has several active regions called
genes carrying the coded message for the synthesis of a particular
substance. As the chromosomes are in pairs, the corresponding genes
also appear in pairs. In normal persons, both the genes of a particular pair
are normal, i. e. they carry the message for synthesising normal
haemoglobin. But in some persons, one of the genes in the pair is normal
and the other thalassaemic. This person is said to be a carrier or thalassaemia
minor. The carrier person may be either male or female and has no apparent
outward symptoms. When marriage takes place between two such carriers,
then there is a 25% chance of their offsprings inheriting thalassaemia major.
On the other hand, if one partner is normal and the other as carrier, then
their offsprings will not be affected by thalassaemia major, but there is chance
of 50% of their offsprings being carriers.
Treatment and Prevention of Thalassaemia
The lives of persons affected by this disorder may be prolonged by
regular transfusion of normal blood, at an interval of three or four weeks.
But blood transfusion alone is not sufficient treatment, for repeated
transfusion tends to accumulate excess iron in the body, which affects the
vital organs like liver, heart, etc. So, along with blood transfusion, the excess
[71]
iron has to be removed. This is done by slowly pumping a drug called Desferal
under the skin from a small pump.
But the best way of preventing the occurrence of the disease is to
know before marriage whether both the partners are carriers or not. This
can be done by performing a simple blood test, and if both the partners are
found to be carriers, then such marriages should be discouraged or partners
may be persuaded not to bear any child. Diagnosis is also possible during
antenatal period which allows a choice for medical termination of pregnancy.
Haemophilia
Haemophilia, an inherited genetic disorder linked to the sex
chromosome, is characterised by a marked increase in the coagulation
time of human blood. The disease is transmitted by carrier females, who
herself shows no symptoms, but the disease is manifested only in the male
offspring. The blood is a fluid when, it flows through blood vessels, but
clots when it comes out of the body. The blood of normal person clots in 5
to 10 minutes, while the blood of persons affected by haemophilia may
[72]
take 1-12 hours for clotting. The chemistry of blood coagulation involves an
interaction of several factors and if any one factor is deficient or lacking, the
coagulation time is prolonged markedly. In haemophilia, a normal plasma
thromboplastin factor, which is essential for satisfactory thrombin (another
essential factor for blood coagulation) formation, is missing. This plasma
thromboplastin factor is a kind of globulin protein which is called Anti
Haemophilic Globulin (AHG). It is also known as Factor-VIII.
Inheritance of Haemophilia
As explained earlier, sex chromosomes of females are XX and in males
these are XY. The gene carrying the coded message of synthesizing the
Anti- Haemophilic Globulin (Factor-VIII) is located in the 'X'- chromosome.
In normal females both the 'X'-chromosomes have normal genes and in
normal males one 'X'-chromosome present has normal gene. But in the
carrier females, one of the'X'-chromosomes bears the normal gene while
the other is haemophilic i.e., it lacks the normal gene. Now, when a female
gamete (egg) with haemophilic gene on its 'X'-chromosome unites with a
male gamete (sperm) having normal 'X'-chromosome, the resulting offspring
will be a carrier daughter. These carriers have no problem with dotting of
their blood, since they possess one normal 'X'-chromosome which is capable
of producing sufficient quantity of Factor VIII required for blood clotting.
But when a haemophilic egg unites with a sperm containing 'Y'
chromosome, the resulting offspring will be a son. This son will be
haemophilic, for it has no normal 'X' chromosome to produce Factor VIII.
As the defective gene is located in the sex chromosome, it is called sexlinked genetic disease. Such patients would need cryoprecipitate or factor
VIII throughout the life at regular intervals.
Part of the family tree of Queen Victoria
[73]
Rhesus Babies (Haemolytic Disease of Newborn)
If the father is Rh positive and the mother is Rh negative, the child can
be Rh negative like mother or Rh positive like father. If the child is Rh negative
like mother, there would not be any problem. If the child is positive like
father then there can be problem, if not in first pregnancy but in subsequent
pregnancies unless taken care of after the first delivery. About one child in
900 may be born as a 'Rhesus baby'
Before delivery, blood may leak from the child in the womb into the
circulation of the mother. Mother's defence mechanism is alerted with the
entry of this 'foreign body'. She starts producing anti Rh positive antibody
to destroy the invading Rh positive red cells. The antibodies remain in her
blood for a few months after the delivery and may then disappear. But she
is now permanently sensitised and if Rh positive cells enter into her
circulation again at the time of a subsequent pregnancy she will respond
after 72 hours by making anti Rh positive antibodies in a large scale, which
passes into the baby in the womb and attack its red cells. Red cells of the
baby are destroyed and release a pigment yellow in colour. The baby may
die in the womb or is bom with Haemolytic Diseases of the Newborn (HDN).
[74]
To save the life of such babies exchange transfusion is needed.
Exchange transfusion is the gradual removal of the baby's blood and
its replacement by O Rh negative or mother's group specific negative blood.
This blood for such transfusion should not be more than five days old.
Now a days Anti Rh positive antibody (a protein called immunoglobulin present in the plasma of the people sensitised to Rh factor) is refined,
and concentrated and injected to Rh negative mother within 60 hours of
her giving birth to a Rh positive first issue. It has the effect of causing any
Rh positive cells which have passed from the baby's to the mother's
circulation to be neutralised in her blood. Rh negative mothers treated in
this way do not become sensitised unless a large number of red cells have
passed from the child to the mother. However, once a mother has become
sensitised and has formed Rh antibodies, there is no method of removing
them. This injection is administered only to Rh negative mothers who are
not already sensitised and must be repeated at each pregnancy if the baby
is Rh positive. It is of no value to already sensitised mothers since the leakage
of blood from the child in the womb to the mother takes place at the last
stage of the pregnancy. Often the child is taken out a few weeks before the
full term by caesarian section to prevent complication.
It is prudent to advise the family to organise one or two of O negative
or mother's group specific negative donor well in advance before the
scheduled date of delivery. If the situation warrants, these donors may be
called upon to donate blood for exchange transfusion to the newborn. A
timely action in such a case makes the difference between life and death.
"Science may have found a cure for most evils, but it has found no
remedy for the worst of them all — the apathy of human beings".
— Helen Keller
[75]
Transfusion Transmitted Infections
M
alaria. Hepatitis (B&C), Syphilis, AIDS are considered as transmissible
infections associated with blood transfusion. According to law all these
tests are to be conducted after blood collection. It is not pragmatic to conduct
these tests before blood collection as donors have to come twice, to suffer
the needle pricks and may have to wait for quite some time. As a result,
transfusion service may lose donors. So, donor selection can be on the basis
of history of past ailments. After donation laboratory testing of blood should
be undertaken in the blood bank.
Presently, a sensitive screening test for malaria is not available. The
most effective way of screening donors is to take the proper case history of
malaria and of fever that could be due to malaria. Donor selection criteria
should be designed to exclude potentially infectious individuals from
donating blood. However, available slide test for malarial parasites is
mandatory according to the rules now in force in the country.
To reduce the occurrence of post transfusion hepatitis, it is essential
to screen all blood donors for hepatitis B surface antigen, by the most
sensitive and specific tests. Results may be made known to the donor with
an advice to contact family physician for guidance.
Hepatitis C can also be transmitted through blood transfusion. HCV
antibody testing has become mandatory from June 2001 in India.
Serum samples from all blood units must be selected for Venereal
Disease Research Laboratory (VDRL) test before transfusion to detect
syphilis. Any unit found positive should be discarded. But if blood is kept in
cold room for three days, then there is no chance of contracting syphilis by
transfusion of such blood as these germs become ineffective in cold.
For transfusion safety, each and every unit of blood donated should
be tested by combined HIV/1 and HIV/2 assay using ELJSA reader. This is
just a screening test, and not a confirmatory test. Blood should be discarded
if the test gives positive results but the donor should not be informed and
should not be identified as HIV positive or AIDS patient. Strict confidentiality
should be maintained. In smaller blood banks or in cases of emergency,
rapid spot tests can be done to reduce the possibility of HIV/AIDS infection
due to transfusion. But all these tests are not full proof. These are indirect
tests to trace the antibody formed caused by the entry of foreign body from
outside. Body mechanism takes time to produce antibody to fight against
entry of germs from outside. There is a time lag between the entry of germs
[76]
and formation of antibody known as window period. The tests are ineffective
during this window period. Motivators should, therefore, attach due
importance not only to the truthful declaration of the donors but also to the
pre-donation counselling for self exclusion to ensure safe blood transfusion.
The confirmatory tests for HIV infection include Western Blot test and
Immunofluorescence tests. These tests cannot be done in the blood banks
due to high cost, time and expertise required.
It has been observed that blood collected from genuine voluntary
donors recruited through education based motivation are much safer and
are very rarely to be discarded on the basis of the above mentioned screening
tests.
[77]
Donor Selection
A
ll intending donors have to be screened before they are actually
permitted to donate blood. This ensures safety of both the donors and
the recipients.
Donor screening has three primary objectives. Firstly, to ensure that
the donor's blood has such qualitative standards as to be useful to the
recipient. For instance, if a red cell suspension is to be transfused to a patient
having severe anaemia, it is necessary to establish that the donor's blood
has the requisite haemoglobin level to fulfil the purpose of transfusion.
Secondly, screening of the donor is required to ensure that the recipient
does not have any harmful reaction after the transfusion of the donor's
blood, owing to offending agents being present in the donor. Thirdly, donorscreening also ensures that the donor does not come to any harm for the
benevolent act. Donor safety is as much a concern of the blood banker as is
the question of welfare of the recipient.
With these objects in mind, donor-screening has to be undertaken in
all blood donation camps as a necessary prerequisite before the actual
blood donation. A trained social worker or a technician should be able to
handle most of the work involved in this regard. However, it must be made
clear that all blood donation camps must function under a medical officer,
whose responsibility is to safeguard all interests of both the donor and the
recipient, and that the medical officer of the camp must be the final authority
for deferring or accepting a donor.
Donor-screening is undertaken by (a) recording of personal particulars
and history of past ailments and (b) physical examination of the donor by
the medical officer.
Selection Criteria
General:
The decision as to whether an individual is suitable for blood donation
is based upon certain general criteria and upon the donor's health history,
physical examination and tests done prior to donation. This decision is
made before donation at the donation site. Some transfusion service
personnel prefer to use a predetermination system on the day before the
donation. However, there are two major disadvantages of this approach:
a) it is inconvenient for the donor, involving the expenditure of time and
travel on two different days; b) explaining a disqualification to the donor is
[78]
made more difficult and prone to breach of confidentiality. For these reasons
screening on the previous day is generally not recommended, though there
is a valid argument for using such pre-screening for new (first-time) donors.
General information to be obtained from all donors should include
the following:
Name, address, telephone number, office address, employer, etc
The necessity to identity and trace donors requires that all donors
provide standard identifying information. This basic information is essential
for follow-up, retention of the donor and for accurate maintenance of
donation records, in situations where a donor who has been permanently
disqualified, but for some reason attempts to donate again, accurate identifying information permits recognition of the unsuitability.
Date of last donation
Rules for frequency of donation vary from country to country;
some stipulate the maximum number of donations per year while
others spell out the minimum interval between donations. Some set
different criteria for men and women. Whole blood donation must be
restricted because the iron lost in a blood donation is not restored quickly
from the diet. Frequency of whole blood donation should not be more
than 4 times in a year.
Date of birth (and age)
This information serves to ensure that donors are not too young or
too old to donate. Accuracy can be confirmed by matching stated age with
date of birth. This information can also serve to confirm the donor's identity
in situations where there may be more than one donor with the same name.
The minimum age for donation is 18 years. It is legally the age of
consent in India at which young people can reasonably be expected to be
sufficiently matured to decide to be blood donors.
Occupation
It is better to know the occupation of the donor, to enable the doctor
to instruct the donor on taking certain precautions applicable for those in
hazardous professions, like flying, long distance driving and so on.
Time of Last Meal
All donors must be asked about the time when the donor took the
last meal (major or minor), and about activities during the last two hours or
so. The idea of such queries is to ensure that the donor has not been starving
for more than 4 hours or that the donor has not been exposed to undue
[79]
exertions, sweating or dehydration. This situation particularly applies to
suburban donors attending blood donation camps in the city, or for people
starving voluntarily for religious or other reasons (Mohammedans during
Ramzan month, or certain Hindus during Navaratri or other religious
festivals).
History-taking
(i) Only for Lady donors
The relevant queries should be made by a lady-worker or by a lady
doctor or a lady volunteer from the organisation of the collection drive.
Suitable questions are to be asked about the menstrual and obstetric history
of the donor.
(ii) For ail donors (including ladies)
History taking concerns elimination of certain transmissible infections
in the donor. Some donors may understand what malaria or jaundice is,
but not all donors are expected to be knowledgable enough. For the latter
category, specific question is to be asked for elimination of malaria. "Did
you ever have fever, periodically (on alternate days or the like), with chill
and shivering?" Whenever the reply is in the affirmative or is uncertain,
suitable notes are to be made in the screening form, to enable the blood
bank to undertake special tests. Donors with history of repeated attacks of
malaria are to be deferred. Those that had a single attack, and were cured
after due treatment, may be accepted after a lapse of three months from
the last attack. Regarding jaundice, similarly, the question would be: "Did
you ever have yellow discolouration of the eyes, accompanied by high
coloured urine, and loss of appetite?" Donors with such history are not to
be accepted within one year of illness. All such cases are to be referred to
the medical officer. Another transmissible infection for which the donor
must always be specifically screened is syphilis. It is preferable, however,
that the donor is not asked directly about such illness, unless it is volunteered
by the donor spontaneously. Such screening is done by later post-donation
laboratory tests.
The donor has also to be asked about any major illnesses like
typhoid, malaria (during the last three months) or about any major surgery
or bleeding illnesses (like piles) during the last six months. Such illness would
lead to deferral of the donor. Donors receiving immunisation against viral
diseases (like rabies, yellow fever etc.) or having suffered from any viral
disease during the past one month or so are unacceptable. History of drug
use of the donor is important for people who are under heavy antibiotic
therapy, cortio-steriods (patients of bronchial asthma or skin diseases).
[80]
and antidiabetic drugs. These donors are to be deferred also. However,
symptom free diabetic, not under drug therapy, are acceptable as donors.
Donors giving history of allergic states (bronchial asthma, eczema, persons
with history of skin rash after ingestion of certain food stuff) should be
avoided. History of epilepsy, particularly in young adults, disqualifies the
donor.
There is yet another issue of tuberculosis of the donor. If the disease is
active, the donor should be deferred outright. History of tuberculosis in past
years has to be judged critically before deferring the donor. A donor who
had tuberculosis, and has since been cured, is acceptable. Such acceptance
must necessarily be at the discretion of the medical officer only, who may
ask for radiological and laboratory evidence of the cure.
History taking should be followed by a physical examination of the
donor. Such examination must include weight check. The medical officer
should undertake the general examination of heart, lungs, blood pressure
etc. and decide on the acceptability or otherwise of the "donor on the basis
of such examination, in collaboration with the history sheet, which is usually
filled up by social workers.
All these apart, the donor is screened by way of some laboratory
tests. Estimation of the haemoglobin level is done before the actual donation.
This is done by collecting a drop of the donor blood in a pasteur pipette
and dropping it freely into a solution of copper sulphate (the specific gravity
of which is 1053) from a height of one cm. If the drop, after the initial
momentum of the fall, floats up eventually, it indicates that the donor has a
haemoglobin level less than 12.5 gm/100 ml, and is unacceptable as a donor.
If, on the other hand, the drop sinks into the solution, the donor is all right
and acceptable. It has to be made clear that this method of estimating
haemoglobin level is crude, and rather inaccurate. However, it has the
time honoured sanction, because of its simplicity, quickness and low cost.
To be effective, the blood bank worker must ensure that the copper sulphate
solution is fresh, and is replenished after every 30 tests, or so. Unless this is
done, the specific gravity of the solution will go down significantly, and
blood drops from donors with haemoglobin levels below 12.5 gm/100 ml,
will sink to the bottom of the solution, thus causing acceptance of unsuitable
donors. The disposable piercing needle is required to be used once only to
avoid transmission of infection in consecutive donors.
The emergence of HIV/AIDS has revealed another type of donor
population which must be excluded. Persons predisposed to sexually
transmitted diseases are not safe blood donors and must be excluded. This
is difficult because sexual practices are a sensitive and private matter and
[81]
sexually unsafe persons are not segregated or easily recognisable. It has
become clear that male homosexuality is incompatible with safe blood
donation, that prostitution and indiscriminate heterosexual activity facilitate
the transmission of syphilis, hepatitis and HIV/AIDS. Intravenous drug abuse
is a potent source of infection within groups who are sharing injection needles
Furthermore, the recipients of unsafe blood products, most notably regular
transfusion recipients like people with haemophilia and thalassaemia, also
including certain recipients of sporadic transfusions, are more than usually
liable to transmit dangerous infections to others. All of the above are
unsuitable blood donors and must be excluded from blood donation. The
same is true of their sexual partners.
Individuals whose risk factors require exclusion from donation:
• Homosexuals
• Prostitutes
• People having multiple Sex partners
• Intravenous drug abusers (particularly multiple-use of needles)
• People with haemophilia or thalassaemia
• Sexual partners of any of the above.
Techniques for identifying and excluding high risk persons:
• Direct questioning, including specific questions about sexual
practices or by circulating information sheet.
• Physical examination, including a search for stigmata puncture
marks of drug abuse by syringe,
• Facilitation of self-exclusion by those at risk, by providing explicit
written information to all donors in a confidential way to inform
the Blood Transfusion Service that the donated blood should
not be used for transfusion, and confidential procedure at the
time of donation informing all individuals known to be specifically
• at risk that they should not donate blood.
• Maintaining confidential data concerning persons who have been
permanently excluded from blood donation (donor deferral
register).
• Discouragement of persons tempted to give blood so as to obtain
results of blood tests.
Notwithstanding the generality of the standards mentioned above,
each donor is to be assessed for acceptance or otherwise, in his or her own
merit, and that, the final decision must lie with the medical officer of the
blood bank, who would be held responsible. Translated into other form, it
may be said that while it remains the duty of the citizen to volunteer to
donate blood for the cause of the afflicted fellow - human, it is up to the
[82]
blood banker to screen the volunteer effectively in the interest of the welfare
of the recipient and safety of the donor.
Deferral
General:
The exclusion of anybody who is willing to be a blood donor is a
delicate task for any Blood Transfusion Service (BTS). Nevertheless, the
safety of the donation process and of the blood supply are at stake. Systems
for the exclusion of unsuitable donors must be reliable and error free. At
the same time, the community's resource of healthy blood donors must be
protected and encouraged. What this means, in practical terms, is:
• donors who must be permanently disqualified must be identifiable
and must be effectively excluded: the donor should be informed
of the reason and referred for further investigation, if necessary.
• donors who are temporarily deferred must be clearly informed of
the reason and actively encouraged to return after a suitable
interval.
• active donors should be informed about these procedures while
being reassured that, in their own case, continued regular
donation is quite safe and is encouraged.
Temporary Deferral
In all cases, the donor must be informed of the disqualification and
the reason for it. A written explanation should also be provided to the donor.
The explanation requires sensitivity, with the understanding that the donor
may feel upset and dejected and therefore needs encouragement and
support. It is particularly important that the donor understands clearly that
the deferral is temporary and that further donation is encouraged after a
suitable interval. No transfusion service can afford the permanent loss of
donors whose deferral need only be temporary. The donor should be told
when it will again be possible to donate. A Donor Deferral Register would
be useful.
If the donor's condition seems to warrant referral to a physician, this
recommendation can appropriately be made at the time of the deferral. A
written record of all referrals is essential.
Regular Voluntary Donors
Voluntary blood donors who give blood regularly are considered to
be donors at the lowest risk of all, because their blood is tested frequently
and they are less likely to attend the donation site if they know that they
have engaged in any risk behaviour. Since they donate blood regularly,
[83]
they help to ensure that there is normally an adequate supply of blood, and
they can also be relied upon to donate blood in emergencies.
Blood transfusion services and hospital blood banks should therefore
always encourage donors to become regular donors. Individuals who have
donated blood at least three times and who continue to donate at least
once a year (or whenever called on to do so) can be regarded as regular
donors. Some centres use stricter criteria to define regular donors. They
may, for example, require donors to give blood at least two or three times
a year before they can be considered regular donors.
Donor Self-Exclusion and Self-Deferral
Encouraging donor for self-exclusion and self-deferral is a very
important part of recruiting donors whose blood is likely to be safe. Selfexclusion means that potential donors make the decision not to give blood
because they recognise that their blood may be unsafe for the recipient as
a result of risk behaviour or because of the state of their own health, selfdeferral means that they wait until the condition that makes them unsuitable
has been resolved.
Every donor motivator has a responsibility to educate existing donors
and the general public, who are potential donors, about the importance of
avoiding risk behaviour. It is also essential that a motivator is trained to
counsel donors about risk behaviour and to encourage them to self-exclude
if they have engaged in any behaviour that may have exposed them to the
risk of transfusion-transmissible infection.
Confidential Unit Exclusion
Some donors may be unwilling to self-exclude or self-defer, even if
they know that their blood might be unsafe, because they do not want
other people to know why they are reluctant to give blood. For example, if
you are visiting a factory to collect blood, some people may donate because
their friends or their manager expect them to do so. They may be worried
that, if they refuse, others may suspect that they are HIV positive and will
be hostile towards them. This is known as 'peer group pressure'.
Because of this, it is important to give all donors the opportunity to tell
motivators/social workers in confidence to remove and dispose of the blood
they have donated. This is called confidential unit exclusion. Strict
confidentiality must always be maintained when donors ask for unit exclusion.
It is imperative for the donor motivators to make themselves
conversant with the standards for donor screening prevalent in the country
[84]
at least, to satisfy the inquisitiveness of the listeners in the question-answer
sessions.
Drugs and Cosmetic Rules, as amended in 1999 prescribe the criteria
for blood donor summarised hereunder and should be strictly followed.
(i) Age . Between 18 and 60 years
(ii) Weight: 45 kg. or more
(iii) Pulse : 60 to 100 beats per minute and regular
(iv) Blood Pressure : Systolic 100 to 180 mm of mercury; Diastolic 50
to 100 nam of mercury
(v) Haemoglobin : Minimum 12.5 gm/100 ml of blood
(vi) Oral temperature : Not exceeding 37.5°C.
Before each donation queries shall be made to determine that the
donor is in normal health and has not suffered from or is not suffering from
any serious disease or illness like malignant disease, epilepsy, renal disease,
allergic disease, abnormal bleeding tendency, unexplained weight loss of
a significant degree, cardio-vascular disease. None should be accepted as
a donor during the period of pregnancy and till six months after delivery
and during lactation and also in case of excessive menstrual bleeding.
Persons immunised or vaccinated can be accepted after two weeks if
they are symptom-free. In case of bite by any rabid animal, the donor can
be accepted only after one year. Those receiving anti-tetanus, anti-venom,
anti-diptheria, anti-gas gangrene sera may be accepted four months after
the last injection. If there is no history of having suffered from hepatitis
within a year, the donor will be accepted. Donors having a history of malaria
and treated with anti-malarial drugs may be accepted after three months.
Donors are acceptable six months after recovery from any major operation
and three months after the recovery from minor operation. One can be
allowed to donate blood once in twelve weeks (3 months).
The medical officer of blood bank shall explain to the donor any
clinically significant abnormality detected at the time of donor screening.
[85]
Theory of Donor Motivation
T
he words motivation, innovation and communication have Latin origins.
Motivation comes from the word motive, which in turn derives from
the Latin verb movere', meaning 'to move'. So a motive, quite simply, is
something that moves one to action.
Characteristically the words 'motive' and 'motivation' suggest that
something within one is at work impelling or driving the person. It may be
a need, desire or emotion. Any single action can be driven forward by
more than one motive. In other words, motives are often mixed.
People are identical in-as-much as they share the same general physical
and mental characteristics. At the same time, each individual is a unique
product of genetics and environmental influences. We are all born with
individual sets of characteristics and are then continuously influenced for
the rest of our lives through contacts with other persons ranging from parents,
relatives, friends, teachers, colleagues, political and religious leaders by
education, training, books, films and jobs coupled with a variety of
experiences.
Life is a process of continual learning, modification and change.
Depending on factors such as intelligence, background, schooling and
sensitivity, some people are more disposed to learn or help others. No
human being, however, can avoid the influence that comes from the external
environment. The effects of these influences on behaviours are not always
perceived at the conscious level. Individuals may change their behaviour
without being aware that other person or experience has initiated the
change. The external influence might shape values, attitudes, perceptions,
motivations, judgements and decisions. Values and attitudes developed
through' motivation are important determiners of behaviour.
Motivation is the impetus that drives people to behave in various
ways and seeks to fulfil a variety of needs. We all have needs.
In the age of the great Epic the Mahabharata, Lord Krishna in the
battlefield of Kuruskhetra (circa fifteenth century B.C.) delivered a lecture
consisting of 745 verses in eighteen chapters to motivate the great warrior
Arjuna to fight for a cause. This book, the Bhagabad Gita, is an algorithm of
motivation for decision-making.
Mastow, Herzberg and Vroom among the social scientists have earned
universal fame for their studies on human motivation. The theories of
[86]
motivation studies as produced, vary in their emphasis and conclusions,
but there is a general consensus:
• Motivation is a force that drives people to satisfy needs.
• Needs that people seek to satisfy are universal.
• The motivational force has a direction towards specific goal.
• The intensity of motivation depends on desire.
• The motivational force may be short or long lasting.
• With the satisfaction of need, motivation terminates and may be
transferred to a new goal.
• Motivation is the result of individual's perception of personal value
system.
• Two great movers of the human mind are the desire of good and
fear of evil.
In the field of blood donor motivation, the oldest theory on earth the
"carrot and stick" principles of man management - never motivates real
altruistic blood donors. Similarly, money cannot ensure good quality of
blood for transfusion.
No theory of motivation has been so influential as Abraham Maslow's
hierarchy of needs enumerated in the U.S.A in 1943 in his paper 'A Theory
of Motivation.' In essence, it suggests that a person is not motivated by
mere external motive such as rewards or punishment but by an inner
programme of human needs. These needs are arranged in sets of steps.
When one set is satisfied, another set comes into play . A satisfied need
ceases to motivate. Maslow organised human needs into a hierarchy of
relative prepotency.
Self
Actualisation
Sofety
Physiological
Hunger. Thirst,
Sleep
Security,
Protection
from Danger
Social
Esteem
Belonging.
Acceptance,
Social
life.
Friendship
Love; Affection
Self Respect,
Achievement.
Status,
Recognition
[871
Growth
Accomplishment,
Personal
Development
Professor Maslow, in 1950 explained his concept of the "Self
Actualising Man" further in his paper Self Actualising People: A study c f
Psychological Health. "'Even, if all these needs are satisfied", wrote Prof;
Maslow "We may still often (if not always) expect that a new disconten
and restlessness will soon develop, unless the individual is doing what he
is fitted for, A musician must compose music, an artist must paint, a poe~
must write, if he is to be ultimately in peace with himself. What a man car
be. he must be. This need we may call self actualisation". Maslow defined
self actualisation as "man's desire for self-fulfillment, namely to tend for
him to become actualised in what he is potentially…..the desire to become
more and more what one is, to become every thing that one is capable of
becoming. The clear emergence of these needs usually rests upon prior
satisfaction of the physiological, safety, love and esteem needs".
This is exactly where blood donor motivator should decide :
• Who of motivation?
• What of motivation?
• Why of motivation?
• When of motivation?
• Where of motivation?
but at the same time by keeping things simple.
The blood donor motivators have to bear in mind that there is a
driving force as well as a restoring force as according to Newton's Law, all
bodies tend to remain in a state of rest or of uniform motion in a straight
line unless acted upon by a force. The force can promote a change but
again according to Newton's Law: for every action there is an equal and
opposite reaction. There will always be factors which will resist change
and need to be neutralised according to the land, people and culture.
In 1959, Fredrick Herzberg, an American Professor of Psychology
published his research work in a book "The Motivation to Work". Herzberg
established two separate sets of factors which influence motivation. Prior
to this, people assumed that motivation and lack of motivation were
opposite of one factor on a continuum. Herzberg upset the traditional
view by stating that certain job factors primarily dissatisfy people when
the conditions are absent. But their presence brings people to a satisfied
neutral state. The presence of these factors does not motivate automatically
but absence acts in demotivation. He called these potent dissatisfactory
factors as Hygiene Factors or Maintenance Factors because they are
necessary to maintain a reasonable level of satisfaction in people. Herzberg
[88]
identified some components of job satisfaction which motivates people.
He labelled these factors as Motivation Factors.
Examples of Maintenance Factors are :
• Policies of organisation
• Quality of supervision
• Working condition
• Status and inter personal relationship.
Examples of Motivation Factors are :
• Achievement
• Recognition
• Advancement
• Work itself
• Responsibilities
This theory is known as Herzberg's Two Factor Theory.
Donor motivators have to find out the factors promoting people to
donate or not to donate blood or dropping out after the maiden donation.
Another widely accepted approach of motivation is the "Expectancy
Theory" developed by Prof. Victor H Vroom.
Vroom explained that motivation is a product of how much one wants
something and one's estimate of probability that a certain action will lead
to it.
He used the formula:
Valence'
X Expectancy',
= Motivation
(Strength of.
(Probability of
(Strength of desire
one's desire for
getting it with a
towards action)
. something)
certain action)
In short, all want is aimed at satisfaction of some order. This satisfaction
may be extrinsic or intrinsic. This motivation often springs from the want.
The want may be for love or recognition to derive satisfaction.
[89]
This theory was further expanded on the assumption that WE ALL
HAVE WANT.
Level of want X Expectancy
Motivation
Action
Result
Satisfaction
From these premises, blood donor motivation can be defined as a
force or a process which causes non-donors to donate blood on their own
desire without any compulsion.
Thus blood donor motivation means;
• Encourage, inspire and stimulate people to donate blood
• Provide reason and logic to donate blood
• Develop desire to solve a social problem
• Instil pride for blood donation.
It has to be accepted that 50% of such motivation comes from within
and 50% from the environment.
There may be two types of motivation:
• Attitude Motivation
• Incentive Motivation.
Blood donor motivation essentially aims at attitude motivation;
incentive motivation would not ensure good quality of blood.
Laws of Motivation can be summed up as:
• Only the motivated can motivate
• Motivation requires goal, recognition, challenge, participation and
group belongings.
• Motivation once achieved may not last for ever.
• Motivation is an ongoing process
• Progressing motivates
• Everybody can be motivated.
[90]
Thus,
motivation
to
donate
blood
involves
several
distinct
steps
or
processes. It requires first an awareness of the need for blood. This requires
education.
Awareness
about
the
need
is
an
external
part
of
donor
motivation
but
awareness
alone
is
not
sufficient
to
cause
people
actually
to donate blood.
The
motivation
requires
interest
in
the
idea
of
donating
blood
voluntarily to save a life. Interest is an outgrowth of awareness. It develops
over time, with the family or among friends, in school or in work place
through discussion and reconsideration over and over again. It is a small
group function and not totally a function of the public or mass.
Interest alone does not lead people to donate blood. It is however an
essential
step
in
the
process
of
motivation
towards
commitment
to
donate
blood voluntarily without coercion whatsoever.
Motivation implies that the person has a desire to donate blood. This
desire is found only in people who have already been made aware and
interested.
The role of the blood transfusion service is to harness the strength of
networks of donor groups or donor organisations in the country.
The desire to donate blood may also come in a disorganised fashion
through
a
family
crisis
or
national
calamity
or
disaster
or
even
battle
or
war.
This
is
a
normal
human
instinct
and
reaction.
The
donor
motivators
and
blood
transfusion
service
can
utilise
this
human
reaction
in
a
constructive
manner.
However,
it
is
not
sufficient
to
rely
upon
such
causes
to meet the daily need.
Even
the
desire
to
donate
blood
will
not
without
necessary
organisation
to
channel
the
desire
motivation
of
the
blood
transfusion
service
as
a
voluntary blood programme for the country.
The
essential
point
is
that
blood
process
needing
education,
organisation
transparencies and credibility of blood transfusion service.
donor
with
lead
to
blood
donation
into
action.
This
needs
whole
to
achieve
total
motivation
good
is
a
continuous
planning,
perfect
All
these
will
not
happen
without
continuous
effort
of
blood
donor
motivators
and
transfusion
service
in
an
organised
form
as
the
saying
goes
Together
Every
One
Achieves
More
(TEAM)
to
build
awareness
and
creation of interest and desire to act.
[91]
Principles of Donor Recruitment
A blood bank with a beautiful building, well equipped and trained staff .sophisticated
modern equipment and techniques, blood collection vans, kits, reagents, chemicals and glow
sign cannot serve the ailing patients unless it has adequate blood. For safe blood transfusion
good quality of blood is needed. To ensure quality, voluntary blood donors are to be recruited
and voluntary blood donors base has to be built up in the community to keep the blood bank
shelves full all the time,
It is accepted all over the world that blood donors are microscopic minority in any
community, be it industrial, developed, developing or backward country; although in every
society there are enough people capable of donating blood.
•
•
The chief reasons for not donating blood all over the world are:
Fear complex
Nobody approached people to donate blood.
