Last Word

Voluntary, altruistic blood donation has proven to be safer than paid or replacement donation. Yet most countries of Latin America and the Caribbean continue to rely on the latter. Reversing this trend is the most important blood safety issue facing the region today.

An Argentine colleague at the Pan American Health Organization (PAHO) recalls the day her elderly father was hospitalized in Buenos Aires. "They told him he needed to get five donors to give blood for an emergency operation. I went with my husband. When they found out I was O-negative, universal donor, they asked if they could take more. I said, 'Take all you want!' I thought, thanks to my donation, my father would get the blood he needed for a second chance."

It happens every day, in dozens of countries in Latin America and the Caribbean. Hospitals with chronic blood shortages tell their patients they must recruit friends and family members to donate blood before the patient undergoes a procedure. Known as "family replacement" donation, the practice is seen as essential. Unfortunately, it is not very safe. Like blood from donors who are paid, blood from replacement donors has proven to be less safe than blood from those who donate for nothing more or less than the general public good.

Reports to the World Health Organization's (WHO's) Global Database on Blood Safety consistently show higher prevalence of HIV and other blood-borne pathogens among paid and replacement donors than among "altruistic" donors. A study by the former head of Ecuador's national blood program found that the blood from banks that rely entirely on replacement donors was 12,000 times more likely to test positive for HIV or hepatitis B or C than blood from banks that had at least 60 percent altruistic donors.

Despite this kind of evidence, in Latin American and Caribbean countries, at least half-and as much as 90 percent or more-of available blood continues to come from family replacement donors. Reversing this trend is the most important blood safety challenge facing the region today.

Why is blood from altruistic donors so much safer? Every blood bank asks potential donors a series of screening questions to find out if there is any reason to doubt that their blood is safe. The problem is that both replacement and paid donors tend to hide risky behaviors from blood bank personnel. Paid donors don't want to hurt their chances of earning some cash, while replacement donors may feel pressure to comply with family requests to give blood but be embarrassed to admit risky behaviors to blood bank personnel. In some cases, families have trouble recruiting donors and end up paying donors with cash. In contrast, voluntary donors whose only motivation is to give the gift of blood have no reason to give false answers to screening questions.


The world's richer countries have abandoned both paid blood donation and family replacement. Yet developing countries still rely heavily on replacement donation. Their problem, of course, is getting enough blood. According to WHO and the International Federation of Red Cross and Red Crescent Societies, a country needs to collect blood from the equivalent of 3-5 percent of its population yearly to maintain an adequate blood supply. The United States and Canada collect blood from about 4.6 percent and 3.3 percent, respectively. On average, Latin American and Caribbean countries collect blood from only 1.4 percent of their populations.

PAHO and the Red Cross federation are working to help countries in Latin America and the Caribbean address the problem of chronic blood shortages and reliance on family replacement donation. These efforts face important challenges:

Attitudes of potential donors: Many people in the region believe that giving blood can make a donor gain or lose weight. Others think giving blood means giving away part of one's life. PAHO has supported sociocultural research to develop social marketing campaigns that are culturally sensitive and aimed at the lowest-risk populations.

Blood bank practices: Lack of training and the absence of structured questionnaires can lead blood bank staff to turn away potential donors for reasons that are not always valid. Moreover, because the safest donors are repeat donors, altruistic donors must be treated with courtesy and respect. Well-trained staff are essential for making donors feel safe and comfortable.

Blood bank outreach: Mobile teams are needed to collect blood in workplaces, social clubs, churches, and other meeting places. Indeed, there are very good reasons to take blood collection out of the hospital environment, creating blood banks that are more accessible and donor-friendly.

Latin America and the Caribbean have made great strides in blood safety in recent years. Widespread screening has significantly reducd the risks of transfusions throughout the region. The challenge now is to make sure that every country has a safe, ample, and timely supply of blood available to all its inhabitants. Working together—PAHO, the Red Cross, ministries of health, and others—to promote voluntary, repeated altruistic donation will go a long way toward achieving that goal.

Peter Carolan is senior officer for blood at the International Federation of Red Cross and Red Crescent Societies.Marcela Garcia is technical officer for laboratories and blood services at PAHO.

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