Therefore, donor recruiting is a demanding task. This is a continuous process with newer
innovation with time. Pragmatic programmes suitable for land and the people based on rational
principles have to be formulated.
There are two models in vogue in different countries:
One is:
•
Publicity
•
Propaganda
•
Enticement.
•
•
•
•
Second one is:
Education
Motivation
Donation in camp
Recognition of donor.
Some of the countries have taken coercive or compulsive method which should not be
taken into consideration in democratic countries like India. We have to choose between the two
for the country/region/state.
Many donor recruitment programmes overemphasise audio-visual publicity through poster,
newspaper, radio and TV announcements. Without a thorough organisational process to reach
the donors individually or in groups, these publicity techniques in Indian context have not
recruited
[92]
sufficient donors. The publicity may have a reinforcement effect. But this cannot be the prime
principle.
Propaganda of blood shortage in blood banks and consequent appeal for blood donation
send a wrong message. This propaganda gives impression that blood transfusion service is
failing in its mission. These appeals have never been productive.
Donor recruitment is the process that includes public motivation, identification and
recruitment of donor groups; education and motivation of donor recruiters, donor groups and
individual donor: organisation and scheduling of blood collection sessions; maintenance of
records of donors and donor groups; development and maintenance of comprehensive
programme for retention of known donors; maintenance and analysis of statistics and
recognition of the contribution of individual donor and donor groups for the cause.
Thus, motivation to donate blood involves several distinct processes. It requires first an
awareness about the need of blood and then an awareness that there is no harm in donating
blood.
Desire to donate blood may come in organised or unorganised manner through the process
of being asked by somebody, normally a blood donor motivator. It seldom comes from publicity
or public appeal as all these are too impersonal to motivate an individual to take action.
Even the desire to donate blood must be channelled into action, that is, by organising
blood donation camps. Encouragement to donors e.g. pinning a lapel pin or awarding a
certificate helps in recognition of donor.
A person can donate blood 168 times between the age of 18 and 60 years. So a donor has
to be retained and converted to a regular donor as this is a tested blood and can ensure safe blood
transfusion. Thus, in the Indian context, the principles Education, Motivation, Donation in
Camp, Recognition of Donor should be followed.
Motivation of the whole population is necessary if the country is to ‘succeed in collecting
requisite quantity of blood from the voluntary blood donors. This challenging task requires indepth knowledge of the land and people, their attitude and common behavioural pattern.
Before a public education programme can be planned, knowledge must be available of the
current understanding, attitudes and taboos within the community.
[93]
The principles of donor recruitment may be short term i.e. to recruit: donors to meet the
immediate blood need. But without any long tern, planning to recruit donors of tomorrow, a
culture of voluntary blood donation in the community cannot be developed. Thus, short term and
long term programmes should go hand in hand.
The approach to the community can be:
•
Individual Approach
•
Group Approach
•
Mass Approach.
Again, mass approach is impersonal and costly. Besides proper feed back cannot be
obtained. The result is not proportional to the effort put in and expenses incurred.
So in the Indian context combination of Individual approach and Group approach may be
considered as pragmatic and ideal — individual approach for the leader or influential member of
the group and group approach for the group as a whole.
SOME MYTHS RELATED TO BLOOD DONATION IN INDIA
Blood donation Causes weakness or fatigue.
Donating blood disturbs the balance of the body.
It may Cause weight gain.
Fear of transmission of foreign genes.
Fear of the possibility of discovering some disease.
Belief that a man who gives blood for his wife will die before she does.
Fear that one who gives blood will not be able to have children.
Belief that one will become a blood relative of the spouse.
“If you have a Rupee and I have another, and we exchange, we have one Rupee each. But
if you have a better idea and I have another and we exchange, we have two better ideas
each. Ideas are more powerful than weapons”.
-Anon
[94]
Donor Recruitment Strategies
Many techniques of blood donor recruitment have been advocated. The best methods are
understandably based on personal contact between motivator and prospective donor or at least
contacts between motivator and group. Person to person contact may be difficult. But person to
group contact is pragmatic.
The transfusion service must get steady flow of blood to keep their shelves full all the year
round. Some group or other should organise blood collection drive throughout the year.
Group approach being considered as most pragmatic and effective approach to recruit
donors as a short term strategy, the community may be divided into various target groups that
may be approached during their convenient period. The groups may be:
• Educational Institutions
• Industrial and Commercial Organisations
• Social and Cultural Organisations
• Religious Orders
• Political Organisations
• Trade Unions
• Fan Clubs
• Govt. Organisations
• Sports and Recreational Clubs and Organisations
• Women’s Organisations
• Medical Organisations/Institutions
• Uniformed Services.
Each group may be encouraged to select a suitable day for its blood collection drive. Every
organisation likes to associate its blood donation day with significant day. The significant days
may be International, National, Regional or even Local for the particular organisation.
With a little library work and stretching of imagination, a calendar may be drawn up
whereby every day can be found to be a significant day for some group or the other. Some such
dates are listed in the Annexure IX.
When a group of dreamers with conviction of purpose and a plan to act unite, an
organisation is born. On the strength of such an organisation social change depends. The status
of voluntary blood donation movement in different countries of the world and even among the
states of this vast
[95]
country bear testimony to the strength, weakness or presence of such organisations.
In 1947, India achieved independence. But before 1964, Independence Day was never
observed by donating blood. The accident to Nari Contractor dates back to 1962. But Nari
Contractor inaugurated the blood donation camp at Calcutta only in 1981 by donating blood in
memory of Sir Frank Worrell for the first time anywhere in the world. It is the imagination
which is needed in the motivation, recruitment and retention of blood donors.
The motivator may approach the leader or the key person of the group and after convincing
him or her. sits with the group for a motivational session using display materials and or flip
charts. After the talk or discussion there should be question and answer session followed by
distribution of some take-home materials like folder or booklet containing basic information on
blood and blood donation.
In the motivation session a suitable date for blood collection drive may be chosen. The gap
between the motivation session and the date of blood donation drive should not be normally
more than seven days. The key personnel of the group should be provided with
posters/folders/stickers and encouraged to launch campaign locally.
If a suitable date for the group is fixed and efforts are made by the motivators to induce the
group to hold the camp in and around the date for 3/4 years then the blood collection drive
becomes a regular activity of the group.
The print and electronic media may be used to publicise the blood collection drive so that
the group feels important.
Handing over blood group-cum-donors card to the donors in due time helps in sustaining
the blood donation by the group for years to come
Weekdays are most suitable for educational institutions, industrial and commercial houses,
trade unions, government organisation, uniformed organisations. Sundays and holidays are
suitable for clubs and other groups
Short Term Methods
Any programme supporting and helping to propagate the message of particular blood
collection drive is a short term strategy which may include seminars, talks, meetings, poster,
banner, hoarding, leaflet, radio, TV newspaper announcements and reporting.
[96]
Long Term Methods
Any donor recruitment strategy meant for recruiting donors of tomorrow may be considered
as long term strategy. These include walk, rally, hoarding, articles in print media and general
awareness programme to inform and educate common people. School education programme,
incorporation of lessons in school text book, demonstration of blood donation camps in schools
are the methods for recruiting donors of tomorrow. Converting blood donors and young adults to
honorary donor recruiters through structured training programme to spread the message of blood
donation deep down in the community helps building up a healthy people’s movement.
After successful school education programme the school may be encouraged to organise
blood donation camps with teachers, parents, ex-students and people of the locality as donors
and the children as organisers and motivators. The children able to motivate their parents and
relatives to donate blood in the camp organised at their school may be presented with a badge
with inscription like “I am proud. There is blood donor in my family”
Mass blood donation camps after a general awareness campaign by bringing in a number of
blood banks to work side by side and pre-donation announcements and post-donation reporting
are also considered as long term strategies as these camps help in spreading of the message of
voluntary blood donation in the community, which in turn helps in organising smaller camps
throughout the year. On one occasion there can be a number of camps in different places
concurrently.
The quiz contest, debate, elocution contest, sit and draw contest, slogan contest, essay
contest on blood and blood donation are also part of long term strategies.
Direct method
The most common methods employed generally are lectures / discussions / seminar /
symposia / group-meetings, etc. These are particularly applied to organised target groups like
industrial and commercial establishments, dubs or locality based organisations, schools and
colleges as also for organised professional bodies like those of medical professionals, Paramedicals, nurses, teachers and those of sportsmen, intellectuals, performing artists and the like.
The areas covered in such talks include:
• brief history of blood donation movement and blood transfusion,
• present status of blood transfusion service of the region,
• indications of blood transfusion, as a life saving measure,
[97]
• blood requirement of the region vis-a-vis availability and their
source,
• evils of blood procured from commercial sources,
• eligibility of the donor,
• actual ‘material loss’ after donation and recuperation thereof
• advantages of blood donation.
• importance of safe blood donation,
• blood donation as safe procedure
• possible role of the target audience in this regard,
• an appeal to participate in the movement.
In conclusion, some time should always be made available for a question and answer
session.
Indirect methods
•
•
•
•
•
•
•
•
•
•
•
The common but useful method applied for group or community
motivation is by way of putting up of banners, display hoardings
posters, etc. in public places and distribution of leaflets and
handouts.
Puppet shows, drama, songs and poems with the theme of blood donation.
Presentation of badge, lapel pin, watch-sticker (depicting blood
group), awarding certificate in public ceremonies to help motivate
the non-donor general public. Occasionally such awards is
modelled to have a special appeal to a particular group of donors.
Impressive thanks letter addressed to the donor to generate lasting
warmth and to induce the donor to repeat the act of donation,
Group recognition like inter-institution / inter-class / inter-club
trophies are awarded for mobilising maximum number of blood
donors.
Organisation of ‘Know your blood group’ stall decorated with colourful slogans,
posters and allied visuals at fairs, exhibitions. festival pandals etc. accompanied by
short talks and distribution of leaflets.
Short-film show and skit on the theme of blood donation. Display
of cinema slides and mobile audio-visual campaigns.
Use of mass-media like news papers, periodicals, Radio and TV.
Debate, poster, quiz and slogan competitions.
Distribution of special donor-badge for multiple donations, e.g.
5/10/25/50/100 times.
Printing of blood donation slogans on hospital outdoor ticket.
bill presented by Electricity / Water board / Treasury, Premium
[98]
notices and receipts of LIC, Milk pouch or Food packing, Postal cancellations, etc.
• Introduction of national / state level awards for donor
organisations.
• Appeals from religious leaders to their followers and general
public.
Supplementary methods
• Motivation of the blood users, i.e., medical professional, paramedicals and nurses as well as those in the administration who
run the service.
• Laying stress on the importance of a well-organised and
standadised blood transfusion service as part of the national health
care service.
• Emphasis on avoidance of injudicious use of blood.
• Impressing upon the blood bank personnel the need to be
courteous in approach to the donors.
• Introduction of comprehensive in-service training of blood bank
staff for the updating of their knowledge and skill.
• Pleasant housing for blood banks and appropriate collection
apparatus to impress the donors.
• Strict donor-screening according to the standard norms to instil
confidence in the donors.
In donor recruitment ideas and imagination play a great role to boost up blood donation
movement.
Technique to Meet Rare and Fresh Blood Need
With the advancement of technology of open-heart surgery in the hospitals of the
country, the people irrespective of social and financial status are haunting donor motivators and
social welfare organisations in this field, in quest of blood donors to meet their fresh blood need
(i.e., blood of a donor bled on the date of the elective surgery).
The people, otherwise willing to donate blood in camps, are reluctant to donate blood in
such cases to the dictate of surgeons and according to the administrative and managerial balance
of convenience of the blood banks. These blood needs put the regular donors under pressure
over and over again.
Motivators may try the following pre-tested method:
[99]
At least fifteen days before these elective surgeries, motivational
sessions are organised either at the place of work of the patient or next of
his/her kin or at the locality of the patient. The science of blood and blood
donation is explained vis-a-vis the blood need of the particular patient.
The blood groupings of the willing donors are carried out on the spot. The
simplicity of the procedure often prompts the onlookers to volunteer. A
short list of donors of the right group is then prepared and handed over to
the patient or his/her relative to escort the donors to the hospital on the day,
of elective surgery. Such donors in their locality or place of work are
considered as heroes as the patient is known to all of them.
There is no magic formula for success in donor recruitment and success
is not automatically guaranteed unless backed by hard work, sincerity,
dedication, conviction and imagination.
[100]
School Education Programme
An ideal blood donor recruitment programme to ensure a blood transfusion service
for the country entirely depending on real total voluntary blood donation must have two
concurrent strategies: (i) short term strategies to meet the need of today as far as possible
and (ii) long term strategies to meet the need of tomorrow or day after tomorrow. There
are programme for donors of tomorrow in Australia, Portugal. France, USA, Zimbabwe
and India. Each one is culture specific of the country.
A pretested programme of a particular region of India is being suggested for the
whole country. This is. in fact, a class room teaching by the trained volunteers / staff
from blood bank or voluntary organisation. The programme should be in the form of
extension lecture and should not be a passing head of examination.
Lecture Plan
I. Title of the Lecture : Blood and Blood Donation
II. Entry behaviour
Students of age group between 13 and 16 years who normally study “Human Blood”
in their Life Science/Biology curriculum in school.
III.
•
•
•
Object
To inspire students to donate blood on attaining the age of 18.
To explain the need of knowing one’s own blood group.
To impress upon the students the danger of transfusing blood
collected from blood sellers and commercialisation of human
blood.
IV. Teaching Aids
Chalk, duster, chalk board, flip chart, poster, models, polybag, leaflet, folder and
booklet.
V. Duration
Not exceeding two periods (70 to 90 minutes) including time for question and
answer.
VI. Method
Lecture, board work, demonstration followed by question and answer including
general discussions.
[101]
VII. Concept to be imparted in a single lecture/talk/interaction
Concept 1 -
Importance and significance of the topic in the present society.
Concept 2 -
Importance of blood transfusion in modern medical science.
Concept 3 -
Who needs blood and when (indications of blood transfusion).
Concept 4 -
History of blood transfusion and blood banking.
Concept 5 -
Blood requirement of the state and its source of supply - statistics.
Concept 6 -
Reasons for shortage of blood for transfusion in the country (i.e. reasons for
not donating blood).
Concept 7 -
There is no substitute for human blood.
Concept 8 -
Blood volume, volume of donation and time for recuperation - no special diet,
rest or medicine necessary. Normal life of blood cells and shelf life of blood.
Interval between two successive blood donations.
Concept 9 -
Blood is collected from vein - pain experienced in venipuncture during blood
donation.
Concept 10 -
Who can donate blood (selection of blood donor)?
Concept 11 -
What do voluntary blood donors gel?
Concept 12 -
Blood group and importance of knowing one’s own blood group and
inheritance of blood group.
Concept 13 -
Evils of commercialisation of human blood vis-a-vis professional blood sellers.
Concept of safe blood transfusion in the days of blood communicable diseases.
Concept 14 -
Why should every eligible person donate blood?
Concept 15 -
hat can school students do?
Concept 16 -
Conclusion - One can donate blood on attaining the age of 18 years.
(viii) Evaluation : Question and Answer and Quiz Competition.
[102]
(ix) Exit behaviour; Students are motivated to donate blood on attaining the age of 18 years.
Methodology
The classroom may be decorated with attractive colourful posters with visuals and message
of voluntary blood donation. The lecture should be supple merited by board work and flip charts.
The selected stories from the epics, literature, history and everyday life are to be used as the
vehicle of oral communication of message and science along with simile, metaphor, allegory and
parable to keep a mark on the young mind to act later, even after five years.
Attractive printed materials communicating messages of blood donation with visuals like
class routine (timetable) / folder / booklet / card may be presented to every student at the end of
the class to carry home and retain as memento.
Evaluation
After effective interactions students would normally be able to answer the following
questions by spontaneous raise of hands.
• Would you donate blood on attaining the age of 18 years?
• Can you calculate your own blood volume? How much surplus
blood you have in your body? How much blood you can part
with without causing any harm to yourself?
• Will you buy blood from commercial blood sellers?
Inter-school quiz contests can be organised on Blood and Blood Donation as a follow up
action.
Follow-up by Short Term Programme
Wherever teachers of the school or head of the institution and students will be interested to
organise a blood collection drive as a part of their community service or social service
programme, a blood donation camp may be organised in the school premises on a subsequent
convenient date where school students of tender age become organisers, motivators and
recruiters with teachers, guardians and ex-students as blood donors.
Teachers’ Training
The trainers/instructors/teachers of this programme are volunteers coming from different
walks of life to extend their labour of love for the cause. They are to be
trained/groomed/oriented in the oral communication and art of teaching through a series of
workshops and other teachers training
[103]
programme. The teachers’ manual, teachers’ hand book and guide book ensure the uniformity of
this teaching programme.
The trained volunteer teachers should remember:
• Indoctrination of the teenaged students with idealism of serving
fellow human beings need be practised with conviction.
• In every school 90 minutes time may not be available. When
time is a constraint, the history of blood transfusion may be pruned
and if necessary, may be omitted.
• Use of medical terminology or jargon should be avoided as far as possible.
• Concept of unit 8 and 10 being the means to remove fear
complex, should not be curtailed or omitted.
• Salient points should clearly be written on the board at d
demonstrated by flip charts.
A popular story used in School Education Programme
School students forget the speaker but remember the story.
in
West
Bengal.
A NIGHT TO REMEMBER
The majestic passenger liner Titanic’ on her maiden voyage with 2203
passenger and crew on board struck an iceberg while cruising through
the Atlantic on the midnight of April 14, 1912. The blow was fatal for
survival. SOS signals were sent out and the life-boats lowered. Captain
Arthur Rostran of the SS Carpethia sailing in the opposite direction
responded first. Within minutes the Captain altered the course and;
covered a distance of 58 miles in 4 hours and picked up 763 survivors
from the life boats. Another ship, the SS Californian, commanded by
Captain Stanly Lord noticed the distress rockets fired from the Titanic
from a distance of 19 miles, did not care to respond. His timely response
could have saved all the lives, in all probability, because the distance of
19 miles could have been covered in 90 minutes at the most. The ‘Titanic’
was afloat for two and a half hours after the collision.
Which Captain would be your idol of life?
[104]
Women in Blood Donation
Movement
Population-wise the men: women ratio is almost 50:50, blood donor-wise though the same
would be about 95 : 05 in the country, whereas in the consumption of blood the ratio is again
somewhat like 40 : 60. This would logically lead to the conclusion that in case of blood
transfusion, women of our country are dependent on the men-folk. The task before the donor
motivator is to inspire them and to win over their shyness.
Both in physical and mental characteristics, women differ from men and these differences
have determined their respective domains and roles in the society. Of course, today’s
spokeswomen of “Women’s Lib” in their revolutionary flair often deny this fact outright.
According to them, there is no difference of domains earmarked for the male or the female.
Sociologists may engage in an unending debate on who is dominating whom or who wants to be
dominated by the others and similar other issues. But what appears to us are that the elements to
become a sister, to become a wife or to become mother is instilled in the very nature of women;
but never to become a servant. Women posses more love and affection — otherwise the child
would not have grown to manhood, the family would have toppled down. Mother nurtures the
child out of sheer love, there is not obligation; wife serves the husband out of love and not as an
obligation.
Today, all over the world, women have come out to take their rightful position in the vast
expanse of the world. Now, they have equal responsibility in the community of mankind. If they
cannot discharge the same then it would be a matter of shame, a failure on their part. Such being
the perspective, the women of contemporary India have to think over and over again, as to how
best they may play their role, shoulder to shoulder with their male partners in the development of
the country.
Physiologically, the size of the heart of women is smaller; similarly
their blood-volume is 66 ml/kg, of body weight as against 76 ml/kg for men. But in the social
life, lion-hearted women outnumber the men, since they have the instinctive love to overcome
gracefully tribulations and yet remain magnanimous. Once we reach this loving heart of women,
the problem of donor recruitment would be solved.
Women in any community may serve the transfusion service in more ways than one: by
becoming a blood donor (which is the simplest way) and by educating their children to become
blood donors on their attaining
[105]
adulthood (which is a more far-reaching way}. Women are in an advantageous position to
eradicate the superstitions and taboos from the minds of their children. Once the child is allowed
and trained to think free, there is less chance of confused thinking later on.
Emotionally, women are more receptive. One may try to motivate the students in any coeducational college to vouch for this. Listening to the same talk on the story of blood and blood
transfusion, girls would respond more than boys in registering their readiness to donate blood.
Has anyone ever come across an instance where a sister has refused to donate blood for the
need of her brother or a mother refusing to donate for her son or daughter? There is no example
of ladies of rare group empaneled who have to serve as on call donors refusing to respond to
donate blood for a newborn baby. This is unimaginable. May be, shyness and fear initially stand
in the way, but once they are made to understand what is what, their readiness is exemplary.
West Bengal’s experience of ‘Florence Nightingale Day’, when nursing sisters of all the Nursing
Schools of West Bengal hospitals donate blood every year, is yet another example of women’s
response to the call of the ailing fraternity. Similar is the experience with women’s colleges.
Indian women are generally shy in nature. Donating blood in the open camps exposed to the
public eye often acts as a hindrance to their willingness. In any assembly of women they behave
more freely as may be seen in camps organised on the occasion of International Women’s Day
and in camps organised at women’s colleges. Use of draw sheets for female blood donor in a
camp is a must.
In fine, women should not forget that they require quite a large quantity of blood in
treatment of various surgical cases and particularly at child-birth. So they have an obligation to
donate back. However, where women are concerned, the question of obligation need not arise at
all. They will be ready to donate out of sheer love and ‘love without obligation is heavenly’. To
motivate women-folk to donate blood would be the task of the donor motivators. Motivators
should remember the maxim: “If you can educate a man. you educate a person. If you can
educate a woman, you educate a whole family”. Let us remember that women are the mothers of
the human race.
[106]
Blood Donation Camp
Voluntary blood donation programmes - recruitment and retention are about people and
community, about understanding them, capturing their interest and influencing their behaviour.
The main communicating task for both blood donor recruitment and retention should be
geared towards getting public understanding about the importance and triggering a response for
action.
Once a blood donor motivator raises awareness, he or she must motivate and persuade
people to donate blood.
One key secret of successful blood donor recruitment is to take the beds to the donors as
close as possible on their convenient date and time rather than expecting the donors to come to
the blood bank. The closer the bed to the potential donor, the stronger is the likelihood of
success. This is possible only through outdoor blood donation camps.
If the camps are held in a relaxed manner, it can be an enjoyable pleasant experience for
all concerned. All over the world, most blood from voluntary blood donors is collected from
outdoor camps in rural and urban areas.
In Indian context camps can be organised on holidays or in the evening in residential area
or locality based socio-cultural organisations not only in cities or towns, but also in suburbs and
villages. The people of all ages assemble either on holidays or at the end of day’s or week’s
work and the example of adults donating blood would be a strong teaching and demonstration
effect for the children. Even diehard determined non-donors may be expected to donate blood
someday if the camps become a regular activity in a particular venue.
Camps can be organised in educational institutions, industrial and commercial houses
throughout the week. Only all these combined efforts would ensure steady flow of blood in the
blood banks.
A few blood banks have well equipped mobile blood collection vans fitted with everything
including beds, doctor’s chair, wash basin, storage refrigerator and even a small refreshment
corner with own power generating unit. These vans are quite costly and cannot negotiate through
the roads in suburban areas and villages and are not suitable for mass blood donation camps even
in camps with 200 donors. Besides, festive mood of the environment and demonstration effect
would not be there.
[107]
So in Indian context, best method is outdoor camps by carrying blood
bank personnel and equipment in a vehicle and pitching the camp in a
prefixed well ventilated place.
The outdoor camps in India are and will be organised in places fa
away from blood banks. So a checklist of blood collection equipment and
instruments
should
be
maintained
and
carefully
checked
before
the
departure of the vehicle from the blood bank. Most of the blood collection
items cannot be organised locally. Any omission to carry even a small item
may frustrate the noble effort of the donor organisers and the donors.
•
•
•
•
•
•
•
•
Advantages of collection of blood from camps:
Intending donors get opportunity to donate according to their
convenience.
Familiar faces and known atmosphere help in the shedding of
fear complex by the first time donors.
Community participation.
Recruits new donors.
Health status and habits of intending blood donors are known to
organisers, quality blood is assured due to self exclusion.
Demonstration effect.
Convert non-donor to donor.
Help in donor retention.
In camp management and organisation, local organisers have scope
of using their imagination to convert the area to a festive mood with
decoration, light music rather than the silence inside a hospital blood bank.
The motivator should identify a key person amongst the group. In
consultation with the key person, motivation session and the date and time
of the camp should be fixed up according to the convenience of the donor
group.
The proposed camp site should be inspected well
due importance to the following points:
• Adequacy of the space for anticipated number of donors and
on-lookers
• Lighting and ventilation
• Electrical outfits
• Availability of water
• Toilet facilities
• Waiting space
• Donors’ screening space
• Furniture (tables and chairs)
[108]
in
advance
with
•
•
Refreshment space not far away from the donors’ beds
Cleanliness of the site.
Movement of the donor in the camp should be as far as possible unidirectional. Flow
diagram of donor may be as hereunder;
Intending
donor
Reception
Filling in
Registration
card
Checking Body
weight
Registration
Haemoglobin
Estimation
Medical Check
up
Medical
Questionnaire
Blood donation
and rest in
Refreshment
and rest
Recognition of
donor by badge
and certificate
Hearty send off
Donor
On the day of the camp, the chief motivators and the team of volunteers and the blood
bank team should reach in time. The donors should be warmly received and guided and escorted
through different stages.
Presentation of memento, badge, certificate with courtesy and sincerity
and answering all queries of donor should be considered as part of donor motivation. The
refreshment corner should be well managed and donors should be handled with personal human
touch. This being the last point of the camp, it leaves a permanent impression in the mind of the
donors.
Talking with the donor throughout all the stages is extremely important, as it helps donors
to feel wanted and also helps the first time donors to shed their fear.
The donors should be advised to remain in refreshment room for at least 15 minutes and
should be advised to increase their water consumption I during the day and refrain from
smoking for half an hour.
A hearty good-bye with a request to donate again after three months is destined to inspire
a donor to become a regular repeat donor.
Signs of minor reaction like the following should be handled with tender loving care and
compassion :
•
Restlessness
•
Perspiration on forehead
•
Pale colour
•
Lack of willingness to communicate
[109]
•
•
Nervous glances
Tendency to faint.
When reaction occurs to a donor, motivator or medico-social work should remain calm and
try not to get other donors upset and call in the medical officer-in-charge of the blood collection
team, but ensuring the prevention of the donor from falling down. Placing the donor in the bed or
floor with a pillow under the feet, helps in subsiding minor reactions. But doctors should check
up the donor in all such cases. In case of bleeding from the seal of venipuncture, finger pressure
with cotton wool, folding the arm with a cotton wool pad in between and raising the folded hand
a little upward helps in stopping such bleeding. Once the bleeding stops, the venipuncture site
may be sealed again.
The best motivational efforts may go in vain, in spite of best possible donor recruitment and
retention strategies, if the camps are not organised in an efficient manner with active
involvement of blood bank team, local organiser and motivators. At every stage, care should be
taken so that the donor can leave the area with a good impression with a resolution to come back
again.
Donors’ blood cards should be made available to the donors in time directly or through their
local organisers.
Refreshment should be offered neatly with a friendly gesture and hospitality. The
motivators should understand the significance of serving refreshment to keep the donor engaged
under the watchful eyes of socio-medical volunteers or the medical officer. The donor should be
made to understand that refreshment has nothing to do with immediate recuperation of blood
loss due to donation. A piping hot or cold drink and light refreshment are offered to compel the
donor to spend some time in a relaxed mood. Whatever be the items of refreshment, they should
be served neatly and nicely with a smile.
A well organised camp inspires many onlookers around to become blood donors.
Blood Donation Camp Premises
The premises used for outdoor donor sessions may often be the only local venue available,
but they must be of sufficient size, suitable construction and in an appropriate location to allow
proper operation. They must be clean and maintained in accordance with accepted rules of
hygiene.
[110]
Space Requirement
The space required will obviously depend on the number of staff and donors and the rate at
which donors arrive. The following activities should be kept in mind when accepting a venue.
• Registration of donors and all other necessary information
processing. Wherever possible, there should be easy access to a
telephone, preferably within the venue.
• Pre-donation counselling, the medical history and the health
check-up to determine donors’ fitness to donate blood. Facilities
should be available for confidential discussions between donors
and social workers or the medical officer.
• Withdrawal of blood from donors without risk of contamination
or errors. Visitors and onlookers should not be allowed to come
too close to the bleeding area.
• The social and medical care of donors, including those who suffer
adverse reactions. Sufficient seating arrangements should be
provided for donors and staff, with allowance made for possible
queues during busy periods.
• Storage of equipment, reagents and disposable.
Health and Safety
Health and safety factors should be taken into account when selecting
venues for outdoor camps. In particular, the following points should be
kept in mind:
• The venue should be as close as possible to the centre of
population being served. It should be possible for the vehicle to
park close to the access doors in order to facilitate the unloading
of equipment. The ground to be covered by staff carrying
equipment into the building should be even and well-lit, if possible,
the space to be used should not require the carrying of equipment
on stairs. A similar safe approach to the building should be ensured
for donors. Notices should be displayed directing donors to the
appropriate entrance to the building and to the room being used.
• The place should be free from dust as far as practicable. Cement
floor with appropriate matting would be helpful.
• The furniture and equipment should be arranged within the
available space to minimise crowding (for avoiding possibility of
mistakes or accidents), enabling privacy and adequate supervision
to be maintained and ensuring a smooth and logical work-flow.
• There should be adequate lighting for all the required activities.
Wherever possible, there should be provision for the use of
[111]
•
•
•
•
•
•
emergency lighting in the event of a power-cut. The blood
collection team should always carry a hunter’s torch.
It may not be possible for the collection team to control the
temperature, but every effort should be made to ensure that the
space does not become too hot. too cold or stuffy and must be
comfortable. There should be arrangement for fans in summer.
Facilities for providing refreshments for donors and staff should
be separate from other activities, wherever possible. Every effort
should be made to ensure that equipment used in this area does
not pose a safety hazard.
Toilet facilities for male and female donors and staff should be
available. Separate washing facilities are desirable for staff.
Adequate facilities should be available for .the safe disposal of
waste. Sharp and solid waste should be collected in suitable
containers for return to the blood transfusion centre or blood
bank and for subsequent safe disposal.
The premises should be free from vermin.
Proper arrangements should be made for cold chain
maintenance.
Mass Blood Donation Camp
In industrial or commercial houses and educational institutions, facilities for holding blood
donation camps may be extended once in a year by suspending their normal activities. If smaller
blood banks opt to collect blood according to their need or capacity many willing donors have to
be refused. This may send a wrong signal to the community and would certainly make the task of
the donor organisers a difficult one. as they would not be able to make such make-shift
arrangement for camps again at successive intervals. The organisations may not like to suspend
their normal work for the camp in the same year once again.
Camps at such a place organised by massive awareness campaign, particularly when the
camp is organised at a central place where donors come individually by availing themselves of
public transport, should be planned in a different way as refusal to accept from such donors on
account of logistics may affect the blood donation movement to a considerable extent. Besides
large scale awareness campaign through electronic or print media is not possible for smaller
camps of 20/50 blood donors. The solution lies in bringing in a number of blood bank teams to
work side by side under the same roof, each collecting blood according to its respective capacity.
Donor screening, registration and donors refreshment corner may be arranged for centrally so
also the campaign.
[112]
There have been such successful mass blood donation camps in the cities like Delhi.
Calcutta, Mumbai. Chennai, Surat, Bangalore, and Pune. Some such camps have become regular
fixed day camps of over twenty years’ standing. Many donors of these mass donation camps
have subsequently become organisers of smaller camps in their place of work or in their locality.
There are three main advantages derived from a mass donation camp. First the resources
available with any voluntary agency in India are just not sufficient to sustain a mass awareness
campaign round the year .However, a specific campaign can start about three weeks before a
mass donation camp and can gradually build up into a crescendo through postering, outdoor
hoardings, radio talks, TV. exposures and through the free coverage in the newspapers. The
publicity generated leads to increased awareness in general. Secondly, mass camps have a
demonstration effect. When one sees so many fellow human beings donating blood, he feels
inadequate unless he also donates himself. This is the demonstration effect of peer pressure. The
third benefit is that a number of big and’ small blood banks working side by side act as a
technical workshop and activate the less active blood banks. This, of course, needs a competent
technical supervision.
Mass blood donation camps call for very well coordinated organised efforts between the
organisers, the collecting agency and above all, the donors. A well managed mass blood
donation camp can motivate the non-donors and a reminder to repeat the act may also become
instrumental in ensuring better participation on subsequent occasions.
Mass blood donation camps also open up opportunities to involve more blood bank
personnel, social organisations and volunteers with the blood donation movement. Such camps
may be organised in educational institutions, factories, big offices, banks, social clubs or at
central convenient places where donors being motivated through campaign may come
individually.
Precaution should always be taken so that quality is not sacrificed for the sake of quantity.
All technical procedures should be strictly adhered to.
In mass blood donation camp poor turnout due to natural calamity or situation beyond the
control of the organisers may frustrate the elaborate arrangement. So the organisers should be
pragmatic and not over ambitious while planning such camps.
[113]
Mass Blood Donation Camp
114
Mega blood donation camps of India
[115]
Donor Counselling and Care
The recruitment of blood donors (and retention of them as a sustained regular activity
based on systematic and scientific manner) is not merely a combination of education, motivation,
donation and recognition but includes donor counselling and donor care.
Donor counselling starts from the motivational and educational sessions for motivating and
recruiting donors. The chief reasons for not donating blood by the majority are fear complex,
social taboo and age-old superstition. Therefore, pre-donation counselling in the motivational
session; should aim at eliminating fear complex through information and education This should
include blood need for transfusion in the region, indication of blood transfusion, harmlessness of
blood donation, blood volume in human body, amount of surplus, amount of donation,
recuperative power of human body, principles of donor selection, blood communicable diseases,
safe blood transfusion, safety of blood donor, safety of recipient and need of self exclusion by
the intending donors when one is not fit to donate blood Techniques are oral communication
supported by display materials and distribution of short attractive reading materials in readers’
friendly language
Pre-donation counselling is essential for ensuring safe blood supply because lack of
education and awareness aggravates problems of transfusion transmitted infections. The
objectives of pre-donation counselling are:
•
To increase donor awareness
- of transfusion transmissible infection, route of transmission and
prevention.
- of that the donated blood would be tested.
- of the implication and possible consequences of that process.
•
To discourage blood donations
- by self-deferral of people coming only for testing.
- among people who may have history of risk.
Pre-donation counselling should be provided before donation in private area maintaining
confidentiality and stressing the need for hones; and truthful reply, explaining the need of selfdeferral when history of pas: ailments or recent risk history so demands.
[116]
A prospective donor, motivated through the above, arrives at the site of blood donation.
His/her first impression is of paramount importance. The reception should instill a sense of
confidence. Quick, efficient and to the point handling of a donor right from the entry of the
donor till departure from the donation spot are considered as a part of donor care and donor
retention.
Punctuality is considered as a virtue. To the donor, his/her time is important. Unnecessary
waiting would put the donor off for ever. Scientific donor screening with tender loving care is an
indicator of donor care and creates in the donor a sense of satisfaction and feeling of safety of
donation. Giving company to donor and escorting donor upto bed are part of care.
During donation, all operations are keenly observed by the critical eyes of the donor.
Talking to the donor, answering to all questions to satisfy the curiosity of donors, clean
atmosphere, a few words of confidence add credence to the blood collection team.
Care should be taken to avoid haematomas, bruises or double puncture of vein. The donor
has to be persuaded to rest in bed or in a couch for the prescribed period. Any short cut for quick
disposal of donors should be avoided.
Pinning of the voluntary donor badge at the end of the donation by the social worker and a
smiling “thank you” before the donor leaves the bed, pay enormous dividends to retain donors.
The donor should be escorted to the refreshment corner which must have a cheerful look.
Food and drinks should be served neatly and cordially with a smile. Giving company and
advising about do’s and don’ts for the next few hours are part of donor care. A hearty “good
bye” with a request to donate again after three months is part of donor counselling and care.
In the post donation stage, handing over of donor certificate and blood donor cards to
respective donor in the shortest possible time should be considered as part of donor care so that
the donor in case of first donation can know his/her blood group. The blood group should be
carefully determined and cards and certificates should be neatly prepared. Indicating wrong
blood group to repeat donors may deter them from donating again resulting in loss of motivated
persons.
The donor has a right to know everything about blood, blood donation and blood
transfusion service. Motivators and social workers should equip themselves to answer questions
in an easy-to-understand language which should include, apart from the science of blood
donation, blood group, its
[117]
determination and inheritance or procedure of getting blood from blood bank in time of need.
Post-donation counselling in case of positive test results can be undertaken by very senior
trained staff confidentially, only after confirmatory tests, about future requirement, treatment and
follow-up facilities with dos and donts. In case of negative test results, post donation counselling
whenever possible may be undertaken on:
•
Need to know about window period.
•
How to remain safe blood donor
•
Need for safe blood donor base.
•
How to be a regular donor.
Proper counselling and care of donors with courtesy, concern, care and sincerity may
inspire many onlookers and potential donors to become blood donors for the first time and one
time donors to become regular donors to strengthen the healthy donor base.
Prevention
reinforced
Stage 1 Stage 1
PrePre- donation
donation information
information
Self-Deferral
Self-Deferral
Stage 2 Stage 2
PrePre-donation
donationcounseling
counseling
physical
physical
check
check
and and
selsction selsction
Deferral/Self-Deferral
Deferral/Self-Deferral
Stage 3 Stage 3
Blood
Blood
donation
donation
andand
testing testing
Positive/Equivocal Repeat
test test
on new
on new
sample
sample
NegativeNegative
Negative
Stage 4 Stage 4
Positive/Equivocal
Positive/EquivocalPostPostdonation
donation
counseling
counseling
and/orand/or
referred
referred
Stage 4 Stage 4
Post- donation
Post- donation
information
information
and/or
and/or
counselling
counselling
Health
Healthcare
careand
andsupport
support
services
services
for testing
for testing
follow-up
follow-up
counseling
counseling
and/or care
and/or care
Recruit for regular donor
Flow Chart of Stages in Blood Donor Counselling
WHO
[118]
Serving refreshment to the donors is a part of
donors’ care
[119]
Donor Recognition
In the four principles of voluntary donor recruitment strategies, recognition of donor comes in
line with the other three — Education, Motivation and Donation. Human beings value positive
recognition — that precious moment when someone important expresses some real appreciation
for what he/she has contributed.
When one person knows that he/she has worked hard and has done something, should
he/she not expect to be recognised for it? If it is not forthcoming from the team leader or
colleagues in the team everybody tends to feel unhonoured, unvalued and unrecognised. The
motivation drops, energy level falls and spirit evaporates.
Therefore, recognition has a big role in motivation.
Milton wrote:
“Fame is the spur that the clear spirit doth raise To scorn delights, and
Hue laborious days”.
Where does recognition come from? It can have a variety of sources. In the case of a
famous person, it is a matter of public esteem. Fame comes from the Latin word ‘fama’ meaning
report. So fame is how people talk about a person which adds up to his/her personal reputation.
A person who is much talked about favourably is a reputed person. Reputation based upon
significant achievements make people famous.
Of course, in our society, individuals can more easily achieve a kind of spurious fame by
gaining the attention of many people for diverse reasons. A footballer, cricketer, television
interviewer, pop singer can easily become famous in our society with the favour of media.
Although, such fame carries positive overtones, it can simply suggest popularity or general
recognition rather than discriminating approval or general recognition of inherent excellence.
The media can, to a large extent, make or break this form of popularity or recognition.
The vast majority of people, however, are not destined to become famous in the real sense
of the word. Therefore, for most, recognition will be particular rather than general.
Recognition for common people needs to come both formally and informally. There should
be formal occasions when you recognise the quality or value of a particular contribution; be it of
an individual or team effort.
[120]
There will also be plenty of informal opportunities for expressing
appreciations. But recognition in both forms should have the following
characteristics:
•
•
•
•
•
•
Giving recognition should be on the principle of treating
everyone
in a fair and equal way.
It should reward real achievement or contribution to the common
good, not self-seeking gain.
It should serve to inspire and encourage all concerned.
Wherever possible, it should be given in a public way in front of
the working group or organisation.
Remember to treat recognition informally as well as formally.
Above ail, it must be genuine and sincere or in a word, real.
The last point is crucial. People dislike insincerity.
In the hierarchy of human needs, recognition plays an important role
in donor recruitment and retention.
Recognition of the donors and enticement to recruit donors are not
the same thing. In some developed countries attempts were made to entice
donors with free hamburger or steak of McDonald or such other renowned
outlets. Donors felt insulted as they thought their gift of love was being
equated with hamburgers. Complaints were received over phone from
some regular donors deploring attitude of persons needing such incentive.
Paying health insurance premium for the donors is a monetary form of
incentive and therefore, is not recommended.
Recognition of voluntary blood donor means honour without any
monetary value. Recognition of donors helps as:
• Automatic incentive
• Paramount impression
• Social prestige
• Motivation to panel donors
• Healthy spirit of competition
• Spurs donors to greater participation
• Feeling appreciated and honoured
• Forms stronger commitment
• Help in retention of donors.
•
•
•
•
Forms of Donor Recognition may be in the following form:
Letter of appreciation
Greetings cards / Thank you letters
Certificate
Badge
[121]
Certificates play a big role in Donor Recognition
[122]
•
•
•
•
•
•
■
Memento
Souvenir
Annual felicitation by way of convocation
Donors card
Special award for 10/25/50/100 time donation
Donors' get-together
Honouring at a public function.
1' 0/25/50/100 donation award or badge at a public ceremony is a
part of donor recognition.
Recognition of donor organisations in the form of letters of
appreciation, greetings cards for special occasions and by giving award/'
souvenir/memento, etc. through public function is highly recommended.
Although a voluntary donor does not expect anything in lieu of gift of
love, yet a metal badge bearing the national emblem and marked voluntary
donor and a certificate presented in the camp just after the donation in
recognition of the donation help a long way in motivating people to donate
blood. Blood group-cum-donors cards also help in the promotion of the
blood donation movement. Special awards for multiple donations draw
the attention of the society to this social cause and should be instituted for
donors. Outstanding social workers, doctors, camp organisers may also be
honoured and recognised.
Inter organisation challenge trophies can build up a healthy
competition among various groups. Within the state, a three-tier system of
awards is recommended, i. e., local, district and state. There should be
recognition of the services of the blood banks and donor motivating
organisations by the appropriate authorities at all three levels.
It is desirable that the performance of the state blood transfusion
service should be evaluated against a predetermined norm and meritorious
service may be acknowledged by National Awards.
Recognition and awards act as an incentive to existing donors/
institutions and motivate potential donors to become regular voluntary
donors.
A very effective motivational tool is an annual prize distribution function
which could be held at the local, district or state level. This affords the voluntary
organisation an opportunity to publicise its activities in the community and
project its positive image. It can outline its goal and spell out the targets it
hopes to achieve. Involving a respected person of the community as its Chief
Guest, enhances the image of such programme. Efforts should be made to
I give maximum possible publicity through mass media.
[123]
Another method is to organise an "At Home" for repeat donors/group
motivators at Raj Bhawan, if possible, or at, any important place involving
a V. l. P This makes donors feel appreciated and important.
Again, at Republic or Independence Day Functions, outstanding
donors/motivators could be honoured by requesting the local authority
organising the function to do so. Public recognition makes their commitment
even stronger and donors become a part of the movement.
Membership of imaginary 5 litre or 10 litre clubs with a presentation
of appropriate memento is another way of donor recognition.
Printing of photographs of donors in house magazine may boost up
morale of the donors and help in recruitment of new donors in subsequent
blood collection drive.
It will be interesting to have a look at the method of donor recognition
in different countries.
Awards given in some countries:
Germany;
• A bronze badge for 3 blood donations
• A silver badge for 6 blood donations.
• A gold badge for 10 or more blood donations.
Austria;
• A badge in the form of a drop of blood at the first donation.
• A silver badge for 5 donations.
• A gold badge for 10 donations.
Belgium:
• A special certificate for those who have distinguished themselves
as blood donors or as voluntary blood donor recruiter.
• A certificate at the first donation (giving them the right to an
equal amount of blood and plasma for themselves or their next
relations for one year).
• Certificate after 10 donations.
• Small bronze "Pelican" plaque after 25 donations:
• Certificate with bronze medal for 40 donations.
• Gold medal for 80 donations.
U. S. A.:
• After first donation a badge in the form of a drop of blood.
• For all following donations the same badge in gold with a figure
marked corresponding to the number of donations.
[124]
Greece:
• Ordinary badge for upto three donations.
• For 5 to 9 donations, a badge with one star,
• For 10 to 14 donations, the same with two stars.
• For 15 to 19 donations, the same with three stars.
• Silver medal and certificate for 20 to 21 donations.
• Gold medal and certificate for 50 donations.
Turkey:
■ Amongst other genera! recognitions, the Turkish Red Crescent
gives women donors a pair of earrings in the form of a drop of
blood.
In India, recognition of a donor with a badge and a certificate at the
time of each donation are very common in most of the states. Special award
after multiple donations like ten/twentyfive/fifty donations are also in vogue
in some states. In states like Gujarat and Jharkhand donors donating blood
for hundred times are specially honoured and they are called "Centurion
Blood Donor".
50 TIMES VOLUNTARY
BLOOD DONORS
UPTO MARCH 2002
2 Donors were honoured upto March
2001
3. Sri Arunabha Chattopadhyay
25 TIMES VOLUNTARY BLOOD
DONORS
UPTO MARCH 2002
95 Donors were honoured upto
March 2001
96. Sri Amitava Cangvili, KolkaLi
- 11
97 Sri Alish Chakraboriy, Kolkata
- 26
98. Sri Chiranjib Bhattacharya,
Howrah
99 Sri Dipak Roy, Kolkata - 48
100. Sri Gobindalal Ghosh,
Kolkata- 15
101SnKallolKumarchattaprj
ee, Kolkata-30
102Sri Kamalesh Dey, North
24 Pgs.
103.
Sri Nanda Dulai
Paul, Kolkata - 48
104.
Sri Netal Bardhan.
Howrah
105.
Sri Rajkumar Tat,
Howrah
I06- Sri Shyamal Kumar Nath,
Kolkata-58
107. Sri Subrata Das, Bardhaman
108. Sri Subrata Kumar Panja,
Kolkata 13
109 Sri Sukumar Gupta,
holkala-^
[125]
Donor Retention
o establish a transfusion service, dependent totally on voluntary blood
Tdonors to meet the entire blood need of the country or the region, a
good donor base is absolutely necessary. Building up a good donor base is
not an easy task and retaining the donor base is equally difficult. To maintain
a donor base, recruitment of new donors and retention of the old donors
are absolutely essential.
There are people who do not donate blood after their first donation
and remain one time donor for the rest of their lives. Retention of old donors
is equally important along with the recruitment of new donors. The reason
is simple. These pool of eligible donors have already overcome superstitions,
taboos and fear complex for donating blood and therefore, the dropping
out of such donors weakens donor base.
The entire work of donor motivators or organisers is lost if a donor
donates blood once and then does not return for future donation.
Further, if the reasons for the dropping out of donors are not taken
care of, they may in the long run adversely affect the donor recruitment
drives. Any whispering from such dropouts communicated to the non-donors
is magnified and exaggerated and may strengthen the will of non-donors
to remain non-donors for ever.
The reasons for dropping out generally are:
• Illness/weakness/general health consideration
• Lack of time
• Lack of communication/information
• Unfavourable location or time of the camp
• Unhappy past experience
• Bad handling by the blood bank personnel
• Negative reactions of the blood donation e. g., dizziness, fainting,
painful venipuncture, double puncture etc.
• Non-availability of blood in time of his/her need
■ Wastage/improper utilisation of blood.
Donor retention is emphasised in the days of fatal blood
communicable diseases not only because it significantly eases the work of
donor recruiters but even more important is the fact that regular repeat
donors are safer than new donors. Their blood was tested and transfused
safely keeping all records with the transfusion service or the blood bank.
[126]
An active programme of donor retention is necessary. The most
important is the care and handling of donors. Good public relations is the
tool. Phlebotomy staff must ensure that the donation process is a pleasant
experience for the donor. Scientific donor selection, proper examination
and testing instil confidence in the mind of donors. Personal attention, smiling
face, clean blood collection site, cheerful refreshment corner and show of
sign that donors are wanted by the service help in donor retention. Pinning
of donor badge, properly handing over blood group card with correct
bloodgroup written neatly speak about the effectiveness of the service.
Careful avoidance of haematomas, bruises or double puncture of
veins speaks highly about the competence of the blood collecting team. A
single case of post donation fainting acts as a big damper at any camp with
consequential loss of the donor on the day and also for the future. Donor of
less than three donations may need special encouragement before during
or after donation to come back again.
The regular donor who may be temporarily deferred for medical
reasons should be handled carefully with encouragement to come back
when fit to donate.
Recognition of donors always plays an important role in retention.
Besides, the following activities help in donor retention:
• Observing days of importance, days of joys and sorrows by
different groups help in accepting blood donation drive as a part
of annual activity of the organisation:
• Outdoor blood collection drives at the same place on a fixed day
every year help in retaining old donors:
• Donors may be encouraged to become voluntary donor
organisers through training programmes/workshops;
• Formation of blood donors' club, society, pledge 25 groups.
association, friends of blood bank society or group and guiding
them with due recognition of their service also help in retaining
old donors.
The best motivational efforts may go in vain if blood collection teams
treat donors indifferently. On the other hand, they can convert one time
donors to regular repeat donors.
In India if has been observed that:
Retention of old donors becomes easier if the task of donor motivation
and recruitment are in the hands of one or more weII-organised voluntary
organisations rather than on the transfusion service itself.
[127]
Such organisations may have separate identity but should work hand
in hand with the transfusion service in a well co-ordinated manner with
mutual respect for each other as an essential member of the team.
Donor retention is a global problem. Motivators should keep in mind
the following cardinal points to retain donors:
How do you keep Blood Donors as Regular Donors?
The short answer would be "to make the donors feel wanted and
appreciated". To achieve this, the transfusion service or the organisations
responsible for donor motivation should do several things.
Maintain accurate records:
Encourage donors to intimate change of address.
Treat donors courteously.
Each contact between the staff member of the blood bank or
volunteers of social welfare organisations in the field of donor
motivation and the donor, whether by letter, telephone, in blood
bank, at the camp or at the enquiry/blood distribution centre of the
blood bank can either cement or strain the donor-blood bank
relationship.
Try not to keep donor waiting:
Donors are busy people, and may have constraints on their time.
Make sure that there are sufficient staff and volunteers available all
the time to minimise the pre-donation waiting period.
Listen to complaints:
Every complaint, real or imaginary, merits investigation and prompt
and polite response. A soft (prompt) answer 'take away wrath'.
Recognise the donor:
Thanks offered at each visit, together with tokens of honour (badges,
certificates, and cards) will encourage donors and make them feel
appreciated.
Inform the donor:
Keep the donors aware of the invaluable role they play and the use
which is made of their gift of love. Donors are to be intimated and
invited to camps when they are eligible to donate again.
[128]
Encourage donors to bring others:
A satisfied and committed donor is the best ambassador of recruiting
other donors.
No blood bank, however well supported by its donors, can afford to
become complacent about such support. The donors' support cannot be
taken for granted for ever. The transfusion service must be attentive to its
donors, encourage them and inform them of the vital and unique support
they are extending in supporting the health services of their community.
Individual intimation retains donors
[129]
Panel Donors
There are people and organisations who preach that there is no r =ed
of regular blood donation drives or camps. People are to be blood*
grouped and listed with addresses and telephone numbers. In time of need
they should be called to donate blood. The propagators of this technique
Torget the basic point that the blood donors may also be busy people md
may not be available always at their recorded addresses. They may be i: or
out of station. On top of this, there may be problem of communication,
transport and road condition. Above all, who would meet all these costs?
This system has not met the basic need of blood banks. Furthermore, when
blood is needed, time may be the most important factor.
Some organisations have printed donors' directory. They have burnt
their fingers. Donors being approached from different corners, on the same
day, have decided not to donate blood again.
It may be appreciated that donors would love to donate blood
according to their convenience and at a convenient camp. They would like
to donate blood with known faces around, They would not like to donate
amidst stony silence in isolation in a blood bank.
Besides, there is the ethics of anonymity between the donor and the
recipient. Thus the method of 'on call donation system' ultimately leads to
directed donation resulting in many social and legal problems.
It has been observed that unless one has never donated blood in
camps, when empaneled as a panel donor on the basis of blood grouping,
one does not respond in time of need as an 'on call donor'. In some
European countries they are called "Paper Donors".
Still, there is a need for panel donors for a second line of support for
rare group, fresh blood and preparation of particular component.
Such panel can only be developed from amongst the regular donors
after obtaining their consent in writing.
The panel has to be maintained by the blood bank or a reputable,
voluntary blood donor organisation in the field. Such a panel should never
be made public. The blood bank or the voluntary organisation should act
as an intermediary between the donors and the patients in emergencies
requiring blood; otherwise confidentiality between the donor and the
recipient cannot be maintained.
[1301
The record of such panel donors should be maintained, updated for
the simple reasons that they should never be approached for donation
more than once in three months and also for facilitating award for multiple
donation. They should be asked to donate once or twice in a year in any
camp and save the other two for on call donation to maintain their habit of
blood donation.
A meet of such donors once in a year with blood bank or voluntary
organisation in a ceremonial manner for sharing of experience and better
utilisation of the panel would be helpful. In the meet various aspects of
transfusion service should be discussed and good suggestions from the
panel donors, if implemented, may help in maintaining the panel effectively.
The modalities of record keeping of such donors and method of
approaching and utilising them sensibly may vary from place to place but
should be pragmatic and easy to understand, keeping in mind all the time
that donors' convenience and goodwill are most important for such service.
It should be kept in mind by donors, blood banks and blood users
that this panel is not a substitute for regular camp donation but a
supplementary support to camp donation.
In cases of regular blood requirement of genetic disorder like
Thalassaemia or Haemophilia, a regular blood donation camp can be
organised in the locality of the patient or the workplace of their parents.
From these camp donations, a list of twenty five donors belonging to right
group of the patient may be prepared with consent. Such donors may be
requested to adopt the child with the genetic disease in respect of their
blood need. This list may be made available to the parents of the child who
may contact the donors when blood would not be available from the blood
bank owing to shortage. Such donors should be advised to donate at least
once or twice in a year in a camp and save remaining two for possible
donation for the child as on call donor. Such donors would not normally be
asked to donate for the child more than once in two years. A get-together
of such donors, patients and their parents once in a while would be
enjoyable, refreshing and useful. Such donors may form a very informal
'Donors' Club' for the child. The presence of many such groups or clubs in
the society would be some sort of insurance of the children with hereditary
blood disorders in respect of their blood need. By this method confidentiality
between the donor and the recipient cannot be maintained. But as a very
special case the method may be accepted in the interest of the child.
[131]
Law and Transfusion Service
Blood and blood components are categorised as a "drug" under Section
3(b) of Drugs and Cosmetics Act, 1940 because of their interna
adminstarion. This Act and the Rules thereof provide the legal framework
for regulating the functions of blood banks, which in turn directly irnpart
and determine the quality of the blood transfusion service delivery in thecountry. Since initial formalities, the ambit of the Drugs and Cosmetics Ac
1940, has been expanded and the Rules have frequently been amended
to incorporate blood as drugs because of their internal administration and
use in treating diseases. The transfusion of blood cells is also transplantation
and cells must survive and function after transfusion in order to have
therapeutic effect. As with drugs, adverse effects may occur due to blood
transfusion. All these necessitates careful consideration and handling of
service in accordance with the law of the land.
Article 21 under part III titled fundamental rights of the Constitution
of India clearly spells out that no person shall be deprived of his life. Blood
transfusion can be life saving and also can be fatal, therefore, comes under
this section of fundamental rights. Besides under chapter XIV of the Indian
Penal Code Section 269 provisions for fine and imprisonment for negligent
act likely to spread infectious disease dangerous to life and section 270 of
the Malignant Act likely to spread infection of disease dangerous to life
covers blood transfusion and blood banking in all aspects.
Consumer Protection Act
Consumer Protection Act of 1986 came into force in July, 1987 for
all goods and services, covers all sectors - private, public, cooperative etc
It enshrines the six rights of the consumers:
• Right to safety
• Right to be informed
• Right to choose
• Right to be heard
• Right to seek redressal
• Right to consumer education.
The portions of the Act are compensatory in nature.
Supreme Court Directive
The Supreme Court on November 13, 1995 upheld the National
Consumer Commission's judgement of April 1992, whereby patients who
[132]
received deficient services from medical professions and hospitals are entitled
to claim damages under this Act. Naturally, blood banking service comes under
this Act and both donor and recipient may take the cover of this Act.
public Interest Litigation
On a public interest litigation filed by a Delhi based organisation
'Common Cause' by a writ petition (civil) no 91 of 1992 under Article 32
of the Constitution of India, Hon'ble Justice S C Agarwal and Hon'ble Justice
G B Pattanaik on January 4, 1996 issued the following directives:
1.
The Union Government shall take steps to establish forthwith a
National Council of Blood Transfusion as a society registered under the
Societies Registration Act. It would be a representative body having in it
representation from the Directorate General of Health Services of the
Government of India, the Drug Controller of India, Ministry of Finance in
the Government of India, Indian Red Cross Society, private blood banks
including the Indian Association of the Blood Banks, major medical and
health institutions of the country and non-Government organisation active
in the field of securing voluntary blood donations. In order to ensure
coordination with the activities of the National Aids Control Organisation,
the Additional Secretary in the Ministry of Health, who is in charge of the
operations of the programme of National Aids Control Organisation for
strengthening the blood banking system could be the President of the National
Council.
2.
The National Council shall have a secretariat at Delhi under the
charge of a Director.
3.
The basic requirements of the funds for the functioning of the
National Council shall be provided by the Government of India but the
National Council shall be empowered to raise funds from various other
sources including contributions from trade, industry and individuals.
4.
In consultation with the National Council, the State
Governments/
Union Territory Administration shall establish a State Council in each State/
Union Territory which shall be registered as society under the Societies
Registration Act, The State Council should be a representative body having
in it representation from Directorate of Health Services in the State, State
Drug Controller, Department of Finance of the State Government/Union
Territory Administration, important medical institutions in the State/Union
Territory, Indian Red Cross Society, private blood banks, Non-Government
Organisation active in the field of securing voluntary blood donations. The
Secretary to the Government in charge of Department of Health could be
the President of the State Council.
[133]
5.
The State Council should have its headquarters at the premises of
the premier medical institution or hospital in the State/Union Territory and
should function under the charge of a Director.
6.
The funds for the State Council shall be provided by the Union of
India as well as the State Government/Union Territory Administration. The
State Council shall also be empowered to collect funds in shape of
contributions from trade, industry and individuals.
7.
The programmes and activities of the National Council and the
State Council shall cover the entire range of services related to operation
and requirements of blood banks including the launching of effective
motivation campaigns through utilisation of all media for stimulating
voluntary blood donations, launching programmes of blood donation in
educational institutions, among the labour, industry and trade,
establishments and organisations of various services including civic bodies
training of personnel in relation to all operations of blood collection, storage
and utilising, separation of blood groups, proper labelling, proper storage
and transport, quality control and archiving system, cross-matching of blood
between donors and recipients, separation and storage of components of
blood, and all the basic essential of the operations of blood banking.
8.
The National Council shall undertake training programmes for
training of technical personnel in various fields connected with the operation
of blood banks.
9.
The National Council shall establish an institution for conducting
research in collection, processing, storage, distribution and transfusion of
whole human blood and human blood components, manufacture of blood
products and other allied fields.
10.
The National Council shall take steps for starting special
postgraduate courses in blood collection, processing, storage and transfusion
and allied fields in various colleges and institutions in the country.
11.
In order to facilitate the collection of funds for the National Council
and the State Councils, the Government of India (Ministry of Health and
Ministry of Finance] should find out ways and means to secure grant o100% exemption from income tax to the donor in respect of donation
made to the National Council and State Councils.
12.
The Union Government and the Government of the States and
Union Territories should ensure that within a period not more than one year
all blood banks operating in the country are duly licensed and if a blood
bank is found ill equipped for being licensed, and remains unlicensed after
[134]
the expiry of the period of one year, its operations should be rendered
impossible through suitable legal action.
13. The Union Government and the Governments of the States and
Union Territories shall take steps to discourage the prevalent system of
professional donors so that the system of professional donors is completely
eliminated within a period of not more than two years.
14. The existing machinery for the enforcement of the provisions of
the Act and the Rules should be strengthened and suitable action be taken
in that regard on the basis of the scheme submitted by the Drugs Controller
(I) to the Union Government for upgradation of the Drugs Control
Organisation in the Centre and the States (Annexure II to the affidavit of
Shri R Narayanaswami. Assistant Drug Controller, dated September 16,.
1994. )
15. Necessary steps be taken to ensure that Drug inspectors duly
gained in blood banking operations are posted in adequate numbers so as
to ensure periodical checking of the operations of the blood banks
throughout the country.
16. The Union Government should consider the advisability of
enacting a separate legislation for regulating the collection, processing,
storage, distribution and transportation of blood and the operation of blood
banks in the country.
17. The Director General of Health Services in the Government of
India, Ministry of Health shall submit a report by July 15, 1996 about the
action taken in pursuance of these directions.
18. It will be open to the Director General of Health Services,
Government of India as well as the National Council to seek clarification/
modification of these directions or further directions in this matter.
Drugs and Cosmetics Act
In accordance with the directive of the Supreme Court, NACO
appointed an expert committee to revise the Drugs and Cosmetics Rules
Pertaining to blood banking. After a series of meetings spanning over two
years the amended Drugs and Cosmetics Rules virtually a total revision
came into force with effect from April 5. 1999. The rules thereafter were
modified thrice till 2003.
Under this act and its rules, no blood bank in the country can function
without first obtaining license from the Central License Approving Authority
of the Ministry of Health and Family Welfare on the basis of recommendation
[135]
of Director, Drug Control of the state by abiding the condition laid down: in,
the Act and the Rules. The license has to be renewed on expiry.
The most important point of this legal provision
motivators should take note of that blood from voluntary
out door camps can only be collected by:
* A licensed Government Blood Bank,
* Indian Red Cross Society,
' A licensed Regional Transfusion Centre
State Blood Transfusion Council constituted
Government.
that the donor
blood donor in
designated by
by the State
Relevant extracts of the Drugs & Cosmetics Rules (1999) for blood
donor motivators are given in Annexure IV.
Drugs and Cosmetics -::
^: - • Act 1940. - -:; -.
(23 Of 1940)
:
-,
THE DRUGS AND COSMETICS RULES, 1945
amended by
THE DRUGS AND COSMETICS (THIRD AMENDMENT}.
RULES, 2003 t -
[136]
Ethics in Transfusion Service
The word 'Ethics' is derived from the Greek adjective 'Ethica' which
comes from the Greek substantive 'ethos' meaning customs, usages
and habits. It is also known as 'Moral Philosophy'. The word moral is derived
from the Latin substantive 'mores' which also means customs or habits.
Customs are not merely habitual ways of acting. They are ways approved
by the group or society. Thus 'Ethics' is the science of rightness and
wrongness of conduct. Conduct is purposive action, which involves choice
and will. It is the expression of character which is a settled habit of will.
Character is the permanent habitual inner bent of mind, and naturally
reflected in habitual conduct. This is how any text book of 'Ethics' will
explain the term; a term intimately connected with the 'science of ideal
involved in human life'.
Blood transfusion is a complex science that links healthy blood donor
with the ailing patient in quest of a new lease of life with various
intermediaries and a system.
The first requirement is the blood donor. Only four out of a thousand
people in India can think of donating blood. Dearth of donors prompted
many people to trade in human misery, to open commercial blood banks
engaged in buying and selling of blood. Nowhere in the world can paid
professional sellers ensure the quality of blood in spite of sophisticated post
donation tests. So, all over the world stress is given on voluntary blood
donors and switching over to total voluntary blood programme. To achieve
this, the culture of blood donation should be the custom of the community.
This can be done by converting the Egoism of individuals to Altruism. The
ideal life of one requires others to complement it, and it is by mutual help
that the whole develops towards perfection. An individual is a member of
a social unit, his supreme will should not simply be the perfecting of his
own life, or the realisation of what appeals to him as the most fundamental
values but also the perfecting of the society to which he belongs. To a great
extent one end will coincide with the other.
When we seek simply our own individual ends, this attitude is called
'egoism' while the term 'altruism' has been used to devotion to the ends of
others. We can realise the true self or the complete good only by social end.
In order to do this, we must negate the merely individual self, which is not
the true self. We must realise ourselves by becoming worthy of the society
to be useful for others. The more fully we do so realise ourselves, the more
do we reach an universal point of view - i. e., a point of view from which
our own private good is no more to us than the good of anyone else. This
[137]
is self-realisation — self realisation for the sake of the whole. This good is
clearly a social good.
With conviction and faith in this philosophy, any individual, group
and organisation can take up the task of blood donor motivation, recruitment
and retention by converting 'egoism' of individuals to altruism, remembering
all the time that motive means what moves us or causes us to act in a
particular way.
The means should not be overlooked. Education of soul is the only
tool. The donor should be assured of absolute confidentiality about identity
and blood test results and reasons of deferral.
Then comes the blood bank to collect blood to ensure safety of the
donor and safety of the recipient.
Scientific donor screening, maintaining confidentiality at every stage
should be the creed of blood bank personnel to collect blood and maintain
adequate stock. In storing and distribution of blood the administrative or
personal balance of convenience should not get precedence but the need
of the patient should be the supreme. For this, development of personnel
at all levels through training, education and self-development would be
necessary. The community should have appreciation for the blood donor,
blood bank personnel including those behind the public eyes working
faithfully in the laboratory, counter and other places.
Then comes the doctors, the users of blood. Blood transfusion is
transplanting from outside in large quantity to human circulation system.
There are some hazards which may be fatal too. Unnecessary transfusion
should be avoided to ensure safety of the recipient. In case of planned,
cold or chronic cases, the attending doctor can deter a patient's relatives
from going' to commercial blood sellers. He/she can inspire the patient's
friends and relatives to donate blood for some one whom they love. He/
she can help the blood bank by sending the report of blood transfusion
through feed back/reaction forms. One more thing. Asking for the so-called
fresh blood every now and then puts the patient in the hands of paid donors
in disguise and also to the hazard of untested blood transfusion. This ethics
can be implanted among the doctors from their student days through
education and demonstration and culture of the elders.
International Society of Blood Transfusion, International Federation
of Red Cross and Red Crescent Societies, World Health Organisation
between the period 1948 and 2000 have released various documents on
the ethics of blood transfusion service.
[138]
Finally, it may be said, that the laws of a country are made by the
rulers and are therefore changeable. Laws of nature are constant, inviolable,
all pervading and unchangeable. The laws of ethics evolve and cannot be
changed but they may be violated. On the attitude of the community about
the ethical laws/practices depends the quality of life of the people of the
country.
A Code of Ethics for Blood Donation and Transfusion formulated
by International Society of Blood Transfusion on July 12, 2000.
The objective of this code is to define the ethical principles and rules
to be observed in the field of Transfusion Medicine.
1. Blood donation including haematopoietic tissues for transplantation
shall, in all circumstances, be voluntary and non-remunerated; no coercion
should be brought to bear upon the donor. The donor should provide
informed consent to the donation of blood or blood components and to
the subsequent (legitimate) use of the blood by the transfusion service.
2. Patients should be informed of the known risks and benefits of
blood transfusion and/or alternative therapies and have the right to accept
or refuse the procedure. Any valid advance directive should be respected.
3. In the event that the patient is unable to give prior informed consent,
the basis for treatment by transfusion must be in the best interests of the
patient.
4. A profit motive should not be the basis for the establishment and
running of a blood service.
5. The donor should be advised of the risks connected with the
procedure: the donor's health and safety must be protected. Any procedures
relating to the administration to a donor of any substance for increasing the
concentration of specific blood components should be in compliance with
internationally accepted standards.
6 Anonymity between donor and recipient must be ensured except
in special situations and the confidentiality of donor information assured.
7 The donor should understand the risks to others of donating
infected blood and his or her ethical responsibility to the recipient.
8 Blood donation must be based on regularly reviewed medical
selection criteria and not entail discrimination of any kind, including gender,
race, nationality or religion. Neither donor nor potential recipient has the
right to require that any such discrimination be practised.
[139]
9
Blood must be collected under the overall responsibility of a suitably
qualified, registered medical practitioner.
10 All matters related to whole blood donation and haemapheresis
should be in compliance with appropriately defined and internationally
accepted standards.
11
Donors and recipients should be informed if they have been
harmed.
12
Transfusion therapy must be given under the overall responsibiliiy
of a registered medical practitioner.
13. Genuine clinical need should be the only basis for transfusion
therapy.
14
There should be no financial incentive to prescribe a blood
transfusion.
15.
Blood is a public resource and access should not be restricted.
16. As far as possible the patient should receive only those particular
components (cells, plasma, or plasma derivatives) that are clinically
appropriate and afford optimal safety.
17
Wastage should be avoided in order to safeguard the interests of
all potential recipients and the donor.
18.
Blood transfusion practices established by national or intemational
health bodies and other agencies competent and authorised to do so should
be in compliance with this code of ethics.
Blood safety
Instruments
* Legislation & regulation
* Committee on Ethics
* operational strategies
* BloodPolicy
Ethical principles
Medicalprofessionals
Human dignity
Non discrimination
Honest & clear information
Free & informed consent
Confidentiality
Medical secrecy
Who is responsible ?
*National authorities
* Health system
RIGHTS
DONOR
RECIPIENT
OBLIGATIONS
[140]
Public Relations in
Transfusion Service
It may be interesting to look back to the historical background of public
relations. Emperor Ashoka used to inscribe his edicts on pillars and hills
I to inform his subjects. There is also ample evidence in records to show that
early Roman and Greek emperors took great care and attention to influence
public opinion.
The American revolution was initiated by a small group of men
including Thomas Paine, Benjamin Franklin. Hamilton and Thomas
Jefferson — all of whom utilised public relations to influence public opinion
in favour of the struggle for independence.
In England too, pamphleteers of the eighteenth century like Jonathan
Swift and Daniel Defoe were using methods to propagate their ideas which
resembled the present day PR practice.
The phrase "Public Relations" was first coined by PresidentThomas
Jefferson when he scratched out the words "State of thought" and replaced
hose with the word "Public Relations" as early as 1807 when he was writing
his address for the seventh Congress.
Modern profession of Public Relations can however be traced back
to 1923. Dr Edward L Bernays wrote a book "Crystalising Public Opinion"
a full length treatise on Public Relations.
At every stage of transfusion service Public Relations is the tools and
implements based on both oral and written communication to ensure safe
blood transfusion.
But mere publicity is not public relations. Publicity is mostly nonI personal stimulation of demand for a product or business unit by planting
commercially significant news about it in published media or obtaining
favourable presentation of it through print or electronic media.
Public Relations practice is the planned and sustained effort to establish
and maintain goodwill and understanding between an organisation and its
publics.
Publics is a part of jargon of public relations. It is an invented word
not to be found in any orthodox dictionary. It shows that public relations is
rarely concerned with the "General Public'.
[141]
An ideal blood bank has five basic functions, as stated and explained
earlier:
• Blood donor recruitment
• Blood collection
• Blood processing and storage
• Blood distribution
• Post transfusion follow-up and research.
Therefore, basic Publics of blood banks would be:
• Blood donor motivators and donor organisations
• Blood donors and intending blood donors
• Community
• Blood bank personnel
• Patients' relatives in quest of blood
• Blood users
• Media personnel.
Advertisement is not public relations. The difference between
advertisement and public relations is:
Advertising Media
Public Relations Media
Display of. Classified Advertisements
Feature Articles, News Stories
Outdoor advertisement Posters
Educational Visual Aids and
Posters
Sales Promotion Schem
Educational Literature
Sates Sales literature
Seminars. Meetings
Modern marketing is also not public relations. Marketing deals with
market and public relations deals with publics.
Public relations is actually a transfer process. In blood banking
a negative situation is converted into positive achievement through
knowledge — the result is the objective of public relations, understanding
in blood banking and the process is known as Public Relations.
In tabular form Public Relations in blood banking may be summed :
up as an activity to change the behavioural pattern from a Negative Situation |
to Positive Achievement as:
[142]
Negative Situation
Non Donor/Irraiional User
Positive Achievement
Blood Donor/Rational User
Sympathy
Acceptance
Interest,
Knowledge
Hostility
Prejudice
Apathy
Ignorance
The Public Relations is a transfer process. Public Relations is NOT • A barrier between the truth and the public.
• Propaganda to impose a point of view regardless of truth, ethics
and public good.
• Publicity aimed directly at achieving sales although public relations
activities can be very helpful to sales and marketing efforts.
• Composed of stunts or gimmicks.
• Unpaid advertisement.
Therefore Public Relations practice includes:
• Everything that is calculated to improve mutual understanding
between an organisation and ail with whom it comes into contact,
both within and outside the organisation.
• Action to discover and eliminate source of misunderstanding.
• Action to broaden the sphere of influence of an organisation by
appropriate publicity, advertisement, exhibitions, films, etc.
• Everything directed towards improving communication between
people and organisations.
International Public Relations Association (IPRA) defines Public
Relations as:
"Public Relations practice is an art and science of analysing the trends,
predicting their consequences, counselling organisations, leaders and
implanting plans and programmes of action which will serve both the
organisation and the public".
The national body, Institute of Public Relations (IPR) has adopted
more direct definition as:
"Public Relations practice is a deliberate, planned and sustained effort
to establish and maintain mutual understanding between the organisation
and the public. "
[143]
Seat and Draw Competition for Motivational Posters
[144]
Communication in
Donor Recruitment
All living organ isms communicate. Starting from the uni-cellular amoeba
to the highly sophisticated human being, all living creatures
communicate their feelings in one way or another. In modern era the
following are the common modes of communication:
• S i g n communication
• Oral communication
• Written communication
• Audio-visual communication.
Human beings communicate by any of the above methods. In our
Society, because of our complex mental nature, such communication may
often be deceptive and difficult to explain.
Sign Communication
Much of our communication is through signs, - the show of fists, the
look of the eyes, the shaking of the head (the North Indian's "no" and the
South Indian's "no" are just the opposite here), the clapping of hands (here
too, slow clapping means just the opposite of the clapping for applause) or
even a silent yawn are some of the many forms of sign communications,
which, though not vocal, are often very much understandable. The
communicator should remember the significance of all such signs,
particularly when he/she addresses the public for getting his/her message
through.
Oral Communication
The spoken word, though short lived, has immense power of
influencing. In fact, it can draw hearts near or tear them as under, it can lull
a mob or move an army. But the success of the spoken word depends
entirely on how effectively the speaker uses it. All leaders, generals and
motivators have succeeded on account of their excellence in verbal
communication.
Such communication has an important advantage of the speaker
noting audience reaction all the time he speaks and he can thus modify his
address according to the needs of the situation.
Basic Communication Theory
But, whatever be the method of communication, the theory of
[145]
communication to be effective, is always the same and can be represented
in the simple diagram as shown below:
Channels
Communicator
encodes
message
Media
Newspaper,
Television,
Cinema,
Poetry. Etc.
message
decoded
Target
audience
Response
Feed-back
It will be seen that the communicator encodes a message and sends t
through different media at his command to reach the target audience. The
message is decoded by the target audience which generates a response,
which, again serves as a feedback to the communicator for revised action
as necessary.
The important factors in this programme obviously are not only the
design of the message but also the study of the feedback. If the message s
not decoded in the manner the communicator desires it to be, the response
will be different from the intended one and the communicator will have to
redesign or revise his message. This is of particular importance to any
speaker whose action must be instantaneous to the response.
Communication Effectiveness: The Design and Delivery of Message
Wilbur Schramm has laid down some excellent points to make
communication effective. He states:
• The message must be designed and delivered in a manner so
that it attracts the attention of the target listener.
• It must employ signs which refer to experiences common to the
target listener and match his value system.
• The message must arouse a sense of needs in the listener and
suggest ways to satisfy them.
• It must reach at a time after the listener may be moved to make
the desired response and be allowed to do so.
Lord Mahabir, bom in 599 BC, in his sermon preached that carefulness
in speech (Bhashasamiti) consists in avoiding slanderous, ridiculous, harsh,
critical, boastful and meaningless talk. These bring good neither to oneself
nor to others. He emphatically preached that a wise ascetic should speak
[146]
what he has seen; his speech should be brief, free from ambiguity and clearly
expressed. His speech should neither be deceptive nor cause anxiety to any
one.
The postulates of Schramm, however simple they may seem,
should be remembered at all times by motivating speaker. They
speak about the manner and the theme of the message have to be designed,
employing experience and analogies that are common to the listening public
and also about the time to be chosen for delivering it so as to make an
effective impact. The occasion, the time, the facilities, the mood and the
inclination of the listeners must be keenly observed before and during the
process of communication. The message will have to be modified, pruned
or enlarged as the situation may demand. The time planning, i. e., duration
of speech or talk is the key to success and must be according to the situation.
While delivering the message, its contents must not be made too
technical or stuffed with statistics. It should contain a promise and must
lead to a personal ego-satisfaction of the listener only then he will be
motivated- A blood donor or blood recipient in the role of donor motivator
will succeed much more in motivating his fellow-workers towards blood
donation than a doctor who is much more knowledgable and may even be
a better speaker.
In verbal communication, the qualities of a speaker are very important.
He/she should know his subject well, and should have a good bearing,
appropriate dress and proper manners. He should have a loud dear voice
with good articulation. He/she should also be able to make friends with the
audience, earn trust and be in a position to persuade them. Thus, he/she
should be a person with versatile knowledge and taste. Finally, he/she must
be tenacious enough to drive his/her point home.
The talk he/she delivers should have the following desirable qualities:
• Appropriate for the audience
• Concise, informative and appealing
• Suiting the time and attitude of the listeners
• Clear, lucid language• Correctly pronounced without
mannerism or unnecessary
repetition of words and phrases
• Should be delivered by the speaker who should look to
each
section of audience by rotation and not vaguely or to one section
of it only
• Contain a sense of humour. Properly chosen moments of lightness,
even in a serious topic, make a speaker impressive and make a
talk interesting.
[147]
The 'X'factor
And yet. even by possessing all the above qualities perfectly, a speake
might fail and without consciously following them, while another may
succeed. This is due to what is called the unknown factor or "X" factor. This
factor is truth and the speaker's firm conviction about it. If the speaker
believes in what he/she says and can say it well, it has a magic influence or
the audience. Truth itself has an inherent strength that gives any speech i
sound foundation. So, if the speaker is himself/herself truly convinced c
his/her mission, words that flow out of him/her are spontaneous. He/she
can electrify and touch the hearts of his/her audience and move them it
the manner he/she desires. Any campaigner would do well to remember it
Donation of blood on a voluntary basis is a social necessity and for a noble
cause. If the campaigner sincerely believes in it and can voice his/her
conviction well, it should not be difficult for him/her to win his/her audience,
even if partially, Conviction to convincing is only one step away.
In Indian context oral communication backed by display materials
and distribution of take-home printed materials are found to be most
effective.
In the oral communication for motivation of blood donors the following
should be focused:
• Need of blood for transfusion
• No substitute of human blood
• Need and importance of voluntary blood donation to ensure safe
blood transfusion
• Statistics of deficit in supply of blood
• Blood volume, surplus quantity, amount of donation, recuperation
period, shelf-life of blood
• Eligibility of donors and donor education for self exclusion
• Blood donation is a social and moral responsibility.
Ten Commandments of Good Oral Communication
• Clarify ideas before attempting to communicate.
• Examine the purpose of communication.
• Understand the physical and human environment while
communicating.
• In planning communication, consult with others to obtain the1
suggestions as well as the facts.
• Consider the content and the overtone of the message.
• Whenever possible, communicate something that helps or is
valued by the receiver.
[148]
•
•
•
•
Communication to be effective requires follow-up.
Communicate messages that is short-run and longrun
importance.
Actions must be congruent with communication.
Be a good listener.
Written Communication
Though effective, the limitation of the written form of communication
is that it can influence literate persons only. Poets, authors and editors have
used the written word to make communication charming and even
memorable. Even today, speeches before august gatherings are read out
from written material. It has the unique advantage of being precise, concise
and unambiguous. It. however, has one shortcoming that the communicator
cannot project his personality and give the finer touches of emphasis which
he/she can do with the spoken word.
Ten commandments of Good Written Communication
•
•
•
•
•
•
•
•
•
•
Use simple and familiar words.
Use personal pronouns (such as you) wherever appropriate.
Give illustration and examples; use charts.
Use short sentences and paragraphs.
Use active verbs such as "The organisation plans".
Economy on adjectives.
Express thoughts logically and in a direct way.
Avoid unnecessary words.
Use simple words and phrases.
Avoid printing or typographical errors.
The audio-visual communication
A combination of speech and sight, this form of communication is
perhaps the best because it incorporates the best features of the written
word, the painted picture and the spoken word. Appealing to the senses of
sight and hearing, its imprint on the mind is most. It can also motivate an
illiterate audience.
Stories as Vehicle of Communication
Since the prehistoric days stories have been used for passing around
the message. Stories of the Upanishads. Parables, stories of Vishnu Sharma
and Panchatantra are well known. In donor motivation and recruitment,
stories are being used with great success. Reasons for success are;
• Stories built on the impact of spoken words are morepowerful
than written words.
[149]
• Everyone is interested in stories; they can identify themselves with
characters of the stories.
• While some educated people might have been trained to thin:
in a logical, organised way, the story format is closer to the wa*.
most people think, including the educated community.
• People remember information better when it is presented in,
story format than in a mere formal talk or lecture.
• Stories can make truth concrete or absolute - abstract ideas can
be expressed in everyday terms.
• Stories begin with things people understand most.
• Stories can help people to discover action plan/values/principles
for themselves or develop an attitude towards life.
The human values might constitute main ingredients of the story with
the hints of blood donation on the sidelines. Another approach is to have
the main story dealing with topics having a high universal appeal with
characters real or imaginary and donation of blood as derived sub-theme.
A well developed story will provoke a response if listeners find it to be
relevant to their life. The stories should be presented in an interesting way.
by changing one's voice to suit the different sequences and the characters.
If people believe in the stories and identify themselves with the characters
they are more likely to remember the message and take action to change
their behaviour.
To find stories, one must look around and pick up stories from every
day life. The Epics and literatures are the store house of enough stories.
A caution of story telling is that one should not miss wood for the
trees. Too many stories without appropriate linkage with the theme may
spoil the presentation.
Using Visual Aids in Donor Motivation Sessions
Visual aids such as films, slides, transparencies can help to clarify the
talk and highlight salient points but these may be counter productive to the
talk in the Indian context. Darkness in the room may result in one's losing
eye contact with the listeners, so essential for successful communication
In the middle of the talk, the hardware may go out of order or sudden
power failure may lead to confusion.
Visual aids are not vital tools in donor motivation sessions. Those can
be used if they add real value to the talk. The speaker should make sure
whether or not they are really needed, and if so. which type should be used
- OHP, slide projector or video and should get the answers to the following
[150]
questions before using the visual aids:
• Does the visual aid add clarity to the speech?
• Is the meaning of the visual aid instantly obvious ?
• Can the speaker talk just as effectively without it ?
Transparecies
Here are tips for successful use of transparencies in such places. They
are;
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Have no more than five words in a line and not more than seven
lines in a transparency; too many transparencies may spoil the
talk.
Omit all unnecessary details. Letters and words should be big
enough to, be clearly visible even from the back of the room.
Avoid spelling mistakes.
Don't spend more than a minute or two discussing each heading.
Consider making transparencies with drawings, cartoons with
the help of computers and colours.
Consider covering up the headings revealing only one at a time
to prevent the audience from getting ahead of the speaker.
Transparencies should be numbered and should be in order.
Projector light should be switched off whenever there are pauses
between transparencies.
Never compel the audience to look at a brightly lit but empty
screen.
Talk to the audience and not to the transparency.
Practice using OHP before the audience enters the room.
Make sure written materials fit in the screen.
Practice transferring from one transparency to another smoothly.
Make sure that the there is a table at the side of OHP high enough
to lay transparency before and after use.
Do not be in the way of anyone viewing the screen.
Transparencies are not substitute for speakers' home work or
organisation of presentation. These can only be visual supplements to the talk.
Only imaginative preparation and use of transparencies can help
in
presentation as aids.
Slides
The use of slides to display the presentation material can be an
effective technique, if and only if the audience needs to see it. A 35 mm
slide programme creates a highly professional image. Similarly, if the
slides are well chosen, less text is needed. Disadvantage of using
slides is in
[151]
momentary lo40ss of eye contact with the audience due to darkness.
Slides are to be kept in plastic pages, in a cool dry area. This will keep
them from warping.
The slides on the very top (as they appear in a box) starting from
front left and moving towards back right are to be maintained. This way
when loading the projector, a quick glance will ensure that all the slides ere
in the right side up and in order.
Flip charts
A flip chart is the easiest visual aid to create. It can be done in advance
or as the audience responds. While using a flip chart for presentation, the
presenter should remember not to speak to audience with his back facing
them. Care must also be taken regarding spelling, legibility, etc.
Though flip charts are the easiest of all visual aids to make, they are
relatively time consuming. Printed flip charts for one campaign may be
used by a number of people.
Presentation with Computer
Presentation with computer (with LCD), however attractive it may
appear, would not be suitable in motivation session for most of the target
group owing to logistics and cost. Preparation of material for such
presentation needs expertise and presentation requires practice.
Using Visual Aids
While using visual aids, there are a few points to be kept in mind.
Consistency: It is important that art work and lettering be consistent
from slide to slide or transparency to transparency. All the titles should utilise
the same size print.
Centering: The centre of the visual aid is the first place the audience
will focus their attention on. This is followed by the top of the visual aic.
Visual aids ought to be arranged in such a way so that the most important
message is in the centre, and other important messages are in the top areo.
Colour psychology: Different colours get different reactions from the
audience. While white stands for peace and tranquility, blue stands for cool
and relaxation. Purple stands for royalty and richness. Red stands for alarm
and stimulation. Yellow stands for happiness and warmth. Green stands for
health and freshness. Too many colours should not be used in one
transparency.
[152]
Over doing: Too many visual aids can be distracting.
Placement: Placement of visual aid should be such that the presenter
and the aid receive equal attention.
Designing Visual Aids
All visuals should be properly planned for the target audience.
Simplicity: Each visual should have one main point and a maximum
of 3 or 4 minor points — more the number, less is the effectiveness.
Format: The format should be the same for all visual aids of a particular
presentation.
Not cue cards: Visuals should not be a cue card. One should know
his/her presentation well enough so that the presenter need not have to
rely on visuals to know what comes next.
Distribution of Take Home Materials
It is always better to distribute take-home materials at the end of
presentation.
Listening
Listening is an important tool in donor recruitment in individual
approach or group approach strategies. The chief complaint about donor
recruiters is that they do not really listen. They always go on talking. This is
a mistake. Listening is a part of communication. One can pay people no
greater honour than to actually absorb the content and intent of what they
have to say. Communication in donor motivation session is neither one
way nor superficial stringing of words together. Communication for blood
donor recruitment is actually a communication between heart and heart
supported by head.
Once people find that motivators are willing to take the time to
understand them, they will take time to arrange thoughts into concepts that
are easier to comprehend. The motivator may even create some listeners
of his/her own. Then one can reach a state where true communication
takes place. The motivator is actually transmitting and receiving real
messages.
Once the motivator has a basis for eliminating or preventing
misunderstandings, success is at hand. Nothing is more important than
true understanding and nothing is harder to come by.
[153]
President Lincoin makes "A few appropriate remarks"
At the dedication of the National Cemetery at Gettysburg.
On November 19, 1863
"Fourscore and seven years ago, our fathers
brought forth upon this continent a new
ation, conceived in liberty, and dedicated
o the proposition that all men are created
equal. Now we are engaged in a great civil
war, testing whether that nation, or any
nation so conceived and so dedicated, can
long dure. We are met on a great
battlefield of that war. We are met to
dedicate a portion of it as final resting place
of those who here gave their lives that that
the nation might live. It is altogether fitting
and proper that we should do this. But in a larger sense we cannot
dedicate - we cannot consecrate - we cannot hallow this ground. The
brave men, living and dead, who struggled here, have consecrated it
far above our poor power to add or detract. The world will little note,
nor long remember, what we say here, but it can never forget what
they did here. Is for us, the living, rather to be dedicated here to the
unfinished work that they have thus far so nobly advanced. It is rather
for us to be here dedicated to the great task remaining before us, that
from these honored dead we take increased devotion to that cause
for which they here gave the last full measure of devotion; that we
here highly resolve that these dead shall not have died in vein; that
this nation, under God, shall have a new birth of freedom, and that
government of the people, by the people, for the people, shall not
perish from the earth".
The president had spoken in a clear, loud voice, but he was through
before the audience felt he was fairly started, and the applause was
Slow and perfunctory.
Some newspaper actually ridiculed the address, a few praised it; a
few people at once recognised a masterpiece- Edward Evertte, the
orator of the day who spoke for two hours, himself wrote to the President
the next day: "I should be glad if I could flatter myself that I came as
near the central idea of the occasion in two hours as you did in two
minutes". In his grateful reply Lincoln said: "In our respective parts
yesterday, you could not have been excused to make short address,
nor I a long one. I am pleased to know that, in your judgement, the
little I did say was not entirely a failure".
[154]
Blood- Share Life
[155]
IEC Materials for
Donor Recruitment
A
lthough oral communication, both for short term and long ter n
strategies to recruit voluntary blood donors in the Indian context has
been found to be useful and has been strongly recommended, supporting
information, education and communication materials in print would be
needed as complementary tools and implements.
Most important IEC material is poster. The message of posters should
be short, simple and easy to understand. Message may be emotion; 1,
statistical or scientific. The visuals should be easy to understand and must
appeal to the value system of people of the land or region. The language
should be always local. The trained motivators would be able to write the
copy of such posters and an artist having knowledge or experience in blood
donation may be able to design visuals. Type of printing would depend on
the quantity required and fund available. Printing may be lithography,
letterpress, silk screen, offset or even xerox offset. The quality of paper may
be selected depending on the design and purpose of the poster. The paper
may be art paper, chromo art paper, maplitho, white printing, bond or
even news print. Posters for permanent display or for using over and over
again may be laminated and or mounted on board or wood. A number of
posters covering all aspects of blood and blood donation may constitute a
set and may be used for blood collection drive. For outdoor camps,
Books, booklets, folders, stickers, sunshades, calendars, paperweights,
paper handfans, key rings and badges with appropriate message and design
or content can be supportive lEC materials for blood donor recruitment.
Postal stamps of many countries on blood donation give ideas of visuals
which may be adopted for lEC material. AVIS, Italy has coloured pictorial
booklet with all stamps on blood donation so far published by different
countries.
Slides, transparencies, film, filmstrips. video and audio cassettes, can
be used as IEC materials. In motivation sessions in India it would be difficult
to organise hardware and curtains. Furthermore, by making the room dark
the motivator may lose eye contact with the audience. Eye contact with
audience is an essential ingredient of successful direct oral communication.
But motivators should learn the technology to produce such materials
with the help of others and they should be able to use those when the
situation so demands.
The motivators should be careful while designing messages for IEC
materials. The message must be clear and if possible indicate some benefit
to the donor or to the society. The message must be tested with donors and
non-donors. The messages developed and tested should be used as
frequently as possible because repetition is a key element in communication
process. In addition to creating the messages, graphic elements to
accompany the messages sometimes may be useful.
lEC Materials Used in Different States of India
1, Poster
7. Paper Article with Message
• Class time-table
• Emotional
• Message
• Sun guard
• Statistics
• Fan
• Science
8. Visual
• Announcement
• Slides
2, Flip chart
• Transparencies
• Science
9. Cards
• History
• Greetings
• Statistics
• Announcement
• Story
10. Books & Periodical
3, Sticker
• Book
• Message
• Folder
• Announcement
• Pamphlet
• Watch Sticker
• News Letter
4, Badge
• Journal
• Message
• Bulletin
• Symbol
11. Advertisement
5, Hoarding
• Radio spot
• Message
• TV spot
• Announcement
• News paper Ad
• Ad in Periodicals
6, Novelties with Message
• Key-ring
12. Print & Electronic Media
• Carry-bag
• Feature
• Purse
• Appropriate slot
• Bust
• Special article
• Special programme
[158]
Use of Mass Media
M
ore and more people in the third world have been gaining access to
mass media. Mass media in India are often poorly used as one way
'top down communication' in the field of blood donor recruitment However,
with little imagination, it is possible to make effective supportive use of
media to spread the message of blood donation. Mass media may be
expensive unless the existing slots are effectively used.
The 1990s is a decade of intense social change. The most important
factors contributing to this change are increasing access of common people
to modern electronic media.
Radio is still the media channel that reaches widest audience
particularly away from metropolitan cities. The following slots of TV/Radio
can be used:
• News items
• Interviews
• Spot announcement
• Drama
• Jingles
• Quiz
• Phone ins
• Music
• Discussions
• Panel discussions
There are an estimated 1050 million TV sets in the world. One for
every six persons. Most of these are in industrial countries with one TV for
every two persons. In the developing countries, particularly ir. cities and
towns, there is one TV for every twelve persons. In Asia there is now one
VCR/VCD for every seven TVs. In India more than 12000 VCPs have been
fitted to long distance buses that travel between the states.
Mass media messages tend to be general and are not always relevant
to the needs of the specific community or groups. It is also difficult to be
selective and target one particular age group. And, unlike face to face
approaches, there is no direct feedback. But on the other hard if carried
out well, mass media has the advantage of being able to reach a large
audience rapidly and does not require an infrastructure of field workers.
Although, many people prefer face to face communication, lack of
time, shortage of field volunteers and difficulties of transport can make
mass media a vehicle of communication but these have to be used with
careful pretesting, evaluation and audience research, obviously with
pragmatic planning. The mass media can help in creating awareness and
in behaviour change, agenda setting, creating a favourable climate of
knowledge and opinions suggesting action plan and conveying newer ideas
[159]
and concepts. The feedback of the programme should be obtained through
survey, opinion poll and audience research.
In Amambara state, Nigeria, 43 mini dramas on family planning were
used in the popular variety show "In a lighter mood". During the period
attendance at the major clinic in Enuga increased from 50 in a month to
more than 120 in a month. After the first month, an average 45 percent of
the visitors to the clinic mentioned the show as their source of referral. In a
survey carried out on the streets more than half the people surveyed had.
watched the programme the night before. More than two third of these
people could give the address of the clinic mentioned in the programme
In India, a soap opera produced, was called HUM LOG (our people
that used stories about ordinary people to promote ideas of equal status for,
women, family harmony and small family sizes, An average of 50 millior
people watched 156 episodes spanning over a period of 17 months ir
1985-86. It was evaluated through a survey of viewers. Evaluation revealed
that the first twelve programmes were not as popular as later ones. The
earlier programmes put too much emphasis on family planning messages
and not enough entertainments and establishing the characters for the
drama.
In Switzerland a six month radio campaign was run to promote home
made oral rehydration solution. Twenty radio programmes of 15 minutes
each, 46 radio inserts each of 5 minutes and 22 spot announcements were
developed. A leaflet with mixing instructions was produced and poster
were displayed at health clinics. Training workshops were held for health
workers and participants in turn trained other volunteers. Local volunteer,
were given yellow flags to hang outside their homes to show that they could
help in treatment of diarrhoea. Evaluation of the campaign showed that 85
percent of the country's population had been exposed to the campaign, A
survey before the campaign showed that only 15 percent could correctly
make up the solution. After the campaign, this increased to 42 percent.
In 1981, prior to first ever mass blood donation camp in West Bengal
AVBDWB launched a three-month campaign: announcement of the
programme jointly with the Indian Football Association, sponsored
newspaper advertisement with coupons one month before the camp, display
of posters throughout the state, sponsored hoarding, radio talks in sport
slots, news write-up in sports page and announcement during the interval
of charity football matches through the PA system of the stadium as also at
intervals through running commentary on radio, distribution of 50 thousand ■
leaflets in a single day in a charity football match, decorating the stadium
with colourful announcement posters requesting the TV crews to focus their
[160]
Educational Programme
;Sl"tK.f«ni'll'«i-
live
Reminder to Donors
una
Blut
Motivational Materials
Information Materials
Just be a blood
Donor
screened
blood
Therefore
old transfusion unless
bsolutely necessary.
n of whole blood !■ seldom us
r,.,n*foie
-*** btaod is Hot ii«tf»,iry
rewdrbps4oi your Mood
Educational Materials
Touching the Heart
camera on the posters while the important football match was in progress.
On the day of the donation radio announcements from time to time
communicated the latest number of donois.
On August 16, 1981 there was no newspaper but there were 1208
donors. They came individually by using public transport, despite
intermittent torrential rain. Next day, the press covered the programme
through sports columns as it was a donation in the field of sports. The radio
and TV made it an important local news. This camp has now entered into
its twenty third year generating a large number of smaller camps by the
individual donors of the day in their locality or place of work.
Print media can play an effective role to propagate the news of blood
donation, forthcoming blood donation programme, messages and articles
on blood and blood donation by using appropriate slots without cost besides
advertisements, special issues and supplements. Appropriate slots in print
.media are:
• News items
■ Letters to the editor
• Feature articles
■ Health columns
For all these, donor recruiters must maintain good rapport with media
people.
But media should be used judiciously. Over using media may have a
counter productive effect.
Constant Review & Evaluation
Translating
the vision
In designing
Communication
Strategy —
Message & Media
Target
Operational
Programme
Field Trials
[169]
Rework
Feed back
and
Evaluation
Donor Records
I
n all stages of activities of blood bank, various data are generated. It is
essential to collect and store these data so that appropriate information
can be retrieved as and when required for assistance to patients, planning,
evaluation and research for donor recruitment programme. The objectives
of record-keeping are:
• To improve upon the day to day work of the blood bank
• To help promotion of blood donation
• To provide information of donors' profile
• To monitor availability, distribution and utilisation of blood.
All blood banks and transfusion centres usually have at least one thing
in common, i.e., the volume and scope of their work tend to expand rapidly
beyond the limits originally foreseen. It is important, therefore, that the
record keeping should be systematically planned from the first day so that
for expansion of activities, basic system or format need not be changed.
For small blood banks, records can be maintained manually by
registers.
For medium size blood banks record keeping can be done by cardex
system with appropriate cabinet or box; The best way, however, of modern
age is to use computer .
Now a days, most of the educational institutes have computer centres.
Their facilities and human resources can be easily utilised by transfusion
centres, blood banks and donor recruiting voluntary organisations. This
will also involve the educational institutes with blood donation movement.
From blood donors and donor organisers' side, the following data of
donors are to be maintained in any of the three methods:
• Name
• Address
• Telephone No.
• Pincode .
• Date
• Bag No.
• Camp Code
• Age
• Sex
• Weight
• Blood Bank
• Group
• Rh
• Remark
Each donor organisation can be allotted a numerical code so also the
blood bank collecting blood. By designing a suitable computer coding sheet,
all information can be collected for each and every donor,
[170]
By feeding the fourteen line data in a computer, all embracing donors'
and donor organisers' directory can easily be maintained to give a number
of systems and subsystems:
Donors' Directory subsystem
Apart from the classified particulars in the Donors' Directory files, it
should also contain a short list of Rh negative donors who can be contacted
in case of emergency.
Promotional subsystem
Designed to maintain contacts with the prospective and regular donors.
Outputs of this subsystem are the various mailing lists, camps and
organisations such as:
• Mailing lists of regular donors who should be thanked, recognised
or sent birthday greetings etc.
• Mailing lists of prospective donors who will attain blood donation
age in the following month.
• Mailing lists for sending invitations regarding various functions,
including blood donation camps on special occasions.
The various reports that can be generated from the donors' directory are:
• Negative donors list
• Pincode-wise donors' list
• Multiple donation record of donors and donor organisations
• Collection pattern of blood banks
• Sex ratio of blood donors
• Blood group distribution in the community
• Age distribution pattern of donors
• Average body weight of male/female donors
• Graphical display of all such data can easily be prepared.
Classification of donor organisations and their days of blood donation
camp would help in planning blood donation drives in the next year.
Without proper record keeping, donors or donor organisations cannot
be honoured. Honouring donors and donor organisations help in donor
retention.
The donors' directory may be utilised to meet emergency blood
need,
rare group patients' need, fresh blood need and also for inviting donors for
subsequent donation after three months or at least once in a year and also
for 10/25/50/100 donation awards.
[171]
Blood banks can easily maintain their record of storage, shelf life,
requisition, blood bag movement, blood users' details by properly designing
a coding sheet or their registers/cards/forms suitable for direct data entry in
the computer.
These data in turn would help in developing the following subsystems:
Routine subsystem
To provide information regarding the stock of various categories of
blood and to provide timely warning if certain categories fall short of
specified limit. The subsystem should also provide messages regarding the
bags of which the dates of expiry have crossed.
Analysis subsystem
The objective of this subsystem is to use the information stored in
various files and to provide a number of statistical report as:
•
•
•
Utilisation/wastage analysis
Blood requisition pattern by doctors and for different medical/
surgical cases
Seasonal changes in blood requisition.
In each stage of donor recruitment, the motivators would need data.
At the time of starting the work, available data of others or from other
sources may be used and with the progress of work the motivators should
develop their own data through a survey which should be checked and
updated from time to time. Selection of appropriate sample for the survey
plays a important role in deriving realistic inference.
Deferral donors' list can also be maintained by using the same coding
sheet by only adding the reason of deferral by using pre-determined coding
number. The donors, temporarily deferred may be encouraged to come
back to the main stream of donors on fulfillment of requisite criteria.
Donor counselling record can also be maintained in a similar manner
by designing a suitable coding sheet.
[172]
Quality Management in
Donor Recruitment
Q
uality is never an accident, it is always the result of high intentions,
sincere effort, intelligent direction and skilful execution of many
alternatives.
There are four universal steps to accomplishment: plan purposefully,
prepare pragmatically, proceed positively and pursue persistently. People
forget how fast a job was done - but they always remember how well it was
done.
Donor recruitment is the first step to any successful transfusion service.
In our country, personnel in medical service are mostly taught to handle
sick people, dying people and people hovering between life and death in
conscious, semiconscious and unconscious state. But the transfusion services
have to handle healthy persons as donors as well as anxious and perturbed
able-bodied friends or relatives of patients across the blood bank counter
in quest of the vital life saving fluid with sophisticated technology in between.
Our view of quality in the world today is getting broader as the world
around us is getting smaller. In this small world, owing to the advancement
of information technology, sky is the limit of expectation but we must have
the basic minimum in the country within the various constraints and
limitations.
The quality in donor recruitment obviously includes public relations,
communication and the art of man management, psychology of intending
donor, regular donor and patients' relatives, process control, training of
personnel, statistical measurement and analysis of satisfaction of donors,
users and patients' relatives. All these are based on science. The blood
bank's path of work-flow begins with public relations, donor motivation,
recruitment and retention and proceeds through blood collection,
processing, storage, distribution and post transfusion follow-up and research.
The quality at each stage directly or indirectly has a major effect on donor
recritment and retention, because satisfaction of people in and around
the system help in donor motivation and recruitment in the society. All
activities in the light of quality assurance and process simplification can be
monitored, reviewed and audited for compliance with standard for the
Purpose of improvement. People seldom improve when they have no other
model than themselves to copy after. The saying goes, that "there is always
room at the top". The quality of a system or service is in direct
proportion
[173]
to the commitment of the management to excellence. Unless improvement
is attempted all the time, the system will have an inherent tendency to go
down the stairs.
In the quality system, the next operation in the path of work-flow is
dependent on the output of the one before. Public education, donor
recruitment and donor retention are the first three functions in the blood
banking path of work-flow. Without the proper operation of these three
functions, there will not be enough blood for transfusion to patients.
Voluntary blood donors who offer their gift of love need to be handled with
care at the collection drive as also the patients" relatives or friends in the
blood distribution counter. These help in building up confidence of the
community around on the transfusion service and in turn ensure the steady
supply of blood from the voluntary blood donors for the next stage of the
process.
Quality of donor can be assured prior to donation through interview,
self declaration and some simple testing and physical examination. Scientific
donor screening helps in instilling confidence in the minds of prospective
donors and at the same time ensures the quality of blood. But the quality of
blood in totality can only be assured in the laboratory after collection and
transportation.
The laboratory testings are technical in nature. Their correctness and"
credibility help in donor recruitment. Still., donor recruitment strategies mus
float the idea of inducing all eligible persons to offer their gift of blood. The
system at the time of scientific donor screening and laboratory testing wouk
take care of quality to ensure safety of donor and safety of recipient. The
donor must be motivated and inspired to donate blood voluntarily withou
any coercion, compulsion, pressure and regimentation to endure a little bi
of inconvenience and discomfort. While doing this, the function of the
recruiter is to overcome the negative issues. This task requires skill, prudence
patience, knowledge. There is no short-cut to success in this area of blood
banking activities. Blood banks of this country suffer owing to shortage of
blood by not paying much attention to this vital and fundamental area of
service.
The quality system approach for blood donation ensures that the
process of educating and recruiting potential donors and retaining then
provide the best quality of blood going into the blood bank. Naturally, the
education of common people to donate blood shall include the parameter
for awareness for self exclusion for the purpose of safety of both the donor
and the recipient.
Blood banks must have trained manpower to handle donors an
[174]
their donation for proper utilisation with adequate provision for monitoring,
evaluating and quality assurance in all fronts to ensure blood safety.
Planning of blood collection drive must take into onsideration:
(a) the ability of the community to provide requisite blood donors,
(b) capability of the blood bank to collect enough blood in a day and
store to meet its need for at least seven days,
(c) ability of blood bank personnel to recruit, collect, process, test,
store and distribute blood following standard operating procedures (SOP).
After the major functions are identified, they are analysed using the
flowcharting.
Process analysis on flowcharting demonstrates the way the process is
currently performed. Another activity, called gap analysis, compares the
way the process is carried on now to 'best practice'. Gap analysis of blood
bank's current process to best practice identifies policies, processes or
procedures that are missing and are needed for improvement.
In a quality system the blood bank will actively determine the
requirement of both the donor and the recipient so that it car. plan its process
to accommodate their needs to the level of total satisfacticn.
The needs include :
• safe, satisfying blood donation experience on al counts,
• sufficient supply of blood,
• safe blood transfusion.
This, in turn, will need planning and scheduling more than just
sufficient number of blood donation camps to meet the reed of patients
and hospitals. The donor recruitment function must deliver what it
commits
to deliver for each of the other functional areas to be successful to ensure
blood safety.
Statistical information on public education, donor recruitment and
donor retention functions can be analysed to ensure the success of the
activities of that particular sphere. Statistical measurements capture vital
information on the percentage and type of donor defera the number of
no shows, best days and times for the best turnouts for the group, the best
donation sites and the features that make them successful, effectiveness of
recruitment and promotional strategies including techniques and materials
used. These can help in evaluation of the total programme with path
correction and evolving strategies for both the near and distant future to
achieve total voluntary blood programme by ensuring quality at every stage.
[175]
Community Based Organisations
F
or safe blood transfusion, a wide base of a large number of voluntary
donors and a culture of voluntary blood donation in the community
are required. To recruit and motivate people to donate blood voluntarily
blood donor motivators and organisers are needed. A donor motivator
cannot work alone. Naturally, suitable organisations are required to be built
up to achieve a total voluntary blood programme for the country. The
organisation can be an integral part of the transfusion service with aid
professional people. In India, there are 1832 blood banks; one professional
in each of blood bank is a drop in the ocean. The paucity of fundi .will
restrict blood banks from bringing in the required number of peop to
carry out projects in changing social attitudes. The fund constraints does
not permit blood banks to induct the best persons for the job. These
limitations can easily be overcome by establishing voluntary organisations.
In some states, voluntary organisations with active involvement :
of
the community are working from outside the blood banks to motivate recruit
and retain voluntary blood donors. There can be any number of
organisations in the form of Society, Association. Clubs. Such organise ons
may be voluntary but they can work with professional competence The
organisations may be at state / district / subdivision level or one for each
blood bank. One can see such organisations in Tamil Nadu, West Bengal,
Gujarat, Punjab Chandigarh, Maharashtra, Tripura. Madhya Pradesh, Orissa
and Delhi.
The advantages of such voluntary organisation are:
• Requires little funding as there is no salary and administrative
heads.
• Involves the community.
• Can induct the best available persons for a particular job.
• Helps in improving the quality of life of the volunteers.
• Can embrace any number of volunteers by expanding the
activities, both in the horizontal and vertical planes.
• Manpower is the vital resource.
• People well placed in life get a platform for implementing their
ideas and innovative skills, thus deriving mental satisfaction.
• Volunteers can choose their work according to their ability, skill
and liking.
• There is a place for anybody and everybody willing to work for
the cause in this organisation.
[176]
The essential technique of running these organisations is the blending
of the best of formal and informal structures honouring the classical definition
of organisation, i.e., an organisation is the systematic arrangement of people
working together towards a common objective, goal and purpose.
There are four fundamental requirements for this type of organisation :
(1) Work: product of careful thinking and planning based on objectives.
(2) People: Who will carry out the activities. They must be well qualified
and trained.
(3) Organisational structure: functional set-up with coordination from
the nucleus.
(4) Working place: coordinating office.
The executive committee elected by the members should meet to
formulate the policies, to evaluate the feedback reports and to initiate path
correction, if necessary. The informal volunteers' meetings would implement
the programmes based on the policy laid down by the executive committee.
The coordination and proper liaison between the executives and volunteers
at all level would be needed for success of any programme so also with the
blood banks.
The volunteers would get the authority from the following sources:
Authority given by the executive committee or the volunteers'
meetings.
• By virtue of position in the organisation according to the
constitution, rules and regulations.
• By personal acceptance as innovator or job-doer.
• By recognition of skill knowledge or leadership qualities.
•
The objective, goal and target should be set up after deliberation,
debate and collective decisions on the action to be taken today to obtain
the desired result tomorrow. Activities should be based on anticipating and
predicting the future. A balance should be sought to achieve between the
Present means and future results.
The organisation structure of such a novel organisation should be
functional.
A group of volunteers having more spare time than others should
constitute the core or nucleus of the organisation. The coordination,
monitoring, evaluation, path correction and overseeing all the activities
should be in their hands. In times of extreme need, they may become fullvolunteers for a specified period for a particular project by taking
leave from their place of professional work or engagement.
[177]
Another group close to the nucleus/core, but bigger than the former
should undertake responsibilities of some fixed work by adjusting their free
time according to their liking, skill and temperament. Out of 168 hours in a
week at the disposal of every individual, the voluntary organisation can
claim at least four hours per week from these types of volunteers.
Another bigger ring of people - friends, members and associates
surround the first two rings; they should be available on call for a very short
time to undertake highly specialised work commensurate with their
professional skill. They may work from their own place of work. Beyond
these three rings there should be sympathisers from the community and
friends of the movements who would consider the organisation as their
own in view of their personal acquaintance with the volunteers of the first
three ring of the organisation. They would act as ambassadors of the
movement.
With time, people from different rings may shift their position inwards
or outwards. There may be dropouts with the passage of time. Health,
family, transfers in the field of professional work or pressure of work would
be the causes. They must be replaced by newcomers. New programmes
would induct new volunteers.
The volunteers are individuals, but they have to work together as a
team. Such an organised group always has a distinct character. Though
composed of individuals, their vision, their practices, their attitudes and
behaviour, i.e., the character of the team is a common feature. The
organisation, through various training programmes, should mould the
behaviour pattern and attitudes of the newcomers to fit into the organisation
in an effective manner.
[178]
The nucleus or core should fill in the gap whenever there is any. A
leader of a particular work area should work as a volunteer in other areas
and thereby dignity and importance of all types of work could be maintained.
Small bits of work added together give birth to a big success. Recruiting
better people in the army of volunteers is part of the regular process and
culture.
Since the volunteers will be coming from different walks of life, suitable
training programme would be needed to make these volunteers worthy of
the organisation. For conducting training programmes suitable resource
persons from the society would be needed.
Two sayings exemplify the spirit of these type of voluntary
organisations. First is the Inscription on Andrew Carnaige's tombstone in
USA:
"Here lies α man
Who knew how to enlist
In this Service
Better Man than himself
The second is the slogan "it is the abilities, not the disabilities, that
count". The focus of the organisation is always on the strengths of its
volunteers and not on the weaknesses, because weaknesses of individuals
do not exist when the organisation is considered as a whole.
The following activities may be taken up by these voluntary
organisation from outside the blood bank with success but with proper
networking with other similar organisations working in the region and also
with the blood banks:
1. Education of
• Common People
• Donor Motivators
• Blood Users
2.
•
•
•
Motivation
Seminar
IEC Materials
TV, Radio Programme.
• School Students
• Social Workers
• Blood Bankers.
•Exhibition
•Newspaper Articles
3. Blood Donation
• Regular blood donation camps
• Occasional mass blood donation camp.
[179]
4. Recognition of
• Donors
• Donor organisations
• Donor motivators.
5. Database
• Donors' Record
• Rare group panel donors
• Web page in internet.
6. Publications
• Bulletin
• Periodicals
• Literature.
7. Organisation
• Coordinating regular office
• Sharing of expertise : State /
National /International
Seminars / Conferences /
Colloquium.
8. Study and Research
• Donors' profile
ƒ Donors behaviour
• Blood need
• Use of blood
• System analysis.
These organisations cannot remain
static. It needs periodic changes and
modification according to future needs and
situations in terms of objectives, and work
and personnel. Otherwise the organisation
would be in danger of losing its dynamism.
With time the work should expand
horizontally and vertically. Voluntary
organisations should cause SWOT (Strength, Weakness, Opportunity and
Threat) analysis and initiate action to plug loopholes, if any.
[180]
Leadership in Voluntary
Organisations
T
he success of any voluntary organisation lies in the ability of its leaders
to plan, organise, direct, coordinate and control its activities aimed at
its mission to fulfil a set of well defined objective to reach the goal. Leadership
can be defined as the activities of influencing people to cooperate towards
some goal which they come to find desirable. In other words, leadership
may be defined as the relationship between an individual and a group
around some common interest and behaving in a manner directed or
determined by the individual.
Leaders have the task of visualising and harmonising the desires and
the motives of those led. Thereby, they create better attitude, arouse
enthusiasm, create improved morale and foster a spirit of cooperation. They
use their personal influence to alter human behaviour. They are able to
motivate people.
The four basic leadership styles are:
Style 1:
Directing
The leader provides specific instructions
and closely supervises task accomplishment.
Style 2:
Watching
The leader not only continues to direct and
closely supervise task accomplishment but
also explains, solicits suggestions and
supports progress.
Style 3:
Supporting
The leader facilitates and supports fellow
volunteers' efforts towards task accomplishment and shares responsibility for
decision making with them.
Style 4:
Delegating
The leader turns over responsibility for
decision-making and problem-solving to
volunteers.
In an ideal case all the four styles combined together make a perfect
leader. In a voluntary organisation collective leadership instead of autocratic
leadership is desirable as one can cover the other.
It is a debatable question as to whether leaders are born or made.
Research in behavioural sciences' has shown that leaders barring a few
exceptions are not born but made. Even though personality traits and habits
[181]
tend to be stable, yet all of us change our behaviours, though not basic
personalities. Therefore, there can be training programmes for the leaders
of the voluntary organisations which may have two wings (i) value
inculcation (ii) skill development.
The question - “what makes a leader”, has been asked by many.
The question has been answered at political revolutions, mass movement
or socio-economic field. There are exceptional leaders who make history such as Gandhiji, Netaji Subhas Chandra Bose, Swami Vivekananda,
Abraham Lincoln, J R D Tata and many others. Every system and
organisation need leaders. A leader of the voluntary organisation will move
the organisation rather than be moved by the organisation. Here are few a
qualities and characteristics of the leader:
• A sense of purpose and direction
• Willingness to act
• Sensitivity to and interest in fellow volunteers
• Demands more on self and keeps on growing
• Powerful convictions
• Emotional strength to keep stable under stress
• Ability to differentiate between the significant and the insignificant
• Attaching faith, trust and confidence on fellow volunteers
• Have resourcefulness and ingenuity
• Flexibility to adopt to the community’s needs and demands
• Ability to develop a team.
It must be remembered that leadership in a voluntary organisation is
concerned with values, issues and motivation. Leaders have to take a stand,
have to take risks and have to anticipate and initiate action often in a
innovative way. Effective leaders of voluntary organisations are not
commanders or controllers or bosses but are servers, supportive partners
and providers. This type of leadership unleashes much more energy, talent
and commitment from the volunteers which the commanding and
controlling types cannot.
There are seven basic principles of leadership known as seven ‘I’s:
• Insight:
Self awareness, understanding others
and seeing the situation.
• Initiative:
Taking responsibilities and risk to direct
action with vitality.
• Inspiration:
With vision, trust, appropriate
communication and passion.
• Involvement:
Enrolment, experiment and feedback.
[182]
• Improvisation;
• Individuality:
• Implementation:
Creativity, flexibility.
Style, personal experience, values,
integrity, neutrality.
Action minded, perseverance, model
behaviour.
Thus the leaders of voluntary organisations have to achieve the task,
building and maintaining team and developing the individual. The seven
‘I’s are a useful way of remembering the seven leadership principles. They
also highlight perhaps the most powerful part of effective leadership. Last
but not least, the leaders of voluntary organisations should be successful
volunteers first and work with the volunteers hand in hand as one near and
dear to them.
Ultimately, on the ability of team building by the leadership of
voluntary organisation, depends the success of any programme provided
the programme is specific, measurable, action oriented, realistic, time and
resource bound.
“The great difference between the real leader and the pretender is that the one sees into the future, while the other regards only the
present; the one lives by the day, and acts on expediency; the other
acts on enduring principles and for immortality”.
- Edmund Burke
“A leader takes people where they want to go. A great leader takes
people where they don’t necessarily want to go but ought to be”.
- Rosalyn Carter
[183]
Handling Errors and Complaints
Errors accompany us everyday in our lives. Most of them are annoying
although rarely serious or fatal, others are neutral, and a few may result
in a happy finding. Sir Alexander Fleming discovered penicillin as the result
of an error, most of the genetic mutations (errors) produce aberrant
consequences, but some of them represent a progress. Our attitude towards
errors should be a mixture of fear and curiosity. To hide an error is an
additional mistake, because error study is a fruitful source of knowledge on
the one hand as its analysis is the right first step in order to prevent its
recurrence, and on the other hand we can learn something about
unexpected and positive features connected with an error. Quality
programmes include error management systems designed to detect,
investigate, neutralise the effects, and correct errors.
Entropy (degree of disorder inside a system) is a quantity studied in
Thermodynamics. A physical principle states that entropy grows on and on
continuously unless something is done against this growth. This also applies
to everyday life, even to blood donation. Programmes and tasks that work
well should be actively maintained. Otherwise they would deteriorate little
by little through everyday erosions.
Error categories
What is called an error in a broad sense may be subdivided into
categories:
Errors are the result of a problem badly handled or the result of a
mistake of human origin. In most instances, the consequences are
unacceptable products or services.
Deviations occur when the method followed does not match exactly
with what the accepted procedures say. Many deviations do not result in
unacceptable products or services, but all of them should be studied, the
possibility of adverse effects should be determined, and measures should
be implemented to avoid its recurrence. Audits are the best tools for detecting
deviations.
Accidents are unexpected events which differ from the errors in
their non-human origin. In these cases, the right procedures have been
followed but something has interfered in the method.
Complaints come up when the user returns a faulty product or
requests an explanation related to what has been considered a bad service
[186]
Not always a complaint is equal to an error, but all the complaints of blood
donors should be investigated.
Negative trends are the result of an analysis in which a deteriorating
situation is detected but clear cause or causes cannot be determined. If the
problem is not with an element or a set of elements of the system but their
performance as a whole (structural), then we should speak about crisis.
Error management
As stated above, errors should be detected, investigated and their
adverse effects should be neutralised and their recurrence must be
prevented. To achieve these goals, the system should be accessible and
used by all appropriate members of the staff or volunteers. Strong emphasis
must be put on the positive aspects of error management. The whole system
works on documented basis: written procedures, records, written reports,
documents, audits, etc.
Error management in blood donation
Elements
Usually, a single error management system operates in the whole
organisation, ordinarily managed by the quality department. Nevertheless,
we shall see how the system may be applied to the particular situation for
the promotion of blood donation. The following elements should be put in
place:
1) Complaint files. All written and oral complaints received must
be recorded and all the data gathered with the type of complaint, source,
circumstances, name of the person who received the complaint, etc. The
records should be forwarded to the appropriate person in order to be
investigated in depth. The results of the investigation should be recorded.
A reply to the complaint should be ready as soon as possible. Usually the
reply is done in two steps. Within one or two working days a first reply may
be addressed to the donor (either the donor or the organisation in which
the donor session takes place), and in a period not longer than fifteen
working days, a full reply should be completed. The replies must be
recorded.
2) Written procedures shall bear instructions regarding the method
to be followed in each type of error and circumstance: what should be
done, in which order and period of time, by which person should be replied
to, etc. In general, the following steps should be included:
- Detection of the error. Record.
- Magnitude of the problem. Immediate action to be taken.
[187]
- Documented in-depth investigation. Report.
- Preventive/corrective measures to be included in the system.
- Once corrected, review the system to see if it works.
3) Written records. It is essential to maintain good records from the
beginning. An unimportant detail may be the main clue to the problem,
this happens quite commonly. Moreover, written records allow a study of
the trends and form the basis of the management review in the organisation
A form accompanied by a pre-written questionnaire may be a useful tool
in the error management system.
Other elements may have a role in error detection. For example, an
opinion poll (easier and more interesting to be done on donors than on
non-donors or general population) may include direct questions related to
different aspects of the blood donation and how it is perceived by the donor.
This source of information has an additional value of qualitative nature as
long as one may know the donor’s point of view expressed by herself
himself.
Methods
From the practical point of view, blood banks ideally should manage
errors following two schemes, one for complaints or observations coming
from outside, and another for quality incident reports of internal origin
The main difference between them is that every complaint must be answered
in a timely manner, a matter being of paramount importance. As long as
errors are registered in a book, it is useful to keep two books, one for
complaints and another for internal incidents that makes it easier to control
the follow-up of complaints in the first book. A very few centres manage
lesions and injuries done to blood donors during or after the phlebotomy
following an alternative specific method for registration. An ad-hoc form
for handling this kind of error is filled with answers to specific questions.
A complaint form, an internal incident report, a donor lesion form,
should be completed in three steps.
The information related to the error itself should contain what
happened and what was done immediately. This is usually completed by
the persons who had a direct contact with the error.
Recording of matters related to the study of the error should have the
information about - What were the causes? Are they likely to happen again.
What could be the consequences? Is it necessary to take corrective actions
If necessary it should be stated that measures (if any) have to be
implemented.
[188]
And finally every error should be specifically closec. This means that
someone reviews the records related to the error, the implemented measures,
the answer given to a complaint, etc, and agrees that the error has been
cleared up.
The donor motivators have to face new donors as well as old donors.
In motivation sessions, he/she may have to face questions / statements /
complaints regarding the real / apparent / pseudo errors of blood collection
team or blood bank personnel. He / she must have first-hand knowledge
about handling problems out of error by his / her blood bank or organisation.
In some cases donor motivators can be error resolvers too.
In effect, error management is part of the quality system in Transfusion
Medicine, and consequently in blood donation. Well-handled errors may
be a fruitful tool to improve the quality besides the mitigaton of the negative
consequences of the error.
Standard Operating Procedures
QUALITY ASSURANCE
Quality control
external
Audit
internal
external
Training
“Meaningful work, mutual respect, honest communicator!, continuous
learning - are the ingredients that stimulate men to improve in personal
competence and meet the future with confidence. When these needs
are suppressed, human resources dry up; men become only a fraction
of what they could be”.
- Rohrer Hibler
[189]
internal
Evaluation of Blood Donor
Motivation Programme
Any programme involving Man, Method, Material, Money and
Management would require periodic evaluation, monitoring and path
correction with due regard to the objectives of the programme.
Blood donor motivation, recruitment and retention are complex
subjects involving the above mentioned ‘M’s and naturally the programme
should be evaluated from time to time.
Among all the items, manpower is the main resource and should be
considered as a costly item of the system warranting judicious, effective
and productive use. If the effort and time spent are not commensurate with
or proportionate to the results achieved, it may lead to frustration, particularly
if the effort put in is voluntary in nature. This in turn, may lead to drop out
from the work force causing harm to the cause.
In India finance is a constraint and as such each paisa should be
properly spent and accounted for. There is a rule of thumb to evaluate
social welfare and awareness programme. How much portion of a rupee of
the budget goes to the direct service or awareness head? Higher the
apportionment for the salary and administrative expenses, the less effective
will be the service area.
Cardinal evaluating factor for any donor recruitment and motivation
programme will be the number of voluntary blood donors actually recruited
and retained.
For long term programmes such results may not be immediately
perceived but if the long term programme is effective, it must have a direct
palpable effect on the community. The subject will crop up in everyday
vocabulary, colloquial use, literature, poems, drama, news, songs, jokes.
TV and Radio programmes and even in question papers of educational
institutions and interviews and tests for jobs.
Study on blood donor recruitment programme may be undertaken
to evaluate the end results.
The indicators for evaluation may be:
• Number of units of blood collected from voluntary blood donors.
• Proportion of donors who are voluntary non remunerated
community based with respect to total blood collection.
[190]
• Yearly reduction in the number of replacement donors.
• Proportion of blood donors who are regular repeat donors and
proportion of new donors.
• Proportion of women donors.
• Proportion of one time donors.
• Number of blood units collected per session.
• Actual collection per camp with respect to the arrangements rnade.
• Proportion of blood discarded after collection for markers of
transfusion transmissible infections.
• Proportion of deferred donors.
• Proportion of donors self deferred after going through the
literature in camp.
• Number of organisations and trained volunteers working in the
field.
• Level of increase in blood donation following motivational
programme for different groups.
• Number of organisations accepting blood donation as their regular
routine activity.
• Number of schools accepting blood programme on their own.
• Number of school visits undertaken.
• Number of news/articles/feature on blood donation coming out
in print or electronic media.
• Number of stalls on blood and blood donation in fairs or
exhibitions.
• Number of requisitions honoured by the blood bank.
• Number of requisitions refused by the blood bank.
All these data can be obtained by field study and using proper
questionnaire.
Even the oral presentations in motivation sessions can be evaluated
by conducting a survey among the listeners.
IEC materials can be evaluated through personal interview and
opinion poll.
All these are integral parts of donor recruitment programme. It should
be an in-built concurrent procedure alongwith voluntary blood programme.
[191]
Research in Blood Donor
Recruitment
Blood Banks can be gold mines of academic-minded research workers,
social scientists and donor motivators. Through research work or
research data of their own or of others, the motivators can develop newer
technology of donor recruitment and make the path correction. They may
even do away with fruitless unproductive exercises.
The most important studies would be knowledge, attitude and
behaviour pattern of community towards blood banks and blood donation.
Strength, weakness, opportunity and threat (SWOT) analysis of blood banks
and donor recruiting organisations can be the basic areas of research.
Deferral of donor and discarding of blood after collection can give an
idea of the status of donor group.
Donor recruitment with respect of recruitment strategies and
techniques and in expansion of blood donation movement with time can
be an useful area of research.
The blood group distribution pattern of blood donors of the region
would be needed to determine maximum level and minimum level of stock
in blood bank shelves to meet all requisitions irrespective of blood group.
The research workers can provide these types of information to blood
transfusion service.
Quality of blood supplied by different target groups and their
convenient day and time of organising blood collection drives would give
an insight to the donor motivators to have their blood collection programme
evenly spread throughout the year.
The study of blood requisitions from clinicians and surgeons may
give data about the rational use of blood.
All research workers will need proper training with knowledge about
the land and people, data collection, structured or unstructured interviewing
of people, scientific representative sample selection, blood banking service
including its technical aspects and ability to interpret the data generated
from different sources.
Effectiveness of lEC materials in changing behavioural pattern of the
society can constitute an area of research.
[192]
Starting point of any investigating research work in the field of blood
donor motivation, recruitment and retention is planning in a systematic,
logical manner as hereunder:
Review existing
information
Define general procedure to
follow before starting the
investigation
Define existing
objectives of research
Define general procedure to
follow before starting the
investigation
Define scope and
objectives of research
Define chronogram
Define research
questions
Select and train
research learn
Choose appropriate
methodology
Choose techniques
and develop
instruments
Define sample and select
sites
One of the most important phase of formative investigation is data
collection. During this phase, an order is found and a better understanding
of the subject is attained. This understanding, however, cannot be gained
without the effort, persistence and determination of the research team.
Steps to implement a formative investigation
Implementing the Investigation
• Data collection
• Supervision.
Organising and Analysing Data
• During data collection
• After completing the data collection
• Writing the report.
It is necessary to prepare a written report to present the results of the
investigation. The report should contain:
• Table of contents
• Abbreviations
[193]
•
•
•
•
•
•
•
•
•
•
Executive summary
Introduction
Objectives
Description of the study
Methodology
- Sample selection (units and segments)
- Techniques and instruments
- Selection and training of the research team
- Duration of research
- Limitations
Results
Discussion
Recommendations
Bibliographical references
Appendices.
When writing the report the final product and its use must be kept in
mind to ensure appropriate specific recommendations. It should be
remembered that the information is going to be used as a basis in the
development of strategy with a purpose of increasing the number of
voluntary donors.
Writing the report by sections usually makes the task more simple
and efficient. The easiest section can be written first and then writing the
more difficult ones can be undertaken. The use of tables, charts and other
graphics help to transmit information in a clear way. Quotes of the notes
taken during the investigation give life to an idea and help illustrate specific
aspects of research work.
Research Area for Motivators
• Blood group distribution of region
• Participation of different groups in the region
• Age group of the donors
• Discardation of blood after collection
• Myths and misconception about blood donation in the community
[194]
Modern Technology in Donor
Motivation
Starting point of any voluntary blood donor recruitment programme
requires trained human resource - the donor motivators. The dedicated
willing pairs of hands and legs can do miracle in transforming non-donors
to donors and one-time donors to repeat donors without any modern
gadgets.
But with the development of the movement, Telephone, Computers,
Email. Fax. VCR, DVD can judiciously be used for communication, record
keeping and data retrieval.
Motivators should appreciate that the above mentioned gadgets have
neither any heart nor brain. They are made by man, to be used by
competent human beings for the good of the society, and are not substitutes
of human donor motivators having their heart at the right place and brain
to innovate newer ideas and strategies to recruit and retain voluntary blood
donors to achieve the cherished goal of a blood transfusion service totally
dependent on voluntary blood donors.
Use of computer in blood donor recruitment has been dealt with in
the chapter ‘Donor Records’. Computer network can maintain inter blood
bank contact and exchange of stock position. Email, fax, telephone including
mobile phone can help in informing, reminding and contacting blood
donors. Internet may give information from home and abroad while floating
queries to get appropriate answers from far and near.
One question is often raised: what is the future of blood donation?
This question was provoked in the past by the continuing fascination with
the idea of artificial blood. The term “artificial blood’ is used only for
substances intended as a substitute for the oxygen-carrying functions of
red cells. There are two principal approaches to this endeavour haemoglobin and perflurocarbon. The former has not been demonstrated
to be safe. The later has many unsolved problems of toxicity and instability.
Both can have, at best, a brief clinical effect because their survival in
circulation is less than 24 hours. It must be concluded then that there is yet
no blood substitute in sight which could take the place of red cell. There is
also no early prospect of a substitute for platelets. Factor VIII is the only
blood product which has an imminent prospect of replacement; two
recombinant DNA products have been used in patients with haemophilia
with promising results.
[195]
However, it remains unclear whether production on an industrial scale
will succeed, whether these products can be produced at a cost which can
compete with plasma-derived factor VIII and, indeed, whether recombinant
products have any real advantage.
All indications are that human blood will continue to be needed for
the foreseeable future and that voluntary blood donors will continue to be
the primary source for whole blood, components and apheresis, even in
the third millennium.
In spite of modern sophisticated gadgets, the oral communication in
donor recruitment should remain the most effective tool for years to come
and modern technology will play the second fiddle to support the
motivational activities.
The motivator should build up a flair for the prudent blending of the
proven old techniques proportionately with the induction of beneficial
modern technology to become really successful in donor motivation
recruitment and retention in this era remembering that ‘old order changes
giving place to the new’.
[196]
Land and People
Enveloped by the ocean on three sides and cut-off by mountain ranges
from the rest of Asia. India has all times enjoyed a marked geographical
unity. The dominant geographical features which stand up in relation to
this area are the high and impenetrable wall of the Himalayas which provide
the Gangetic Valley with its great river systems; the Bindhya which divides
the country and separates the peninsula from the plains of North India;
and the Great Indian Desert which is a projection of the arid regions of
West Asia almost to the heart of India. While the Gangetic plain is well
watered by its perennial river system of the Ganges and its tributaries, the
Deccan plateau is an upland where, broadly speaking the rivers become
irrigable only at their deltaic mouths.
India also presents a variety of climates which give to the country its
continental character. From the Himalayan regions with their perpetual
snows to the torrid heat of the South. India possesses every kind of climate.
Another geographical feature -the seasonal trade wind, the monsoon,
blows across the sea and reaches India with almost mathematical regularity
in May and traverses the country in June and July. It brings with it rain
laden cloud which water practically every part of India in varying degrees
and return to the sea in September and October. Ofcouse, coastal areas of
the east beyond the Bindhya have double monsoon. Not only has the
economy of India been dependent on the regularity of this rain fall, but
from early times the monsoon winds helped to make peninsular India a
center of maritime communications.
Not much is known of prehistoric man in India. The Harappans, as
these proto Indians have come to be designated, lived in well-planned
cities with a very good system of drainage. Their houses were commodious
and made of baked bricks. They knew the use of gold and precious stones
and seem to have cultivated cotton and wheat. The humped bull, the sheep,
the elephant and camel had been domesticated. The harbour that has been
excavated at Lothal in Gujarat proves that they were a sea faring people,
who probably had established connections with the ports of Sumer. The
destruction of Harappan civilisation was the result of the Aryan invasion.
Many of the religious practices and speculative doctrines of these early
Indians inspite of destruction of the old civilisation, such for example as
Worship of Siva and the mother goddess, have survived in the Hinduism of
today.
The settlement of nomadic, pastoral of the Aryans in India, their
[197]
culture, the Vedas, the Ramayana, the Mahabharata, the Bhagvad Gita
the Upanishads could put India in the global map by the fourth century
B.C. as a highly developed civilisation. Then invasion after invasion from
the Greek to conquering of the country by the Britishers with Hun and
Muslims in between inter spaced by Pallav, Chalukya, Rajputs, Maratha
and Hindu medieval periods had social, cultural effect on the country. Indian
population is polygenetic and is said to be the melting pot of various races.
At present India has officially eighteen recognised languages. India is
believed to have 1652 mother tongues, of which 33 are spoken by people
numbering over a lakh. The Indian languages now in use have evolved
from different language family corresponding more or less to the different
ethnic elements that have come into India from the dawn of history.
India has an area of 3,287,263 sq km and population over 1 billion
with 28 states and six union territories and one National Capital territory.
The blood donor motivators must have or acquire knowledge about
the country in general and region of their work in particular. They must
have knowledge about: population of the region, sex ratio, birth and
mortality rate, literacy rate, child mortality rate, age group distribution,
occupation of the local people, per capita income, local festivals, tourist
spots, cultural traditions, history and geography of the region, hospital bed
strength, health of the region and the medical history of the country.
Handbooks on the country, census report, publications of Health
Department and National AIDS Control Organisation would provide all
these information. Naturally, such books should be needed for the library
of the blood banks or donor motivating units or organisations.
“The importance of Indian literature as a whole consists of its originality.
When the Greeks towards the end of the fourth century B C. invaded the
north-west, the Indians had already worked out a national culture of their
own, unaffected by foreign influences. And in spite of successive waves of
invasion and conquest by Persians, Greeks, Scythians, Mohammedans,
the national development of the life and literature of the Indo-Aryan race
remained practically unchanged and unmodified from without down the era
of British occupation. No other branch of the Indo-European stock has
experienced an isolated evolution like this. No other country except China
can trace back its language and literature, its religious beliefs and rites, its
dramatic and social customs through an uninterrupted development of more
than 3,000 years.
- Professor Macdonell in his ‘History of Sanskrit’
[198]
Common Questions and Answers
Q.1. Why is one not allowed to donate blood before attaining the age
of 18 years ?
Ans: Physiologically there is no harm if one satisfies otter conditions
for blood donation. 18 being the age of consent in our county, the reason
is legal.
Q.2a. Can one donate blood after 60 years of age if he/she is
physically fit?
Ans: Yes, medically speaking, there would be nothing wrong.
Q.2b. Then why people above 60 years of age are net allowed to
donate blood in India?
Ans: With ageing, blood vessels start constricting. Bloodletting from
constricted veins may lead to unnecessary pressure on hear resulting in
many physiological problems. It is not known at what age blood vessels
start constricting. It varies from individual to individual. Therefore, arbitrarily
the retiring age is considered as the age of cutoff for blood donation.
Q.3. Can one donate blood if one’s body weight is lessthan 45 kg?
Ans: Not desirable. But in extreme emergency, a margial difference
in weight to the tune of 1 to 2 kg is not harmful, so long as body weight x 8
ml is above or equal to the volume of donation.
Q.4. Why blood is not collected from a person having a haemoglobin
content of less than 12.5 gm/l00ml?
Ans: The stipulated haemoglobin content of 12.5 gm/100 ml for a
donor is the standard for a healthy person. Persons having lessHb content
than the prescribed one cannot be treated as healthy donor having sufficient
Hb for donations and hence are not allowed to donate blood. Further,
blood weak in Hb content does not help the patient much in carrying oxygen
to cells.
Q 5. Why 3 months’ interval has been stipulated though donated
blood is recuperated within 21 days?
Ans: As an additional precautionary measure for safet of donor.
[199]
Q.6. What physical tests are performed before blood donation?
Ans:
•
•
•
•
Weighing
Hb estimation (copper sulphate solution method)
Measurement of blood pressure
Checking heart beats, condition of liver, lung and
spleen.
Q.7. What laboratory tests are performed in blood bank for each
bag of collected blood?
Ans:
•
•
•
•
•
•
Jaundice (Hepatitis B & C)
Malaria
HIV (AIDS) test
Venereal disease (STD)
Blood Group
Before issuing blood, compatibility tests (cross
matching) are done.
Q.8. Why the above laboratory tests are not performed before
donation?
Ans: They are time consuming tests, and if performed in camp
before donation, there will be excessive delay in disposal of donors, and
the disgusted donors may leave the camps and refrain from donating blood
for ever. Besides, post donation tests are mandatory.
Q.9. Blood is collected from a vein. Naturally, it is rich in carbon
dioxide content. What purpose does it serve? Why is blood not collected
from an artery to get blood rich in oxygen content?
Ans: Though the blood collected from a vein is rich in carbon dioxide,
it is transfused in the vein of the recipient and is automatically oxygenate
in course of normal circulation and therefore serves the required purpose.
Blood is not collected from artery for the following reasons:
• Veins remain in the upper surface of the body muscle and can be
easily identified while arteries remain in the subsurfaces and
therefore cannot be easily identified.
• Blood pressure in vein is low compared to that in artery.
Puncturing of artery causes bleeding at higher pressure and
velocity leading to trouble in stopping the bleeding after donation
which is not a problem in case of vein. It is easier to pierce a
vein.
[200]
Q.10. Is there any chance of contracting blood communicable disease
by donating blood?
Ans: No, since sterilised disposable bleeding sets areused.
Q.11. What is AIDS? Is there any chance of contracting AIDS by
donating blood?
Ans: AIDS is an abbreviation for Acquired Immuno Deficiency
Syndrome, which reduces the inherent power of the defence mechanism
of human body. As a result, the affected person suffers fromother ailments,
which may be fatal. No. there is no chance of contracting AIDS by donating
blood, since disposable bleeding sets are used.
Q.12. Will my blood group be the same as that of either of my
parents?
Ans: May or may not be exactly. But there should be a sort of
relationship. We inherit our blood group from our parents by random
combination of one gene from each of the parents. Dominant genes (A, B)
prevails over recessive gene (O).
Q.13. Does the blood group of a particular person change with time?
Ans: No.
Q.14. What is Rh factor?
Ans: Rh factor indicates the presence or absence of an organic
compound in the membranes of red cells of human blood, similar to that
present in the membrane of the red cells of Rhesus Macacusmonkey. Those
having the compound are denoted as Rh positive and those without such
compound are denoted as Rh negative.
Q.15. How long can blood be preserved in a bloodbank?
Ans: In India blood is normally preserved in blood bank for 35 days
using CPDA or CPDA1 solution as anticoagulant.
Q.16. The maximum life span of RBC is 120 day. Why is then
blood is preserved in blood bank for only 35 days?
Ans: Donated blood contains cells ranging from 1 to 120 days’ life
span. Naturally, cells having such varied life spans cannot be preserved for
120 days in the bag since in that case there will only be a few living cells
Present. In order to get a considerable number of living cells present in the
blood for transfusion, 35 days shelf life has been found to be optimum with
[201]
CPDA and CPDA1 solution on the basis of various experiments. Furthermore,
cells which can remain alive for 120 days within the human body cannot
survive for such period in an artificial environment.
Q.I7. Will there be any good if blood is transfused to a patient on the
34th day after collection from the donor?
Ans: It will serve the purpose of volume expander. There will still be
a considerable number of living red cells present in the bag which will be
able to carry oxygen to the cells and bring back carbon dioxide.
Q.18. The blood collected from the vein may contain dead cells.
Will there be any good by transfusing this blood?
Ans: The blood collected will contain cells of various life spans. A
considerable portion will certainly be living cells which will serve the purpose.
Q.19. Often on tendering the blood donor’s card, blood is not being
made available from the blood banks and then what is the use of donating
blood?
Ans: Donation in the real sense of the term is unconditional and
without any string. Further, the credit card is given to the donor as a
recognition and to meet the donor’s own future need or the need of the
donor’s near relatives, who have no other alternative but to depend only
on the donor to meet his/her blood need. It is expected that 10-15% donor
cards would be tendered. If all the cards are tendered, then blood banks
would not be able to honour cards in view of existing gap between demand
and supply, as blood banks have to issue blood to serious patients also who
have no cards at all. One should remember blood donors are not depositors.
If there are enough donors, everybody should get blood in time of their
need.
Q.20. Why commercial blood banks are not being banned by
legislation?
Ans: Without organising voluntary blood donor base and the culture
of voluntary blood donation in the community, mere banning of commercial
blood banks will not solve the problem. Rather, the actual gap between the
demand and supply will only lead to the establishment of more illegal
commercial blood banks.
Q.21. Is it true that the donated blood in blood bank is wasted unused?
Ans: No it is just a myth and the story is cooked up by vested interest.
Question of wastage does not arise when a big gap between demand and
supply exists.
[202]
Q.22. Is there any corruption in blood bank?
Ans: So long as there is a gap between demand and supply and
people are afraid to donate for their near and dear ones, chances of
corruption may be there. The only way to combat possible corruption in
this specific area is to step up voluntary blood donation in a big way.
Q.23. Which are the states of India where blood donation movement
can be palpably felt?
Ans: Maharashtra, Gujarat, Delhi, Tamil Nadu, West Bengal and
Chandigarh, Punjab, Haryana at present.
Q.24. Which country of the world has the best blood transfusion
service totally dependent on voluntary donors?
Ans: U. K., Canada and Australia.
Q.25. What is the blood need of India and how is it met?
Ans: 8 million units per year. Total collection is 4 million units. 2
million units by voluntary donors, 2 million units by relative and exchange
donors.
Q.26. What is the harm if blood donation is made compulsory?
Ans: It has been observed that common people are apathetic to
compulsion. The people should be motivated and inspired to donate blood
voluntarily. Compulsion may lead to hatred towards the cause, which does
more harm than good to the movement. Only sustained painstaking
motivational programme based on education can help the country to
achieve total voluntary blood programme. Moreover, blood collected from
people donating under compulsion may not be safe.
Q. 27. We have read in the science journals about artificial blood.
What is it? Can it be used for transfusion as a substitute for human blood?
Ans: The research is still in a preliminary stage. The term ‘artificial
blood’ is a misnomer as blood has various functions. The so called ‘artificial’
blood can only carry oxygen to the cells and bring back carbon dioxide in
a limited way but cannot perform any other function of blood at all. Further,
this so called substitute is quite costly.
Q.28. Why does blood coagulates when it comes outside the body
out do not coagulate inside the body?
Ans: Secretion of heparin by WBC inside the body prevents blood
coagulation. But when tissues are wounded resulting in bleeding, a series
[203]
of reactions takes place in the bled blood which ultimately forms a fine
mesh of hard fibre within which the blood cells are trapped and the blood
is thus clotted.
Q.29. Who can give blood?
Ans: Anyone between 18 and 60 years of age and in normal health
having a body weight of 45 kg. or more and a haemoglobin content no
less than 12.5 gms/hundred ml can be a donor.
Q.30. Does it take long time to donate blood?
Ans: It should take up not more than 20 minutes of time including
time for rest and taking refreshment.
Q.31. How much blood do you take?
Ans: Blood banks take only 350 ml of blood as your gift of love.
Q.32. Why is my finger pricked before donation?
Ans: To estimate “haemoglobin” content in blood. This is the
component of the red cells which transport oxygen in the human body to
all the organs and tissues. If the level is low, it is not wise to give blood.
Q.33. What is the liquid in the bag into which the blood is taken?
Ans: It is called anti-coagulant and prevents the blood from clotting.
It also helps to preserve the blood cells. It is known as CPDA (Citrate,
Phosphate, Dextrose, Adenine) solution.
Q.34. How often can one give blood?
Ans: Not more than once in 90 days.
Q.35. Is blood donation very painful?
Ans: No. Not more than a prick of an injection needle.
Q.36. Will I feel all right after donation?
Ans: Yes, you can go back to your normal work after 30 minutes.
Q.37. I have heard of people fainting. Is that common?
Ans: Very occasionally a donor may faint. The most common reason
is psychological and often due to rushing to get up too soon after donating.
Relax and rest a little and you will be fine.
[204]
Q.38. You wouldn’t want my blood, would you? I am of a common
group.
Ans: We constantly need donors of all blood groups.
Q.39. Nobody has ever asked me to donate blood.
Ans: Consider yourself invited!
Q.40. I am too old!
Ans: If you are between 18 and 60 years and in good health you can
donate blood.
Q.41. But l am underweight!
Ans: Not, if you are 45 Kg. or more, and in good health you can
donate blood.
Q.42. Oh! but I am anaemic!
Ans: We test for anaemia before every donation.
Q.43. But it will make me weak.
Ans: Blood donation has no ill effect on the body. You can resume
your routine duties immediately after blood donation. The amount of blood
donated is a small part of your surplus blood and is recouped by the body
in twenty one days and you can donate blood again after 3 months.
Q.44. I am too busy and it is too inconvenient!
Ans: The entire procedure of blood donation takes about 15-20
minutes whereas the actual Blood Donation is just 5 minutes job!
Q.45. How long does it take to transfuse a unit of blood?
Ans: This depends on the condition for which transfusion is being
given. If the patient is being transfused to replace blood for sudden massive
blood loss, one unit of blood may be given rapidly in about 10-15 minutes.
However, if the blood transfusion is being given for anaemia, it may take
over 3-4 hours. Normal rate of transfusion is 28 drops per minute.
Q.46. Can I develop a serious reaction to blood transfusion with
blood from another person?
Ans: Not usually. People differ from each other with respect to their
blood groups and blood of compatible group is only transfused. Before
blood transfusion, a sample of the blood is tested, and cross-matched with
[205]
a suitable donor unit. These tests reduce the risk of any serious reactions
Of course, no medical procedure is absolutely hundred percent safe. Most
blood transfusion reactions, if they occur, are mild.
There are so many unfounded ifs and buts against blood
donation that donor motivators should equip themselves with
appropriate polite scientific answers
[206]
References
A. publications of World Health Organisation
1211 Geneva 27
Switzerland
or
World Health House
Indraprastha Marg, Ring Road
New Delhi- 110 002
1.
Safe Blood and Blood Products Module I, WHO/GPA/CNP/93. 2B.
2.
Strategies for Safe Blood Transfusion – Dr ZS Bharucha and others.
3.
Blood Transfusion: A Basic Text - Dr. Anthony F H Britten, Dr F A
Ala, Dr Mohammed EL Nageh. Indian Authorised Edition available at
AITBS Publishers & Distributors, J-5/6 Krishnan Nagar. New Delhi
110051.
4.
Management of Blood Transfusion Service - Dr S R Hollan, Dr W
Wagstaff, Dr J Leikola, Dr F Lothe.
5.
Guidelines for the Organisation of a Blood Transfusion Service - Dr W
N Gibbs & Dr. A F H Britten. Authorised Indian Edition available at B
I Churchill Livingstone Pvt Ltd., 54 Janapath, New Delhi 110001
6.
Recruiting, Educating and Retaining Safe Blood Donors, WHO/GPA/
BLS/95.
7.
Safe Blood Starts With Me .......Blood Saws Lives.
8.
Developing a National Policy and Guidelines on Clinical use of Blood.
9.
Safe Blood and Blood Products, Costing Blood Transfusion service,
WHO/BLS/98.8.
10. Guidelines for Quality Assurance, Programme for Blood Transfusion
Service.
11. Consensus Statement on How to Achieve an Adequate Blood Supply
by Recruitment and Retention of Voluntar, Non-remunerative Blood
Donors, WHO/LBS/93.2.
[207]
B. Publications of International Federations of Red Cross and Red
Crescent Societies:
P.O. Box 372 CH 1211 Geneva
Switzerland.
12. Quality Manual.
13. Development Manual.
14. Making a difference Recruiting volunteers, non-remunerative blood
donors.
C. Publications of American Association of Blood Banks
Bethesda Maryland 20814 - 2749 U.S.A
15. Motivating Blood Donors in Today’s World: Recruitment and Retention
- Lorraim, Kohr, Merlyn Sayers.
16. Donor Recruitment: Strategies For Success - Carolyn P Mihalko and
Leslie A Botos.
D. Publications of Council of Europe / European Commission
BP432 RF 67006 Strassbourg Cedex France / or Rue Alcide de Gaspe
L - 2920 Luxembourg. Director General for Development Health and
Family Plannings AIDS Unit, Rue de la Loi 200 B 1049 Brussels
Belgium.
17. Safe Blood in Developing Countries Principles and Organisation - Dr.
C Gerard, Dr D Sondag Thull, Dr EJ Watson-Williams, Dr L Franser
18. Safe Blood in Developing Countries: The Lessons from Uganda - Re.
Winsbury.
17. Mass, Media and Blood Donations - U Rossi, I Cipriani, V Fresia.
F. Publications from Other Sources
19. The Hand Book For Blood Donation in Practice - Dr Gregor Veltkamp
General Sckratarrat Post fach 45030 D-12172 Berlin Germany.
20. Blood Transfusion and the Challenge of AIDS in Greece - Dr Costantina
Politis. Dr Johon Yfantopoulos. Beta Medical Publishers Ltd., 3
Adrianian StreetGR - 115 25 Athens, Greece 11525
[208]
21. Methodological Guide Lines For Socio Cultural Studies on Issue Related
to Blood Donation - Pan American Health Organisation.
22. Organisation & Management of Blood Transfusion Service.
Policies and Plans - Dr Z S Bharucha, Department of Transfusion
Medicine Tata Memorial Hospital. Mumbai, Maharashtra, India.
23. Education as a Toot For Blood Donor Motivation and RecruitmentAssociation of Voluntary Blood Donors, West Bengal 20A, Fordyce Lane,
Kolkata - 700014, India.
24. Science of Blood. and Blood Donation and Transfusion -Association of
Voluntary Blood Donor, West Bengal, 20A, Fordyce Lane. Kolkata 700014. India
25. Blood - Dougls Starr. Little Brown & Co (U. K.), Brettenham House
Lancaster Place, London WC 2E 7 EN U. K.
26. The Gift Relationship - Richard M. Titmus Revised. (1997)
The New Press New York, U. K.
27. Effective Motivation - Johan Adail, Rupa & Co., 15 Bankim Chatterjee
Street, Kolkata - 700 073, India.
28. Developing Presentation Skills - Dr R L Bhatia, Wheeler Publishing, 23
L B Shastri Marg. Allahabad, U P - 211 001, India.
29. Motivating to Win - Richard Denny, Kogan Page India Pvt Ltd. 4325/3
Ansari Road, Daryagunj, New Delhi - 110 002. India.
30. Voluntary Action - D K Ohja, National Book Trust. India, A-5 Green
Park, New Delhi -110 016, India.
31. Guide Lines for Appropriate use of Blood - National AIDS Control
Organisation, Chandralok Building, 36 Janpath New Delhi - 110 001.
32. Guide Book on Blood Donor Motivation - Association of Voluntary
Blood Donors, Tamil Nadu, 6 Cathedral Road, Chennai - 600 004,
Tamil Nadu.
33. Chicago Address - Swami Vivekananda - Advaita Ashram, 6 Dehi
Entally Road, Kolkata - 700 014.
[209]
F. Journals (English)
1.
Transfusion Today:
ISBT Journal
Blood Bank Noord Netherlands
P. O. Box 1191
9701 BD Groningen
Netherlands
2.
Gift of Blood:
Association of Voluntary Blood Donors,
West Bengal
20 A Fordyce Lane
Kolkata - 700 014
India
3.
Donor Recruitment
International:
IFRRCS Journal
P. O. Box 372
CH 1211, Geneva
Switzerland
[210]
INDIAN RED CROSS SOCIETY.
(Constituted under Act XV of 1920)
President:
HIS EXCELLENCY THE
VICEROY
AND GOVERNOR-GENERAL OF
INDIA,
(BENGAL PROVINCIAL BRANCH)
Blood Bank Committee.
Chairman: ‘
Major General W. C. PATON
K. H. P., I. M. S.
ALL INDIA INSTITUTE OF HYGINE
AND PUBLIC HEALTH.
110, Chittaranjan Avenue,
CALCUTTA
The 6th March, 1942
MEMORANDUM
The war has necessitated the establishment of Blood Banks at various
centres
in this country to meet war needs. The Imperial Serologist started a transfusion
service in 1925 fur Calcutta in the School of Tropical Medicine, which
resulted
in the establishment of the present Blood Bank Committee in I939. This
Committee
was expanded for war-time needs and began present operations in January
1942.
The Blood Bank has drawn up its “routines” for self-guidance and appraisal in
the light of experience gained so far. These “routines” are naturally subject to
modification with further experience. However, the accompanying is made
public
in case the procedures may be of some use to any other Banks now in course
of
establishment. It is universal experience that the actual procedures in any
individual
Bank must depend on local circumstances and experience gained locally.
The Blood Bank at Calcutta will, so far as practicable, be prepared to
furnish
any further information upon request and will also be glad to render any
assistance
possible.
W. C. PATON, MAJOR GENERAL, I.M.S.
Surgeon-General with the Government of Bengal
and Chairman, Blood Bank Committee.
[211]
Annexure I
National Blood Policy
INTRODUCTION:
A well organised Blood Transfusion Service (BTS) is a vital component of
any health care delivery system. An integrated strategy for Blood Safety is
required for elimination of transfusion transmitted infections and for
provision of safe and adequate blood transfusion services to the people.
The main component of an integrated strategy include collection of blood
only from voluntary, non-remunerated blood donors, screening for all
transfusion transmitted infections and reduction of unnecessary transfusions.
The Blood Transfusion Service in the country is highly decentralised and
lacks many vital resources like manpower, adequate infrastructure and
financial base. The main issue, which plagues blood banking system in he
country, is fragmented management. The standards vary from State to State
cities to cities and centre to centre in the same city. In spite of hospital
based system, many large hospitals and nursing homes do not have their
own blood banks and this has led to proliferation of stand-alone private
blood banks. The blood component production/ availability and utilisation
is extremely limited. There is shortage of trained health-care professionals
in the field of transfusion medicine.
For quality, safety and efficacy of blood and blood products, well-equipped
blood centres with adequate infrastructure and I trained manpower is an
essential requirement. For effective clinical use of blood, it is necessary to
train clinical staff. To attain maximum safety, the requirements of good
manufacturing practices and implementation of quality system moving
towards total quality management, have posed a challenge to the
organisation and management of blood transfusion service.
Thus, a need for modification and change in the blood transfusion service
has necessitated formulation of a National Blood Policy and development
of a National Blood Programme which will also ensure Implementation of
the directives of Supreme Court of India -1996.
MISSION STATEMENT
The policy aims to ensure easily accessible and adequate supply of safe
[212]
and quality blood and blood components collected / procured from a
voluntary non-remunerated regular blood donor in well equipped premises,
which is free from transfusion transmitted infections, and is stored and
transported under optimum conditions. Transfusion under supervision of
trained personnel for all who need it irrespective of their economic or social
status through comprehensive, efficient and a total quality management
approach will be ensured under the policy.
OBJECTIVES OF THE POLICY
To achieve the above aim, the following objectives are drawn:
1. To reiterate firmly the Govt. commitment to provide safe and adequate
quantity of blood, blood components and blood products.
2. To make available adequate resources to develop and re-organise the
blood transfusion services in the entire country.
3. To make latest technology available for operating the blood transfusion
services and ensure its functioning in an updated manner.
4. To launch extensive awareness programmes for donor information,
education, motivation, recruitment and retention in order to ensure
adequate availability of safe blood.
5. To encourage appropriate clinical use of blood and blood products.
6. To strengthen the manpower through human resource development.
7. To encourage Research & Development in the field of Transfusion
Medicine and related technology.
8. To take adequate regulatory and legislative steps for monitoring and
evaluation of blood transfusion services and to take steps to eliminate
profiteering in blood banks.
OBJECTIVE - 1:
To reiterate firmly the Govt. commitment to provide safe and adequate
quantity of blood, blood components and blood products.
[213]
STRATEGY:
1.1. A national blood transfusion Programme shall be developed to ensure
establishment of non-profit integrated National and State Blood Transfusion
Services in the country.
1.1.1 National Blood Transfusion Council (NBTC) shall be the policy
formulating apex body in relation to all matters pertaining to operation of
blood centres. National AIDS Control Organisation (NACO) shall allocate
a budget to NBTC for strengthening Blood Transfusion Service.
1.1.2 State/UT Blood Transfusion Councils shall be responsible for
implementation of the Blood Programme at State/UT level, as per the
recommendations of the National Blood Transfusion Council.
1.1.3 Mechanisms for better co-ordination between NBTC and SBTCs shall
be developed by the NBTC.
1.1.4 Mechanisms shall be developed to monitor and periodically evaluate
the implementation of the National Blood Programme in the country.
1.1.5 The enforcement of the blood and blood products standards shall be
the responsibility of Drugs Controller General (India) as per Drugs and
Cosmetics Act/Rules, with assistance from identified experts.
1.1.6 NBTC shall ensure involvement of other Ministries and other health
programmes for various activities related to Blood transfusion services.
1.2. Trading in blood i. e. Sale & purchase of blood shall be prohibited.
1.2.1 The practice of replacement donors shall be gradually phased out in
a time bound programme to achieve 100% voluntary non-remunerated
blood donation programme.
1.2.2 State/UT Blood Transfusion Councils shall develop an action plan to
ensure phasing out of replacement donors.
1.3 The following chain of Transfusion Services shall be promoted for
making available of safe blood to the people.
1.3.1 State Blood Transfusion Councils shall organise the blood transfusion
[214]
service through the network of Regional Blood Centres and Satellite Centres
and other Government, Indian Red Cross Society & NGO run blood centres
and monitor their functioning. All Regional Centres shall be assigned an
area around in which the other blood banks and hospitals which are linked
to the regional centre will be assisted for any requirement and shall be
audited by the Regional Centre. It will also help the State Blood Transfusion
Council in collecting the data from this region.
1.3.2 The Regional Centres shall be autonomous for their day to day
functioning and shall be guided by recommendations of the State/UT Blood
Transfusion Councils. The Regional Centre shall act as a referral centre for
the region assigned to it.
1.3.3 NBTC shall develop the guidelines to define NGO run blood centres
so as to avoid profiteering in blood banking.
1.4 Due to the special requirement of Armed Forces in remote border areas,
necessary amendments shall be made in the Drugs & Cosmetics Act/Rules
to provide special licences to small garrison units. These units shall also be
responsible for the civilian blood needs of the region.
OBJECTIVE - 2:
To make available adequate resources to develop and re-organise the blood
transfusion service in the entire country.
STRATEGY:
2.1 National & State/UT Blood Transfusion Councils shall be supported/
strengthened financially by pooling resources from various existing
programmes and if possible by raising funds from international / bilateral
agencies.
2.2 Efforts shall be directed to make the blood transfusion service viable
through non-profit recovery system.
2.2.1. National Blood Transfusion Council shall provide guidelines for
ensuring non-profit cost recovery as well as subsidised system.
2.2.2. Efforts shall be made to raise funds for the blood transfusion service
for making it self-sufficient.
[215]
2.2.3. The mechanism shall be introduced in government sector to route
the amounts received through cost recovery of blood/blood components
to the blood banks for improving their services.
OBJECTIVE - 3:
To make latest technology available for operating the blood transfusion
services and ensure its functioning in an updated manner.
STRATEGY:
3.1 Minimum standards for testing, processing and storage shall be set and
ensured.
3.1.1. Standards, Drugs & Cosmetics Act/Rules and Indian Pharmacopoeia
shall be updated as and when necessary.
3.1.2. All mandatory tests as laid down under provisions of Drugs &
Cosmetics Act/Rules shall be enforced.
3.1.3. Inspectorate of Drugs Controller of India and State FDA shall be
strengthened to ensure effective monitoring.
3.1.4. A vigilance cell shall be created under Central/State Licensing
Authorities.
3.2
A Quality System Scheme shall be introduced in all blood centres.
3.2.1 Quality Assurance Manager shall be designated at each Regional
Blood Centre/ any blood centre collecting more than 15,000 units per year
to ensure quality control of Blood & its components in the region assigned.
He shall be exclusively responsible for quality assurance only.
3.2.2 Every blood centre shall introduce an internal audit system to be
followed by corrective actions to reduce variations in Standard Operating
Procedures(SOPs) as a part of continuous improvement programme.
3.2.3 Regular workshops on the subject of quality assurance shall be
conducted to update the personnel working in blood centres.
3.2.4 Regular proficiency testing of personnel shall be introduced in all the
blood centres.
[216]
3.3 An External Quality Assessment Scheme (EQAS) through the referral
laboratories approved by the National Blood Transfusion Council shall be
introduced to assist participating centres in achieving higher standards and
uniformity.
3.3.l Reference centres shall be identified in each State/UT for
implementation of EQAS. All blood centres shall be linked to these reference
centres for EQAS.
3.3.2 NBTC shall identify a centre of national repute for quality control of
indigenous as well as imported consumables, reagents and plasma products.
3.4 Efforts shall be made towards indigenisation of kits, equipment and
consumables used in blood banks.
3.5 Use of automation shall be encouraged to manage higher workload
with increased efficiency.
3.6 A mechanism for transfer of technology shall be developed to ensure
the availability of state-of-the-art technology from out side India.
3.7 Each blood centre shall develop its own Standard Operating Procedures
on various aspects of Blood Banking.
3.7.1 Generic Standard Operating Procedures shall be developed by the
National Blood Transfusion Council as guidelines for the blood centres.
3.8 All blood centres shall adhere to bio-safety guidelines as provided in
the Ministry of Health & Family Welfare manual "Hospital-acquired
Infections: Guidelines for Control" and disposal of bio-hazardous waste as
per the provisions of the existing Biomedical Wastes (Management &
Handling) Rules- 1996 under the Environmental Protection Act -1986.
OBJECTIVE - 4:
To launch extensive awareness programmes for blood banking services
including donor motivation, so as to ensure adequate availability of safe
blood.
[217]
STRATEGY:
4.1 Efforts shall be directed towards recruitment and retention of voluntary,
non-remunerated blood donors through education and awareness
programmes.
4.1.1 There shall not be any coercion in enrolling replacement blood donors.
4.1.2 The replacement donors shall be encouraged to become regular
voluntary blood donors.
4.1.3 Activities of NGOs shall be encouraged to increase awareness about
blood donation amongst masses.
4.1.4. All blood banks shall have donor recruitment officer/ donor organiser.
4.1.5. Each blood centre shall create and update a blood donor's directory
which shall be kept confidential.
4.1.6. In order to increase the donor base specific IEC campaigns shall be
launched to involve youth in blood donation activities.
4.2.
Enrolment of safe donors shall be ensured.
4.2.1 Rigid adherence to donor screening guidelines shall be enforced.
4.2.2 At blood donation camps, appropriate attention shall be paid on
donor enrolment and screening in accordance with national standards
instead of number of units collected.
4.2.3 A Counselor in each blood centre shall be appointed for pre and post
donation counseling.
4.2.4 Result seeking donors shall be referred to a Blood Testing Centre
(BTC) for post donation information and counseling.
4.3 State/UT Blood Transfusion Councils shall recognise the services of
regular voluntary non-remunerated blood donors and donor organisers
appropriately.
4.4
National/State/UT Blood Transfusion Councils shall develop and launch
[218]
an IEC campaign using all channels of communication including mass-media
for promotion of voluntary blood donation and generation of awareness
regarding dangers of blood from paid donors and procurement of blood
from unauthorised blood banks/ laboratories.
4.5 National State/UT blood transfusion councils shall involve other
departments/ sectors for promoting voluntary blood donations.
OBJECTIVE: 5:
To encourage appropriate clinical use of blood and hood products.
STRATEGY:
5.1 Blood shall be used only when necessary. Blood and blood products
shall be transfused only to treat conditions leading to significant morbidity
and mortality that cannot be prevented or treated effectively by other means.
5.2 National Guidelines on "Clinical use of Blood" shall be made available
and updated as required from time to time.
5.3 Effective and efficient clinical use of blood shall be promoted in
accordance with guidelines.
5.3.1 State/UT Governments shall ensure that the Hospital Transfusion
Committees are established in all hospitals to guide monitor and audit
clinical use of blood.
5.3.2 Wherever appropriate, use of plasma expandes shall be promoted
to minimise the use of blood.
5.3.3 Alternative strategies to minimise the need for transfusion shall be
promoted.
5.4 Education and training in effective clinical use of blood shall be
organised.
5.4.1 Medical Council of India shall be requested to take following initiatives:
5.4.1.1 To introduce Transfusion Medicine as a subject at undergraduate
and all post graduate medical courses.
[219]
5.4.1.2 To introduce posting for at least 15 days in the department of
transfusion medicine during internship.
5.4.1.3 To include Transfusion Medicine as one of the subjects in calculating
credit hours for the renewal of medical registration by Medical Council of
India, if it is introduced.
5.4.2 CME and workshops shall be organised by State Blood Transfusion
Councils in collaboration with professional bodies at regular intervals for
all clinicians working in private as well public sector in their States.
5.5 Blood and its components shall be prescribed only by a medical
practitioner registered as per the provisions of Medical Council Act - 956.
5.6 Availability of blood components shall be ensured through the network
of regional centres, satellite centres and other blood centres by creating
adequate number of blood component separation units.
5.7 Appropriate steps shall be taken to increase the availability of plasma
fractions as per the need of the country through expanding the capacity of
existing centre and establishing new centres in the country.
5.8 Adequate facilities for transporting blood and blood products including
proper cold-chain maintenance shall be made available to ensure
appropriate management of blood supply.
5.9 Guidelines for management of blood supply during natural and man
made disasters shall be made available.
OBJECTIVE: 6:
To strengthen the manpower through Human Resource Development.
STRATEGY:
6.1
Transfusion Medicine shall be treated as a speciality.
6.1.1 A separate Department of Transfusion Medicine shall be established
in Medical Colleges.
6.1.2 Medical Colleges/Universities in all States shall be encouraged to start
[220]
PGdegree (MD in transfusion medicine) and diploma courses in Transfusion
Medicine.
6.1.3 PG courses for technical training in transfusion medicine (PhD / MSc)
shall also be encouraged.
6.2 In all the existing courses for nurses, technicians and pharmacists,
Transfusion Medicine shall be incorporated as one of the subjects.
6.3 In-service training programmes shall be organised for all categories of
personnel working in blood centres as well as drug inspectors and other
officers from regulatory agencies.
6.4 Appropriate modules for training of Donor Organisers/ Donor
Recruitment Officers shall be developed to facilitate regular and uniform
training programmes to be conducted in all States.
6.4.1 Persons appointed as Donor Organisers/Donor Recruitment Officers
shall undergo training for Donor Motivation and Recruitment organised by
State Blood Transfusion Councils.
6.5 Short orientation training cum advocacy programmes on donor
motivation and recruitment shall be organised for Community Based
Organisations (CBOs)/NGOs who wish to participate in Voluntary Blood
Donor Recruitment Programme.
6.6 Inter-country and intra-country exchange for training and experience
of personnel associated with blood centres shall be encouraged to improve
quality of Blood Transfusion Service.
6.7 States/UTs shall create a separate cadre and opportunities for promotions
for suitably trained medical and para medical personnel working in blood
transfusion services.
OBJECTIVE: 7:
To encourage Research & Development in the field of Transfusion Medicine
and related technology.
[221]
STRATEGY:
7.1 A corpus of funds shall be made available to NBTC/SBTCs to facilitate
research in transfusion medicine and technology related to blood banking.
7.2 A technical resource core group at national level shall be created to coordinate research and development in the country. This group shall be
responsible for recommending implementation of new technologies and
procedures in coordination with DC(I).
7.3 Multi-centric research initiatives on issues related to Blood Transfusion
shall be encouraged.
7.4 To take appropriate decisions and/ or introduction of policy initiatives
on the basis of factual information, operational research on various aspects
such as various aspects of Transfusion Transmissible Diseases, Knowledge,
Attitude and Practices (KAP) among donors, clinical use of blood, need
assessment etc shall be promoted.
7.5 Computer based information and management systems shall be
developed which can be used by all the centres regularly to facilitate
networking.
OBJECTIVE: 8:
To take adequate legislative and educational steps to eliminate profiteering
in blood banks.
STRATEGY:
8.1 For grant/ renewal of blood bank licenses including plan of a blood
bank, a committee, comprising of members from State/UT Blood Transfusion
Councils including Transfusion Medicine expert, Central & State/UT FDAs
shall be constituted which will scrutinise all applications as per the guidelines
provided by Drugs Controller General (India).
8.2 Fresh licenses to stand-alone blood banks in private sector shall not be
granted. Renewal of such blood banks shall be subjected to thorough scrutiny
and shall not be renewed in case of non-compliance of any condition of
licence.
[222]
8.3 All State/UT Blood Transfusion Councils shall develop a State Action
plan for the State/UT Blood Transfusion Service where in Regional Blood
Transfusion Centres shall be identified. These centres shall be from
Government, Indian Red Cross Society or other NGO run blood banks of
repute. Approved regional blood centres/ government blood centres/Indian
red cross blood centres shall be permitted to supply blood and blood
products to satellite centres which are approved by the committee as
described in para 8.1. The Regional Centre shall be responsible for
transportation, storage, cross-matching and distribution of blood and blood
products through satellite centres.
8.4 A separate blood bank cell shall be created under a senior officer not
below the rank of DDC(I) in the office of the DC(I) at the headquarter.
State/UT Drugs Control Department shall create such similar cells with the
trained officers including inspectors for proper inspection and enforcement.
8.5 As a deterrent to paid blood donors who operate in the disguise of
replacement donors, institutions who prescribe blood for transfusion shall
be made responsible for procurement of blood for their patients through
their affiliation with licensed blood centres.
8.6 States/UTs shall enact rules for registration of nursing homes wherein
provisions for affiliation with a licensed blood bank for procurement of
blood for their patients shall be incorporated.
8.7 The existing provisions of Drugs & Cosmetics Rules will be periodically
reviewed to introduce stringent penalties for unauthorised/irregular practices
in blood banking system.
[Released by the Ministry of Health and Family Welfare, National AIDS
Control Organisation, Government of India in April 6, 2002. Action Plan
was released in May 2003. ]
[223]
Reading Materials for Donor Motivators
[224]
Annexure II
National Blood Transfusion Council
In accordance with the directive of the Supreme Court, National Blood
Transfusion Council was constituted in 1996 as a Registered Society with
its office at New Delhi with the objectives to:
•
•
•
•
Promote voluntary blood donation
Ensure safe blood transfusion
Provide infrastructure to blood centres
Develop human resource.
The Council has its elaborate Memorandum of Association and Rules
and Regulation.
Additional Secretary and Project Director, National AIDS Control
Organisation, Ministry of Health and Family Welfare. Govt, of India, is the
President of the Council and the Director National Council who shall be
appointed by the Governing Body with the prior approval of the Union
Government shall be the Member Secretary. The Governing Body can
have not more than fourteen members at present but the first Governing
Body however was constituted with seven members.
The management of the affairs of the Council shall be entrusted to
the Governing Body. The Governing Body shall have the power to constitute
the Executive Committee as hereunder:
1. President of the Council
Member
2. Representatives from the Directorate General of Member
Health Services. Govt, of India
Member
3. Representatives of the Ministry of Finance
Govt. of India
4. Drugs Controller of India
Member
5.
One expert in Blood Transfusion Medicine
Member
6.
Representative from Indian Red Cross Society
Member
7.
Director, National Council
Member,
Secretary
[225]
Annexure III
State Blood Transfusion Council
In 1996, State Blood Transfusion Council in all states and union territories
were formed. This was according to the directive of the Supreme Court
The main objectives of the State Council are to:
•
•
•
•
Promote voluntary blood donation through education
Ensure appropriate use of blood
Develop nodal centres/district and subdivision blood centres.
Initiate human resource development programme.
The Governing body of the State Council to whom the management
of its affairs is entrusted shall be constituted in the following manner:
President
1.
Secretary to the Department of Ministry of
Health & Family Welfare
Member
2.
Director of Health Services
Member
3. State Drugs Controller
Member
4
Representative of Ministry of Finance
5.
6.
Representative of State Red Cross Society
Member
Representative of Private Blood Banks
7&8. Maximum two experts in Blood, Transfusion
Medicine & Health Institution of the State
9. Representative of Non-Government
Organisation (active in the field)
Member
Member
10. Representative of Nodal Blood Centres
11. Director, State Council
Member
Member
Member,
Secretary
The State Councils are to be funded by Union and State Government.
National AIDS Control Organisation. State Blood Transfusion Councils have
power to collect donations. All donations to the Councils are 100% income
tax free.
[226]
Annexure IV
Drug Rules
Relevant Portions of Drugs and Cosmetics Rules (1999) for blood
donor motivators are reproduced:
This amended Drugs and Cosmetic rules are applicable for Blood
Banks and Blood Donations effective in the country from April 5, 1999.
Some Definition:
"Donor" means a person who voluntarily donates blood after he has
been declared fit after a medical examination, for donating blood, on fulfilling
the criteria given herein after, without accepting in return any consideration
in cash or kind from any source, but does not include a professional or
paid donor.
Explanation:
For the purpose of this clause, benefits or incentives like pins, plaques,
badges, medals, commendation certificates, time off from work, membership
of blood assurance programme, gifts of little intrinsic or monetary value
shall not be construed as consideration.
"Professional donor" means a person who donates blood for a
valuable consideration, in cash or kind, from any source, on behalf of the
recipient - patient and includes a paid donor or a commercial donor.
"Replacement donor" means a donor who is a family friend or a
relative of the patient recipient.
License;
Each Blood Bank must have licence from Central Licence Approving.
Authority of Ministry Health and Family Welfare on the basis of
recommendation of Director, Drug Control of the State.
Conditions of Licence
1.
The licensee shall neither collect blood from any professional donor
or paid donor nor shall he prepare blood components from the blood
collected from such a donor.
2.
The licence and any certificate of renewal in force shall be displayed
on the approved premises and the original shall be produced at the
request of an inspector appointed under the Drugs and Cosmetics
Act, 1940.
[227]
3.
The licensee shall inform the Licensing Authority and/or Central
Licence Approving Authority in writing in the event of any change
in the constitution of the firm operating under the licence. Where
any change in the constitution of the firm takes place the current
licence shall be deemed to be valid for maximum period of three
months from the date on which the change has taken place unless in
the meantime, a fresh licence has been taken from the Licensing
Authority and /or Central Licence Approving Authority in the name
of the firm with the changed constitution".
Requirements for the Functioning and Operation of a Blood
Bank and/or Preparation of Blood Components:
A.
General:
1.
Location and Surroundings: The blood bank shall be located at a |
place which shall be away from open sewage, drain, public lavatory
or similar unhygienic surroundings.
2.
Building: The building(s) used for operation of a blood bank and/
or preparation of blood components shall be constructed in such a
manner so as to permit the operation of the blood bank and
preparation of blood components under hygienic conditions and
shall avoid the entry of insects, rodents and flies. It shall be well
lighted, ventilated and screened (mesh), where necessary. The walls
and floors of the rooms, where collection of blood or preparation
of blood components or blood products is carried out shall be
smooth, washable and capable of being kept clean. Drains shall be
of adequate size and where connected directly to a sewer shall be
equipped with traps to prevent back siphonage.
3.
Health, clothing and sanitation of staff: The employees shall be
free from contigious or infectious diseases. They shall be provided
with clean overalls, head-gears, foot-wears and gloves, wherever
required. There shall be adequate, clean and convenient hand
washing and toilet facilities.
Accommodation for a Blood Bank:
A blood bank shall have an area of 100 square meters for its operations
and an additional area of 50 square meters for preparation of blood
components. It shall be consisting of a room each for (1)
registration and medical examination with adequate furniture and
facilities for registration and selection of donors.
[228]
(2)
blood collection (air-conditioned)
(3)
blood component preparation (This shall be air-conditioned to
maintain temperature between 20 degree centigrade to 25 degree
centigrade).
(4)
laboratory for blood group serology (air-conditioned).
(5)
laboratory for blood transmissible diseases like Hepatitis. Syphilis.
Malaria. HIV-antibodies (air-conditioned)
(6)
sterilization-cum-washing.
(7)
refreshment -cum-rest room (air-conditioned)
(8)
store -cum-records
Notes:
(1)
The above requirements as to accommodation andarea may
be relaxed, in respect of testing laboratories and sterilizationcum-washing room, for reasons to be recorded limiting by
Licensing Authority and/or the Central Licence Approving
Authority, in respect of blood banks operating in hospitals.
provided the hospital concerned has pathological laboratory
and a sterilization-cum-washing room common with other
departments in the said hospital.
(2)
Refreshments to the donor after phlebotomy shall be served
so that he is kept under the observation in the Blood Bank.
Personnel
Every blood bank shall have following categories of whole time
competent technical staff and their number shall be in accordance
with the quantum of work load:
(a)
Medical Officer - With a Degree in Medicine (M. B. B. S. ) of a University
recognised by the Central Government and having experience in a
Blood Bank for one year during regular service. He shall have
adequate knowledge and experience in Blood Group Serology,
Blood Group Methodology and Medical principles involved in
procurement of blood/ or preparation of its components.
(b)
Technical Supervisor - with a Degree in Medical Laboratory
Technology (M L T) or equivalent qualifications with one year
experience in the processing and preparation of blood components.
[229]
(c)
Registered Nurse(s).
(d)
Blood Bank Technician(s) - With a Degree in Science subject and
having a certificate/ Diploma in M. L. T. (Diploma in Medical
Laboratory Technology) as recognised by a State Government/
Union Territory, with one year of experience.
NOTE:
(a)
The number of whole time technical personnel required by a blood
bank shall be such as may be approved by the Licensing Authority
or Central Licence Approving Authority, in accordance with the
quantum of workload in a blood bank.
(b)
It shall be the responsibility of the licensee to demonstrate through
maintenance of records and other latest techniques used in blood
banking system and the personnel involved in blood banking
activities for collection, storage, testing and distribution are adequately
trained in the current Good Manufacturing Practices/ Standard
Operating Procedures for the tasks undertaken by each personnel.
The personnel shall be made aware of the principles of Good
Manufacturing Practices/ Standard Operating Procedures that affect
them and receive initial and continuing training relevant to their
needs.
Criteria for Blood Donation
Condition for donation of blood
(1)
General: No person shall donate blood and no blood bank shall
draw blood from a person, more than once in three months. The
donor shall be in good health, mentally alert and physically fit and
shall not be inmates of jail, persons having multiple sex partners and
drug-addicts. The donors shall fulfil the following requirements,
namely:
(a) the donor shall be in the age group of 18 to 60 years;
(b) the donor shall not be less than 45 kilograms;
(c) temperature and pulse of the donor shall be normal;
(d) the systolic and diastolic blood pressure are within normal limits
without medication;
(e) haemoglobin which shall not be less than 12. 5 gms/hundred ml.
[230]
(f) the donor shall be free from acute respiratory disease;
(g) the donor shall be free from any skin diseases at the site of
phlebotomy;
(h) the donor shall be free from any disease transmissible by blood
transfusion, in so far as can be determined by history and
examination indicated above;
(i) the arms and forearms of the donor shall be free from skin
puncture or scar indicative of professional blood donors or
addiction of self injected narcotics.
2.
Additional qualification of a donor: No person shall donate
blood, and no blood bank shall draw blood from a donor, in the
conditions mentioned in column (1) of the Table given below before
the expiry of the period of deferment mentioned in the column (2)
of the said Table:
Table: Deferment of blood donation
PERIOD OF DEFERMENT
CONDITIONS
(2)
(a)
(1)
Abortions
6 months
(b)
History of blood transfusion
6 months
(c)
Surgery
12 months
(d)
Typhoid
12 months after recovery
(e)
History of Malaria and
duly treated
3 months (endemic)
3 years (non endemic area)
(f)
Tattoo
6 months
(h)
Breast feeding
12 months after delivery
(i)
Immunization (Cholera)
Typhoid, Diptheria, Tetanus.
Plague, Gammaglobulin)
15 days
(j)
Rabies vaccination
1 year after vaccination
(k)
History of Hepatitis in family
or close contact
12 months
(l)
Immunoglobulin
12 months
[231]
(3) No person shall donate blood and no blood bank shall draw blood
from a person, suffering from any diseases mentioned below:
b)
Heart disease
a)
c)
Cancer
Abnormal bleeding tendencies d)
Unexplained weight loss
e)
Diabetes controlled on insulin f)
Hepatitis B infection
g)
Chronic nephritis
h)
Signs and symptoms,
suggestive of AIDS
i)
Liver disease
j)
Tuberculosis
k)
Polycythemia Vera
l)
Asthma
m)
Epilepsy
n)
Leprosy
o)
Schizophrenia
P)
Endocrine disorders
General Equipment and Instruments:
1. For blood collection room:
(i)
Donor beds, chairs and tables: These shall be suitable and
comfortably cushioned and shall be of appropriate size.
(ii)
Bedside table
(iii)
Sphygmomanometer and Stethoscope
(iv)
Recovery beds for donors
(v) Refrigerators for storing separately tested and untested blood
maintaining temperature between 2 and 6 degree centigrade with
digital dial thermometer recording thermograph and alarm device.
with provision for continuous power supply.
(vi) Weighing devices for donor and blood containers.
2.
For haemoglobin determination:
(i)
Copper sulphate solution (specific gravity 1. 053)
(ii) Sterile lancet and impregnated alcohol swabs
(iii) Capillary tube (1. 3x1. 4x96 mm or pasteur pipettes)
(iv) Rubber bulbs for capillary tubings
(v) Sahli's haernoglobinometer/Colorimeteric method
[232]
3.
For temperature and pulse determination:
(i) Clinical thermometers
(ii) Watch (fitted with a seconds-hand) and a stop watch.
4.
For Blood containers:
(a) Only disposable PVC blood bags shall be used (closed system) as
per the specifications of IP/USP/BP.
(b) Anti-coagulants: The anti-coagulant solution shall be sterile, pyrogenfree and of the following composition that will ensure satisfactory
safety and efficacy of the whole blood and/or for all the separated
blood components.
(c) Citrate Phosphate Dextrose Adenine solution (CPDA) or Citrate
Phosphate Dextrose Adenine 1 (CPDA1) - 14 ml solution shall be
required for 100 ml of blood.
NOTE 1
(i) In case of single/double/triple/quadruple blood collection bags
used for blood component preparations, CPDA blood collection bags
may be used.
(ii) Acid Citrate Dextrose solution (ACD with Formula-A) I. P. 15 ml
solution shall be required for 100 ml of blood.
(iii) Additive solutions such as SAGM, ADSOL, NUTRICEL may be
used for storing and retaining Red Blood Corpuscles upto 42. days.
5.
Emergency equipments/items:
(i)
Oxygen cylinder with mask, gauge and pressure regulator;
(ii) 5 percent Glucose or Normal Saline;
(iii) Disposable sterile syringes and needles of various sizes;
(iv) Disposable sterile I. V Infusion sets;
(v) Ampoules of
Betamethasone
injections;
Adrenaline, Noradrenaline, Mephentin,
or Dexamethasone, Metoclorpropanide
(vi) Aspirin and spirit Ammonia Aromatic.
[233]
6.
Accessories:
(i) Such as blankets, emesis basins, haemostats, set clamps,
sponge forceps, gauze, dressing jars, solution jars, waste cans,
(ii) Medium cotton balls, 1. 25 cm adhesive tapes.
(iii) Denatured spirit. Tincture Iodine, green soap or liquid soap.
(iv) Paper napkins or towels
(v) Autoclave with temperature and pressure indicator
(vi) Incinerator
(vii) Standby generator.
TESTING OF WHOLE BLOOD:
Each blood unit shall also be tested for freedom from Hepatitis
B surface antigen, VDRL and malerial parasite and HIV I and
HIV II antibodies and results of such testing shall be recorded
on the label of the container.
NOTE:
(a)
Blood samples of donors in pilot tube and the
blood samples of the recipient shall be preserved
for 7 days after issue.
(b)
The blood intended for transfusion shall not be
frozen at any stage.
(c)
Blood containers shall not come directly in contact
with ice at any stage.
RECORDS:
The records which licensee is required to maintain shall include inter
alia the following particulars: —
Blood donor record: It shall indicate serial number, date
of bleeding, name, address and signature of donor with other
particulars of age, weight, hemoglobin, blood grouping, blood
pressure, medical examination, bag number and patient's
detail for whom donated in case of replacement donation
category of donation (voluntary /replacement) and deferra
records and signature of Medical Officer in-charge.
[234]
LA BEL S:
The labels on every bag containing blood and/or component shall
contain the following particulars, namely:
(1)
The proper name of the product in a prominent place and in
bold letters on the bag.
(2)
Name and address of the blood bank
(3)
Licence number
(4)
Serial number
(5)
The date on which the blood is drawn and the date of expiry
as prescribed under Schedule P to these rules:
(6)
A colored label shall be put on every bag containing blood.
The following colour scheme for the said labels shall be used
for different groups of blood.
Blood Group
Color of the label
O
Blue
A
Yellow
B
Pink
AB
White
(7)
The results of the tests for Hepatitis B surface antigen, syphilis
freedom from HIV I, and HIV II antibodies and malaria
parasite.
(8)
The Rh group
(9)
Total volume of bags, the preparation of blood, nature and
percentage of anti-coagulant.
(10)
Keep continuously temperature at 2 degree centigrade to 6
degree centigrade.
(11)
Disposable transfusion sets with filter shall be used in
administration equipment
(12)
Appropriate compatible cross matched blood without a typical
antibody in recipients shall be used.
[235]
Annexure VII
Training Modules for Blood Donor Motivators
Module I: Orientation Workshop on Approach to Voluntary Blood
Donation
Target Group: Blood Bank personnel working in the field of blood
donor motivation, blood collection, blood supply across counter i. e., having
opportunity to meet face to face with donor, intending or prospective donor,
patients’ relatives and friends in need of blood and blood donor organisers/
social workers/donor motivators/volunteers of other social welfare
organisations in the field of blood donor recruitment.
Object
(i) To impress upon the participants that blood donor motivation is a
art based on science and should be practised with dedication and organised
manner.
(ii) To expose a large number of people in the field to a organised
structured training schedule as a crash programme.
Entry Behaviour: Prior experience in the field of blood banking: or
blood donor recruitment.
Duration: 4 hours.
Course Content
Unit 1: Basic Concept
Indications of blood transfusion in modern medical science; history
of blood banking with special reference to India and the particular state or
district where the programme would be offered: basic functions of blood
bank; present system of blood banking and blood need of the state
concerned; types of blood bank in the state, types of blood donors; evils of
commercialisation of blood, need of a voluntary blood donor base in the
region to ensure safe blood transfusion; role of blood donor motivators
and organisers to recruit and retain voluntary blood donors to achieve
total voluntary blood programme.
Unit 2: Basic Blood Science
Elementary concept of blood circulation, vein and artery - nature of
blood flowing through them. Blood component -cells-R. B. C., W. B. C,
[248]
platelets plasma; percentage composition of cells, liquid part and water.
Blood volume (Male, Female), amount of donation, surplus; recuperative
period, life span of cells, shelf life of blood. Blood group and importance of
knowing one’s blood group; Donor screening - safety of donor and recipient.
Blood communicable diseases and safe blood transfusion.
Unit 3: Principles and Practice of Blood Donor Motivation
and Recruitment
Definition of motivation. Principles of blood donor recruitment Education, Motivation, Donation and Recognition. Target Setting.
Identification of Target groups. Method of approach, short term and long
term methods. Blood donation in camp and blood donation in blood bank,
consent of donor; Panel donor - formation and utilisation. Anonymity
between donor and recipient to meet fresh blood and rare group blood
need.
Unit 4: Communication and Public Relations
Types of communication, Fundamental basic tools of Donor
recruitment. Theory of oral communication, preparation for oral
communication, maintaining time frame, preparation and use of posters,
folders. Do’s and don’ts of public relations. Telephonic communication and
handling people across the counter and handling of grievances and
complaints. Feed back and reinforcement.
Module II: For Blood Donor Motivators and Recruiters
Object:
(i) To introduce the social workers and donor organisers to the various
facets of blood donor recruitment;
(ii) To inspire the social workers and donor organisers to work with
respect and dignity to achieve their target or reach the goal.
(iii) To instil a sense of importance about the vital basic area of blood
banking to ensure safe blood transfusion in the minds of social workers and
donor organisers.
Duration: 12 hours.
[249]
Course Content
Unit 1: Broad Perspective
Importance of blood banking and blood transfusion in modern medical
science, history of blood banking, blood transfusion science and blood
donation movement at home and abroad.
Unit 2: Blood Bank
Need of blood banks; types of blood banks in the country; functions
of ideal blood banks; source of blood - voluntary blood donor, relative and
replacement blood donor, blood sellers; evils of commercialisation of blood;
ethics in blood banking, blood banking system of the concerned region;
how to get blood at the time of need.
Unit 3: Basic Blood Science
Blood, its composition, function, types and functions of cells and
plasma, percentage of cell, liquid portion and water content, life span of
RBC. circulation system, venous and arterial blood, volume calculation,
amount of surplus and amount of donation, recuperative power of human
body; recuperation of cells and plasma is a natural process, no special diet
or medicines required; pain one has to suffer at the time of donation.
Unit 4: Blood Groups
ABO and Rh systems, its meaning and significance in blood
transfusion. Importance of knowing one’s own blood group; compatibility
of blood group; concept of universal donor and recipient. Haemolytic
disease of new born and precautions. Need of blood group tests in
pregnancy and provision of blood in case of Rh negative mother.
Unit 5: Precautions from Blood Communicable Diseases and
Inherited Blood Diseases
Blood communicable diseases - Hepatitis. STD, Malaria, AIDS; tests,
validity, cost and time involved; quality of blood donor and education.
Inherited blood diseases -Haemophilia and Thalassaemia; technique of
meeting their blood need; counselling for the donors and patients.
Unit 6: Blood Donor Screening
Objectives of donor screening, safety of the donor and safety of the
recipient, scientific donor screening helps in donor motivation. Principles,
techniques and strategies of donor screening - history of past illness and
present ailments, date of last blood donation, age, body weight. Physical
[250]
examination - heart, lung, liver, spleen, blood pressure, pulse, temperature
and physical appearance. Haemoglobin estimation. National standard of
blood donor screening. Role of social worker and doctors in donor screening.
Temporary deferral and permanent deferral; technique of handling unfit
intending blood donor. Need of uniformity of donor screening standard in
all the blood banks of the country, education for self exclusion.
Unit 7: Principles of Blood Donor Motivation
Four basic principles of blood Donor recruitment -Education,
Motivation. Donation and Recognition. Why people do not donate blood,
why people donate blood, why people don’t donate blood after their first
blood donation. Need for both recruiting new blood donors and retaining
old blood donors to build up a healthy voluntary blood donor base to
develop the culture of blood donation in the community: consent of donors.
Types of approach - Individual or personal approach. Group approach
and Mass approach. Need of short term and long term programmes.
Unit 8: Donor Motivation Practice (Techniques)
Dividing the community into target groups; determining the method
of approach. Short term approach techniques for donor recruitment,
advantage of blood donation in outdoor camps in the place of respective
target groups; mass blood donation camps, identification of days of blood
donation of the group on significant or auspicious day of that group; use of
media - news paper, periodicals, TV and Radio. Designing and producing
campaigning materials like - posters, folders, stickers, hoardings, newspaper
ads. TV, Radio spots and programmes in different slots; preparation and
use of audio visual aids-slides, audio and video cassettes, transparencies
for overhead projectors. Techniques of honouring and recognising donors.
Long term programme for the donors of tomorrow - school education
programme - philosophy and technique, demonstration of blood donation
camps in school.
Unit 9: Blood Donation Camp
Planning and setting up blood donation camp; Furniture, equipment,
layout, physical facilities. Using blood donation camp as a tool of blood
donor motivation. Cleanliness, discipline, consent, comfort, entertainment
and handling of donors from reception to send off; paper work in blood
donation camps, significance and simplification. Refreshment of donor budget. menu, serving; donors badge and certificate; donors card: after
donation care; management of donor in case of post donation shock or
any other inconvenience. Role of Social Worker in the camp. Liaison with
technical people and their work.
[251]
Unit 10: Communication Techniques
Types of communication, principles of oral communication, preparation
of lecture/ lesson for short term and long term goal; principles and techniques
of lecture planning, home work; voice, modulation of voice, pronunciation,
pitch of the voice, audibility, study of mental make up of the audience, eye
contact, mannerism, use of story, stories as a vehicle of communicator.
selection and presentation of story, time planning -over stepping beyond
allotted time. Use of audio visual aids and distribution of campaign materials
and literature.
Unit 11: Organisation
The need for an organisation within or outside the blood bank for
recruiting blood donors like blood donors society, club, association by
involving the community - method of formation, registration, running
office work and management of such organisations, books of account;
meetings and meeting procedures and constitution, recruitment and training
of volunteers.
Unit 12: Social Worker and Donor Organisers
Qualities of social workers, development of social workers, types of
leadership qualities, innovative and imaginative leader, responsibilities of
leader, self development, updating, information level.
Project:
(1)
(2)
(3)
To visit a blood bank
To visit an outdoor blood donation session
To attend a donor motivation session.
Module III: Refresher Course For Senior Motivators
Object: To help the motivators to perform better.
Duration: 15 hours.
Course Content
Unit 1: Land and people
Population, area, districts, language, “festival, literacy, birth rate, death,
rate, historical background, contribution to the culture of the country
number of blood banks in the state, total requirement and collection from
voluntary blood donors in the country, blood requirements of the state
collection from other different sources.
[252]
Unit 2: Background
Transfusion medicine is a speciality with blood donor motivation as its
foundation, role of blood donor motivators and organisers. Historical
background of blood banking from ancient days to work of Dr William
Harvey, Dr. Richard Lower, Dr James Blundell, Dr Karl Landsteiner, Dr
Hustin, Dr Andre Bagdasorov, Dr Norman Bethune, advancement during
the second world war, Korean war and Vietnam war. Growth and
development of blood transfusion service in India- vis-a-vis the voluntary
blood donation movement in different states and union territories.
Unit 3: Basic Blood Science
What is blood; composition of blood - blood cells and plasma -their
percentage composition; cells, plasma and water in plasma, types of blood
ceils - RBC. WBC, platelets - function and life span, automatic destruction
and replacement of cells; blood circulation system, function of heart and
lungs; significance of blood pressure, venous blood and arterial blood; reason
for blood collection from vein: approximate distance travelled by a blood
cell and approximate volume of blood pumped by heart in a day in a
circulation system; blood volume, meaning of total volume, approximate
volume of blood per unit Kg body weight for male and female; amount
required in the circulation system for routine work, amount of surplus,
storage places of surplus blood- liver, spleen, lungs; amount of donation its scientific basis, minimum body weight required for donating blood,
normal recuperative power of human body; no special diet or medicine is
required, amount of blood donation and interval between each donation,
recuperative power of human body, shelf and of blood, modern
improvement in blood preservation.
Unit 4: Blood Group
Discovery of Blood Groups, ABO system of Blood Groups, significance
and importance of ABO and Rh system of blood group in blood transfusion;
who can receive blood from whom; statistics of percentage of people
belonging to different blood group in the world, country and the region,
inheritance of blood group - it does not change in life, method of
determining blood group in laboratory; compatibility test and cross
matching; advantage and importance of knowing one’s own blood group,
meaning of rare group, easiest way to know one’s own blood group is by
donating blood voluntarily.
[253]
Unit 5: Blood Donor Screening for Safe Blood Transfusion
Meaning and object of donor screening, safety of donor, safety of recipient,
quality of blood; need of safe blood transfusion; scientific donor screening is a
part of donor motivation strategies; temporary unfit willing donor- responsibility
and behaviour pattern of social worker and donor organisers in each case.
History of past ailments, last date of donation, time of last meal taken, body
weight, age. physical check up - heart, liver, spleen, pulse, temperature by
medical officer of the camp, estimation of haemoglobin, role of social workers,
decision of medical officer present in the camp is final. Tests undertaken in the
blood bank, need of uniform standard for donor screening in all blood banks.
National guideline. Self exclusion.
Unit 6: Human Psychology
Basic human need, analysing human psychology in blood donor
recruitment. Psychology of donor, non-donor and one time donor, common
apprehension of people on blood donation. Donor has a right to know.
Common expectation of donors. Necessity of designing donor recruitment
programme on the basis of above psychology and need.
Unit 7: Blood Bank
Need of blood bank; types of blood banks in the country; functions of
ideal blood banks; procurement of blood by blood banks from voluntary
donors in camps or bank and replacement or relative or directed donor
evils of commercialisation of blood; ethics in blood banking. Blood Banking
system of the concerned state; how to get blood in time of need, panel
donor, on call donor system.
Unit 8: Principles of Blood Donor Motivation
Four basic principles of Blood Donor Recruitment - Education,
Motivation, Donation and Recognition; why people do not donate blood,
why people donate blood, why people do not donate blood after their first
blood donation. Need of both recruiting new blood donor and retaining
old blood donor base to develop the culture of blood donation in the
community; consent of donors. Types of approach - Individual or personal
approach, Group approach and Mass approach. Need of short term and
long term programmes.
Unit 9: Donor Motivation Techniques
Dividing the community into target groups; determining the method
of approach. Short term approach techniques for donor recruitment,
advantage of blood donation in outdoor camps in the place of respective
[254]
target group; mass blood donation camps, identification of days of blood
donation of the group: use of media - news paper, periodicals, TV & Radio.
Designing and producing campaign materials like - posters, folders, stickers,
hoardings, news paper ads, TV, Radio Spots and programmes in different
slots: preparation and use of Audio Visual aids - slides, audio and video
cassettes, transparencies for overhead projectors. Techniques of honouring
and recognising donors. Long term programme for the donors of tomorrow.
Unit 10: Blood Donation Camp
Planning and setting up blood donation camp; Furniture, equipment,
layout, physical facilities. Using blood donation camp as a tool of blood
donor motivation. Adantage of blood collection in camp over collection in
blood bank or mobile van. Cleanliness, discipline, consent, comfort,
entertainment and handling of donors from reception to send off; paper
work in donation camp - significance and simplification: Refreshment of
donor- budget, menu, serving; donors badge and certificate; donors’ card;
- after donation care; management of donor in case of post donation shock
or any other inconvenience. Role of social worker in the camp. Liaison
with technical people and their work.
Unit 11: Communication Techniques
Types of communication, principles of oral communication,
preparation of lecture/ lesson for short term and long term goal; principles
and techniques of lecture planning, home work; voice, modulation of voice,
pronunciation, pitch of the voice, audibility, study of mental make up of
the audience, eye contact, mannerism; use of correct fact, figures and
statistics. Use of story, stories as a vehicle of communication, technique of
story telling, time planning - over-stepping beyond allotted time. Use of
Audio-visual aids and distribution of campaign materials and literature.
Unit 12: Demand and Supply of Blood for Transfusion
Indications of blood transfusion, - Major area. Source of supply;
Techniques of estimating blood need of country/ state/ region /hospital.
Planning to meet blood need. [To be worked out by using relevant data of
a hospital or a region]. Blood donor per thousand of eligible population of
developed, developing countries including India. Fresh blood need, blood
need in disaster, blood need in blood diseases - Techniques of meeting
these needs.
Unit 13: Social Worker
Definition of social work and social worker. Basic difference between
a common person and a social worker, human need and want. Why people
[255]
should do social work. Qualities temperament, background of social worker
Knowledge and information level of social workers in the role of blood
donor motivator / organiser/ recruiter. Expectations from social worker to
meet the challenge of blood donor recruitment to ensure safe blood
transfusion and achieve total voluntary programme for his/ her area of
work.
Unit 14: Blood Communicable Diseases
Malaria, Hepatitis. Syphilis, AIDS; available laboratory tests in he
country - validity of tests, time required for each test and cost involved
Theoretical knowledge about the name and method of each tests
Demonstration of laboratory tests. Feedback of laboratory tests to the donor
or donor organisers and the mode of communication. Confidentiality.
Unit 15: School Education Programme
Object of planning the recruitment of donors of tomorrow. Importance
of school education programme in blood donation movement; Reasons
for selecting school students for education on blood donation: Model; of
school education programme used all over the world -Models used in
Portugal, France, U. S. A.. Australia and India. Technology of the Indian
programme, contents of the programme, methods of teaching aides to be
used, stories as vehicles of communication. Do’s and Don’ts of school
teaching faculty. Should this programme be undertaken as a part of school
syllabus or as an extension lecture by social workers? Difference between
mode of teaching in a school and a talk in a seminar. Children in the role of
donor organiser and message carriers to elders. Demonstration blood
donation camp or demonstration blood grouping camp in school.
(Source: AVBDWB]
[256]
Documents on Blood Donor Motivation
[257]
Guidebooks of Blood Donor Recruitment
[258]
Annexure VIII
Slogans on Blood Donation
With appropriate visuals, posters and stickers may be prepared with
these slogans. In hoardings and TV spots these slogans may also be used:
1.
A bottle of blood saved my life. Was it yours?
2.
My son is back home because you donated blood.
3.
Ma is coming back home because you gave blood.
4.
Blood donation is a friendly gesture.
5.
Blood owners should be blood donors.
6.
Blood is meant for circulation. Donate Blood.
7.
Blood Donors bring Sunshine.
8.
Keep blood bank shelves full. You may need blood someday.
9.
Someone is needing blood somewhere.
10.
Life of some patients is resting on a fraction of hope in quest
of your gift of love.
11.
A life in the surgeon’s hand may be yours. Donate blood for
tomorrow.
12.
Observe your birthday by donating blood.
13.
Wouldn’t you have given blood if this child was yours?
14.
Donate blood - Gift life.
15.
Give mankind the greatest gift. Donate blood when Blood
Bank comes to your place.
16.
A few drops of your blood can help a life to bloom.
17.
At 18 you grow up.
At 18 you drive.
At 18 you give blood to keep someone alive.
18.
Give the gift that keeps on living. Donate blood.
19.
We need you to save life.
20.
You don’t have to have a medical degree to save a life. Just a
fair degree of humanity. Give Blood. Save Life.
21.
Blessed are the young who can donate blood.
22.
Blood donation will cost you nothing but it will save a life !
23.
Patients need your gift of love to fight against mortal sickness.
24.
Your donation of blood today may be an investment for your
future.
25.
Share blood - Share life.
26.
It is a joy to give blood.
27.
Tears of a mother cannot save her Child. But your blood can.
28.
Be a blood donor and save a life.
29.
Donation of blood means a few minutes to you but a lifetime
for somebody else.
[259]
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
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43.
44.
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46.
47.
48.
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53.
54.
55.
56.
57.
58.
59.
60.
61.
People can get along without teeth or hair but not without
blood.
Donation of blood is harmless and safe.
Safe blood starts with me.
You can donate blood 168 times between the age of 18 - 60
years.
Your refusal to donate blood may cost a life of your near and.
dear one.
A life is waiting for a bag of blood from you.
Remember, today you can give your blood. Tomorrow your
near and dear one may need it.
Every tomorrow needs a blood donor today.
Many things in this world can wait but transfusion of blood to
a dying patient cannot.
Calling blood donors to save life. Can you hear?
Give a gift of love. Your own blood.
Vote for life with your Blood.
Be a Life Guard. Give Blood to save life.
Have you donated Blood? If not — do it Now.
Give the gift of Blood, the gift of life.
For every 1000 who can donate blood only four do! What
about you! Give Blood and gift a life.
Blood is meant to circulate. Pass it around.
If blood bank gives blood only to the blood donors, what
would be the chance of those who depend on you?
Five minutes of your time + 350 ml. of your blood = One life
saved.
I am a blood donor. Are you too ?
The finest gesture one can make is to save life by donating
blood.
Blood donors bring a ray of hope.
Blood for human comes from human beings only.
Blood Bank cannot get blood from stone.
Blood Donation would not hurt you, but it would save a life.
Thank you. Blood Donor. Be a regular Blood Donor.
Blood has no substitute as yet.
Anybody having a heart to respond can donate blood to save
life.
Blood donation - a Gift of Love.
Do not shed blood. Donate Blood.
You can be a life saver without knowing swimming.
Have a heart. Give Blood.
[260]
62.
63.
64.
65.
66.
67.
68.
69.
70.
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72.
73.
74.
75.
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93.
94.
95.
96.
97.
98.
99.
100.
Donate blood so that others may live.
Donation of blood makes a difference between life and death.
It is time to roll up your sleeve to offer your gift of love.
Share a little, care a little - Donate Blood.
You too can have the joy of saving a man’s life by donating
blood.
Do you have a blood donor friend to stand by you in time of
your need?
You too can take up the job of saving a life by just donating
your blood.
Do you make friendship with blood donors?
Let us be blood brothers.
Let blood bind us together in friendship for ever.
The colour of human blood is red all over the world. Anywhere you can donate your blood.
It’s time to go to Blood Donation Camp.
Donating blood is a social responsibility
The blood is red gold in time of saving a life.
Blessed are the young who can give back life with their blood
— Donate blood, save a life.
To the young and healthy it’s no loss. To sick it’s hope of life.
Donate blood to give back life.
Donate blood to save the dying.
Care, share and live by donating blood.
Among flowers — the Rose.
Among Human beings — the blood donor.
Life is precious. Save a life by donating a little bit of your
blood.
Blood donation is safe. It will cost you nothing but a few moments of your time.
Heart beat goes on - when you give blood.
Are you a blood donor?
Blood is for the people by the blood donors.
Help them. Help others, make your blood donation.
You cannot manufacture blood in factory. It has to be donated by human being.
Safe blood starts with voluntary blood donors.
Light up a lamp of life by donating blood.
Share the joy of life, give the life of a child by donating blood.
I am proud, there is blood donor in my family.
The blood donor of today may be recipient of tomorrow.
Voluntary blood donors are the key to safe blood.
[261]
Many people pray for mountains to be moved when all they
need is to climb. Donate blood for your near and dear one.
Excuses never save a life. Blood donation does.
Smile and give, some one will smile and live.
Someone lives when someone gives. There is no substitute
of human blood.
The finest gesture one can make is to save life by donating
blood.
Drive carefully — otherwise you might need me — 1 am a
blood donor.
Share the happiness of glory. There is a feeling of joy when
you give the gift of blood.
[262]
Annexure IX
Important Dates for
Blood Donation Drives
It has been observed that different organisations or groups love to organise
their blood collection drive on a significant day. The day may have
international, national, regional and local significance. The donor motivators
have to be on the lookout for such days and make them popular for blood
collection drives. In India nobody observed Independence Day by donating
blood before 1964. Now throughout the country on this day hundreds of
blood donation drives are organised. A calendar can be prepared with a
little bit of library work and by using encyclopaedia of dates and events, so
that every day can be a significant day for blood donation for some group
or the other. The days of joys and sorrows, anniversaries, historical events,
may be the days of blood donations. Some examples are shown below:
January
1
12
14
15
23
26
27
30
February 3
11
19
21
22
28
March
8
12
15
16
18
19
20
Birthday of Guru Gobinda
Birthday of Swami Vivekananda & National Youth
Day.
Birthday of Martin Luther King & Albert Schweitzer
Army Day
Birthday of Netaji Subhas Chandra Bose
Republic Day
World Leprosy Day
Martyrs’ Day
Frank Worrell Day
World Day of Sick
Birthday of Shivaji
Bhasa Sahid Dibash
International Girls’ Guide Day
Science Day
International Women’s Day
National Volunteers Day
Consumer’s Day
Immunisation Day
Handicapped Day
Azad Hind Fouz hoisted National flag at Mairang
Social Empowerment Day
21
Forest Day
23
Bhagat Singh Day
24
World TB Day
[263]
April
May
June
July
August
27
4
5
7
10
11
14
15
25
1
5
8
9
12
13
17
20
24
31
5
14
26
27
1
4
6
8
21
23
26
29
1
6
8
9
15
16
20
Theatre Day
Safety Day
Maritime Day
World Health Day
Birthday of Hahnemann
National Mothers’ Day
Jaliwanwala Bag Dibash
World Standards Day
Words ‘Blood Bank’ first used
May Day
World Literacy Day
Red Cross Day. Birthday of Henry Dunant & World
Thalassaemia Day, Birthday of Rabindra Nath
Tagore
Birth Day of Rana Pratap
Florence Nightingale Day
Solidarity Day
Telecommunication Day
National Public Relations Day
Commonwealth Day
World No Tobaco Day
Environment Day
Birthday of Karl Landsteiner
World Blood Donor Day
Anti Drug Day
Hellen Keller Day
Birthday of Dr B C Roy & Doctors’ Day
Bastille Day (French Revolution)
Birthday of Dr Shyamaprasad Mukherjee
Azad Hind Fauz Day
Adoption of National Flag of India
Birthday of Bal Gangadhar Tilak
Kargil Day
Indian Science Congress formed
Non-cooperation Movement Launched by
Mahatma Gandhi
Hiroshima Day
Quit India Day
Nagasaki Day
Independence Day
Football Lovers’ Day
Ronald Ross Discovered Malaria parasite in
[264]
26
27
29
September
1
5
11
16
22
23
24
26
27
29
October
1
2
4
8
9
10
12
15
16
25
28
31
November
2
7
11
13
14
16
17
18
21
23
28
30
December
1
3
4
Jaharbrata by Rani Padmini at Chitorgarh
Adi Grantha Sahib installed at Amritsar Golden
Temple
National Sports Day, Birthday of Dhyan Chand
Rakhi Bandhan falls on full moon day of August
INA formed
Teachers’ Day
Chicago address delivered by Swami Vivekananda
Peace Day
Alzeimer’s Day
World Deaf Day
Girl Child Day
Birthday of Iswar Chandra Vidyasagar
Birthday of Bhagat Singh/Tourism Day
Matangini Hazra became martyr
All India Voluntary Blood Donation Day
Birthday of Mahatma Gandhi
National Integration Day
Postal Day/Air Force Day
International Natural Disaster Reduction Day
World Mental Health Day
World Arthritis Day
World White Cane Day
World Food Day
United Nations Day
Birthday of Sister Nivedita
Birthday of Sardar Ballab Bhai Patel
Birthday of Guru Ramdas
Birthday of C V Raman
Birthday of Abul Kalam Azad
Birthday of Ranjit Singh
Children’s Day/Birthday of Pandit Nehru
Birthday of Rani Laxmi Bai
Death of Lajpat Rai
Army Day
First Postage Stamp of Independent India released
Birthday of Shri Satya Sai Baba
NCC Day
Birthday of Sir Jagadish Chandra Bose
Border Security Force Day
International Day of Disabled Persons
Navy Day
[265]
10
11
18
25
27
Human Rights Day
UNICEF Day
Goa Liberation Day
Christmas Day
Janagana Mono was first sung at Calcutta session
of Indian National Congress
Occasions like Good Friday, Palm Sunday, Birthday of Guru Nanak
Hajrat Mohammand. Various Pujas and Muharram follow luner calendar
and as such these days fall on different dates in different years. Motivators
should consult almanac every year to find out these days.
Blood donor motivators should prepare his/her own calendar the
calendar must have a relevance with the culture and people of the region.
[266]
Annexure X
State AIDS Control Society
(Blood Safety Units)
Project Director,
Andhra Pradesh State AIDS Cell Society,
Directorate of Medical & Health Services, Sultan Bazar,
Hyderabad-500 059, Andhra Pradesh
project Director,
Assam State AIDS Control Society,
Khanapara,
Guwahati-781 006, Assam
Project Director,
Andaman & Nicobar AIDS Control Society, G. B. Pant Hospital Complex,
Port Blair-744 104, Andaman and Nicobar Islands
Project Director,
Arunachal Pradesh AIDS Control Society, Naharlagun,
New ltanagar-791 110, Arunachal Pradesh
Project Director,
Bihar State AIDS Control Society,
Health Department,
New Secretariat,
Patna-800 015. Bihar
Project Director,
State AIDS Preventive & Control Society, Union Territory of Chandigarh,
General Hospital.
Sector 16, Chandigarh-160 016
Project Director,
Chatishgarh State AIDS Control Society,
State Health Training Centre,
Kalibari, Chhatisgarh
Programme Officer (AIDS) & DHS,
State AIDS Control Society,
UT of Daman & Diu,
Primary Health Centre, Mori Daman,
Daman-3% 220.
[267]
Programme Officer (AIDS)
Administration of Dadra & Nagar Haveli,
Silvassa-396230.
Project Director,
Delhi AIDS Niyantran Samiti,
11, Lancer Road, Mall Road,
Timarpur, Delhi -110054.
Project Director,
Goa State AIDS Control Society,
Directorate of Health Services,
Campal,
Panaji-403 001, Goa
Project Director,
Gujarat State AIDS Control Society,
Old Cardiology Building.
Civil Hospital,
Ahmedabad-380016, Gujarat
Project Director,
Haryana AIDS Control Society,
State Health & FW Training Institute.
Sector-6, Chandigarh,
Panchkula. Haryana.
Project Director,
Himachal Pradesh State Society for AIDS Control,
Health & Family Welfare Directorate,
Shimla-171 009. Himachal Pradesh
Project Director,
J & K State AIDS Prevention & Control Society,
Health & Medical Education Department,
Old Secretariat,
Jammu/ Srinagar., Jammu and Kashmir
Project Director,
Jharkhand State AIDS Control Society,
Sadar Hospital Campus,
Purlia Road,
Ranchi - 834008
Project Director,
Karnataka State AIDS Prevention Society,
Directorate of Health & Family Welfare Services,
Ananda Rao Circle,
Bangalore-560009, Karnataka
[268]
project Director,
Kerala State AIDS Control Society,
IPP Building.
Red Cross Road.
Thiruvananathapuram-695037.
Kerala
programme Officer (AIDS) & DDHS,
Directorate of Medical & Health Services,
UT of Lakshadweep,
Kavaratti-682555.
project Director,
Madhya Pradesh AIDS Control Society. DTC Building.
J. P. Hospital Campus,
Tulsi Nagar, Bhopal-462 003, Madhya Pradesh
Project Director,
Maharashtra State AIDS Control Society,
Directorate of Medical Education, Govt. Dental Medical
College.
3rd Floor, De Mello Road.
Mumbai-400001, Maharashtra
Project Director,
Manipur State AIDS Control Society
Medical Directorate, Lamphelpat
Imphal. Manipur.
Project Director,
Meghalaya AIDS Control Society,
3rd Secretariat Building. Lower Lachumiere,
Shillong- 793001, Meghalaya
Project Director,
State AIDS Control Society.
Govt, of Mizoram,
Aizawl-796 001, Mizoram
Project Director,
Nagaland State AIDS Control Society,
Health & Family Welfare Deptt.
New Secretariat Building.
Kohima-797 001, NagaJand
Project Director,
Orissa State AIDS Control Society,
Directorate of Health Services.
Bhuvaneshwar-751 001, Orissa
[269]
Project Director,
The Pondicherry AIDS Society,
PHC Campus, Odien Salai,
Pondicherry-605001.
Project Director,
Punjab State AIDS Control Society,
Civil Hospital, Phase-IV,
Mohali, Punjab.
Project Director & DHS,
Rajasthan State AIDS Control Society, Medical & Health Directorate,
Swasthya Bhawan,
Tilak Marg, “C” Scheme,
Jaipur-302005. Rajasthan
Project Director,
Sikkim State AIDS Project Cell,
STNM Hospital. Sikkim,
Gangtok-737101, Sikkim
Project Director,
Tamil Nadu AIDS Control Society
4/7 Pantheon Road. Egmore
Chennai - 600 008. Tamil Nadu
Project Director,
Tripura State AIDS Control Society.
Health Directorate Building, Gurkhabasti, P. O. Kunjaban, Agartala, West
Tripura-799006.
Project Director,
UP State AIDS Control Society.
2nd Floor, Maternity Home,
Nawal Kishore Road, Hazratganj,
Lucknow-226001. Uttar Pradesh
Project Director,
Uttaranchal State AIDS Control Society,
Directorate General of Health Services,
Chandan Nagar,
Dehradoon, Uttaranchal
Project Director,
West Bengal State AIDS Prevention & Control Society,
Shed “C”
Bhawani Bhavan
34/1 Belvedere Road
Kolkata- 700 027, West Bengal
[270]
Annexure XI
Glossary
ACD
Acid Citrate Dextrose: anticoagulant preservative solution for donor blood, no longer
much used because better solutions exist, permitting longer storage and better
preservation (e. g. CPDA. CPDA1, and various additive solutions. )
AIDS
Acquired Immunodeficiency Syndrome: chronic fatal disease caused by HIV
infection.
Albumin
Predominant plasma protein, accounting for about 60% of the protein content of
human blood. Plays an important role in maintenance of fluid balance and normal
blood volume. Albumin, prepared by fractionation of human plasma, is one of the
important blood products for transfusion.
Antibody
Protein, of the immunoglobulin class, which is produced in response to exposure to
a specific antigen, and which is capable of binding specifically to that antigen.
Anticoagulant
Substance which prevents blood coagulation (clotting, fibrin formation!.
Antigen
Substance which is capable of provoking an antibody response.
Apheresis
Type of blood donation in which only one specific constituent (e. g. plasma, platelets)
is retained for transfusion while the rest of the donated blood is returned to the
donor.
Australia antigen
Term originally applied to what is now known as HBsAg (Hepatitis B Surface
Antigen).
Air embolism
Obstruction of a blood vessel caused by air entering the circulatory system.
Agglutination
The clumping together of human red cells.
Autologous transfusion
The trnsfusion of any blood component that was donated by the intended recipient
himself/herself.
Blood bank
Facility where blood can be collected, processed and stored for transfusion.
Blood cells
The cellular part of blood. Each cell is a living particle, enclosed in a membrane.
[271]
The principal blood cells ate red cells (erythrocytes), white cells (leucocytes) and
platelets (thrombocytes).
Blood centre
Building or location specifically dedicated to blood collection, component production
testing, storage, distribution, etc.
Blood components
Blood products, which can be routinely prepared by a BTS from donations of
whole blood, which are made by separating specific parts of the blood which are
useful for transfusion. Important components are red blood cells, platelets, plasma
and cryoprecipitate.
Blood donor
Person whose blood is collected for transfusion. This term is most commonly used
for donors of whole blood but may also be used for donors of plasma, platelets. etc
Blood groups
Term referring to systems of antigens on the cell surface, which may vary from
person to person and which determine the compatibility of blood for transfusion.
Blood products
Any preparation which can be made from blood is a blood product. Blood products
include blood components, plasma derivatives and a variety of preparations which
are used for non-transfusion purposes (e. g. serological or cellular reagents).
Blood substitutes
Substances which can be used instead of blood.
Blood transfusion
Intravenous administration of blood or blood components to a patient.
Blood Transfusion Service (BTS)
Any organization designed to make blood and blood components available for
transfusion. The typical BTS is involved in donor recruitment, blood collection,
laboratory testing, component production, storage and distribution of blood products,
and provides a service to multiple hospitals.
Blood typing
Laboratory testing to determine a person’s blood group.
Centrifugation
Technique, based upon spinning at high speed in a centrifuge, and thus exaggerating
differences in specific gravity of different components, useful for separation of whole
blood into its major components.
Component therapy
System of transfusion therapy (haemotherapy) based upon the availability of blood
components and their active appropriate use for transfusion purposes. By implication
most whole blood is used for making components.
[272]
CPD
Citrate Phosphate Dextrose: anticoagulant preservative solution for donor blood.
CPDA1
Citrate Phosphate Dextrose Adenine formula 1 (several other formulae are in routine
or experimental use. ) CPD-Adenine is a better preservative than ACD or CPD but
has, in many countries, been largely replaced by additive solutions.
Cryoprecipitate
One of the major blood components, prepared by slow thawing of fresh frozen
plasma and separation of the resulting cold-insoluble precipitate from the rest of the
plasma. This cryoprecipitate contains increased concentrations of factor VIII, von
Willebrand factor and fibrinogen, fibronectin and cold-insoluble globulin.
Cryoprecipitate has proved useful in the treatment of haemophilia A, von Willebrand’s
disease and fibrinogen deficiency.
Cytapheresis
Apheresis procedure designed to collect specific cells from the donor’s blood.
Chromosome
A thread-like structure which carries genes. They are present in the nucleus of most
living cells.
Coagulation
Clotting of blood which takes place when blood is collected in a dry container or
reaches an open wound.
Commercial or professional donor (seller)
A donor who gives blood in return for money or other form of payment,
Confidential unit exclusion
The removal and disposal of a unit of blood after donation at the request of the
donor.
Demand
Term referring to the blood product/service which is wanted/ordered/requested.
Direct transfusion
Obsolete technique whereby transfusion was accomplished by direct flow of blood
from the donor into the patient.
Directed donation
Blood donation where the donor’s blood is reserved for a specific patient.
Donor deferral
Term referring to the non-acceptance of a prospective blood donor. Deferral may
be temporary (for a specific time) or indefinite (no specific time can be assigned) or
even permanent.
Donor motivation
Term applied to the process of public education and motivation for blood donation.
[273]
Donor recruitment
Term applied to the whole process of ensuring that there will be a sufficient number
of suitable blood donors.
Donor retention
Term applied to the process of ensuring that known donors will become regular
donors and continue to donate.
ELISA (ElA)
Enzyme Linked Immunosorbent Assay. A test system designed to detect specific
antibodies or antigens in a test sample. An important part of BTS technology since
it became necessary and possible to detect the presence of infections transmissible
by blood.
Erythrocyte
The red blood cell (the most numerous blood cell), which contains the red pigment
haemoglobin and is responsible for transporting oxygen to the body tissues.
Factor VIII
Glycoprotein macromolecule, found in normal plasma and necessary for normal
blood coagulation. This factor is absent or abnormal in haemophilia A arid is essentia]
for effective treatment of this condition.
Factor IK
Essential for the treatment of haemophilia B.
Fibrinogen
Plasma protein which is converted to fibrin during the blood coagulation process.
Fractionation
The term ‘fractionation’ is sometimes incorrectly used to refer to ‘component
production’, but this usage is confusing and best avoided.
Fibrin
Fine protein strands produced when soluble fibrinogen is acted upon by thrombin
in the process of blood coagulation.
Family replacement donor
A donor who gives blood when it is required by a member of the donor’s family or
community.
HBV, HCV
Hepatitis B and C Virus respectively.
HBsAg
Hepatitis B surface antigen; antigenic product of infection with hepatitis B which
provides the basis for blood donor screening with the ELISA test for hepatitis B.
Haemoglobin
A red-looking fluid found in the red blood cells which is made up of iron (haem) and
polypeptide chains (globin).
[274]
Haemolysis
The breaking down (lysis) of the red cell membrane which liberates its content:
haemoglobin. Haemolysis results from the reaction between a haemolytic antibody
and its specific red cell antigen in the presence of complement.
Haemolytic disease of the newborn (HDN)
Severe, potentially life-threatening condition caused by maternal antibodies attacking
and destroying the red cells of the fetus/newborn child.
Haemophilia
Hereditary disorder of blood coagulation. Haemophilia A (Factor VIII deficiency)
and haemophilia B (Factor IX deficiency) are clinically identical but biochemically
distinct; treatment depends upon specific plasma fractions for each condition.
Hepatitis
Inflammation of the liver. In the context of blood transfusion, hepatitis refers to the
various forms of viral hepatitis which can be transmitted by blood transfusion, of
which hepatitis B and hepatitis C are of the most serious concern.
HIV
Human Immunodeficiency Virus: retrovirus which predisposes to AIDS.
Homologous
Homologous transfusion refers to the transfusion of blood to a recipient of the
same species. This term therefore applies to most instances of blood transfusion as
currently practised, as distinct from autologous, heterologous and isologous
transfusion.
Heterozygous
A condition where non-identical allelic genes are carried on homologous
chromosomes.
Homozygous
A condition where two identical allelic genes are carried on homologous
chromosomes.
Immunogtobulin
Generic term applying to the class of plasma proteins which comprises the antibodies.
Immunoheamatology
Literally, the study of the immunological aspect of blood. In the context of a BTS,
immunohaematology has traditionally referred to the study of blood groups, their
corresponding antibodies, and assurance of compatibility of blood destined for
transfusion.
Incidence
The proportion of a specific population becoming newly infected by an infectious
agent within a certain period of time.
[275]
Infectious disease markers
The detectable signs of infection appearing in the bloodstream during or after
infection.
Lapsed donor
A voluntary donor who. after making one or more donations, does not return to
give blood, despite being requested to do so.
Legislation
The act of making laws. The distinction is emphasized between legislation and
regulation.
Leucocyte
White blood cell.
Low-risk donor
The term commonly used in blood transfusion practice to describe a donor who is
at low risk for transfusion-transmissible infections.
Match
A term used when testing the patient’s serum against the donor’s red cells and the
donor’s serum against the patient’s red cells, prior to transfusion. This is better known
as cross matching
Naturally -occurring antibody
An antibody that appears in the bloodstream without any known antigenic stimulus.
Neutrophil
A member of the family of white cells involved in fighting infection.
Ova
The reproductive egg cells of the female.
Plasma
The straw-colored protein-rich liquid part of blood in which the blood cells are
suspended.
Plasma derivatives
High purity preparation of specific plasma proteins, prepared by plasma fractionation
Plasma fractions. Plasma fractionation
The process by which plasma derivatives are prepared. Effective fractionation requires
large quantities of good quality plasma and increasingly high technology methods
beyond the capability of most BTS’s.
Plasma products
A generic term applicable to both plasma derivatives and plasma prepared at the
BTS level for transfusion purposes.
Fhenotype
The observable effect of the inherited genes: e. g. the blood group itself.
[276]
Rhesus (Rh)
Important blood group system, also known as D, once the major cause of haemolytic
disease of the newborn.
Regular donor
A donor who has given blood at least three times and who donates blood at least
once a year.
Risk behaviour
Behaviour that exposes a person to the risk of acquiring transfusion transmissible
infections.
Serology
Technology, commonly used in BTS laboratories, involving the interaction between
antibodies (from serum) and antigens.
Self-deferral
The decision by a potential donor to wait until a condition that makes him/her
unsuitable has resolved.
Self-exclusion
The decision by a potential donor not to give blood because he/she has engaged in
risk behaviour or because of the state of his/her own health.
Serum
Plasma minus fibrinogen.
Spermatozoa
The reproductive cells of the male.
Transfusion medicine
Branch of medical science and medical education which deals specifically with blood
transfusion and related scientific topics
Transfusion-transmissible infection
An infection that is potentially capable of being transmitted by blood transfusion.
Thrombocyte
A blood platelet, which plays a major role in the blood clotting mechanism.
Voluntary donor
A donor who gives blood, other blood components freely and voluntarily without
receiving any payment in the form of money or a substitute for money.
Whole blood
Donor blood, with added anticoagulant/preservative solution, from which no
components have been removed.
Window period
The period between infection and the development of detectable antigen or
antibodies.
[277]
Name Index
A
Abanod Pictro
15
Agote
23
B
Bagdasarov A 24. 27
Barnays EL
141
Behring E V
31
Bethune N
27
Bharucha Z S
33
Bhatia H M
33
Bhima
12
Blomback
31
Blundell J
20, 29
Bogdanov A
24
Borcelli
16
Bose S C.
182
Boyle R
19
Burke E
183
C
Camaige A
179
Carrel A
21
Chattopadhyay A 33
Chelliah T
34
Coca A F
30
Coga A
19
Cohn E
31
D
Decastello
22
Defoe D
141
Denis J B
20
Drew C
28
Dorairajan T
34
Duhsasana
12
E
Ehrlichp
31
Elliot J
31
Erasisfratus
12
F
Franklin B
141
Funtus B
27, 40
G
Galen
Galen
12, 15. 16
Gandhi MK
182
Ganguli L K
33
Gasellius F
20
Gupta ML
33
H
Hamilton
141
Harvey W
I5, 16
Herzberg F
Hibler R
Hicks B J
Hirszfeld L
Hood R
Hustin A
Hwang T
86, 88, 89
189
23
24
19
23
11
I
Ijima H
29
Jefferson T
Jorda D F
Jolly J G
J
141
27
33
K
Kabir S A
34
King E
19
Krishen K S
33
L
Landois L
21
Landsteiner K
22, 28, 30, 31
Lattes L
22
Lindman E
23
Levine P
28
Lewison
23
Linclon A
154, 182
Lord S
104
Lower R
19
M
MalpighiM
16
Massari B
16
Mendel G
22
Moss
22
Macdonel
198
Macforlaned
31
McDonald
121
Mahabir
146
Maslow A
86, 87
Mavalankar V G
33
Menghini V
30
Metchnikoff E
31
Mollison PL
30
Moolgaokar L 32, 33
N
Newton I
88
Nightingale F
106
Newmann E
31
[279]
O
Oliver PL
29
Ottenberg R
22, 30
P
Paine T
141
Patton W C
32
Pool G J
31
Pope Innocent VIII 15
R
Rajkumar R
34
Ranganaihan S
34
Reche O
24
Rostran A
104
Rowland R
35
S
Schramn W 146, 147
Serventus M
15
Sen T
33
Skilifovsky N V
24
Soulier J P
29
Struli
22
Stetson
28
Subramanian T
34
Swift J 1
38
T
Tata J R D
182
Tzanck A
29
U
Unger L J
23
V
Vani
33
Vaughan J
27
Vesalius
15
Vishnu Sharma
149
Vivekananda S
182
Vroom V H
88
W
Walter C W
28
Washington G
19
Weiner A
28
Weslls WC
30
Wren C
19
Y
Yudin S
24
[280]