By Willem van der Merwe: SANBS Senior Specialist Donor Relations

Maintaining adequate blood stocks is an ongoing challenge for many countries. In South Africa, less than 1% of the population are active blood donors – and with each unit of blood lasting only 42 days after collection, it is important for blood donors to donate regularly and for blood services organisations to increase the donor pool.

Topping the list of the questions most asked at the South African National Blood Services (SANBS) is why we do not just pay people to give blood instead of relying on voluntary donations and why we charge for the blood we get for free.

Under the National Health Act 61 of 2003, it is illegal for blood donors to be given any financial or other rewards. For most people, donating blood is motivated by pure altruism – the knowledge that their unit of blood can save up to three lives as blood is separated into red blood cells, plasma and platelets.

The World Health Organisation (WHO) and the International Federation of Red Cross and Red Crescent Societies, advocate for countries to move to 100% voluntary blood donation. The foundation for a safe, sustainable blood supply relies on regular voluntary unpaid blood donations.

Perhaps to further understand this voluntary donor approach to which we adhere, as per South African law, it is important to understand how we operate and generate revenue to remain sustainable and ensure the availability of blood and blood components which enable doctors to carry out modern procedures for many malignant diseases, complex surgical and emergency operations.

SANBS is a non-profit organisation licensed to provide blood transfusion services to the country. We receive no funds or subsidies from the government and are fully funded from the fees we charge for our service to ensure safe quality blood products.

Blood is an essential but expensive resource because of the meticulous collection process, screening and testing processes that ensure its safety for transfusion.

The money paid for transfused blood goes to cover services in the collection, testing, storage and delivery of blood. From the moment donors come through our doors, the blood supply value chain requires medical expertise and state of the art technology to ensure quality and safety. Staff salaries and other operational overheads all add to costs.

Every step in the journey of blood is delicate and represents a possible point of failure where any delays, wrong temperature, miscommunications, or procedural issues can result in the product being substandard and unusable, all of which costs money.

Regulatory approved blood bags, personal protective equipment and medical tools are used to draw blood from a donor.  Also factored into the costs is the transportation to specialised laboratories as well as testing on all blood units for transfusion transmissible diseases such as HIV, Hepatitis B and C and Syphilis.

Generally, patients are not expected to pay for blood from their own pockets. At public hospitals, the costs are covered by the government and/or by a patient’s medical aid when admitted to a private facility. Blood products are a prescribed minimum benefit as indicated by the Medical Schemes Act.

If a patient is admitted to a private facility as a cash paying patient, the account for blood usage would be for their account. In cases where the medical aid does not pay the full amount, a patient should contact SANBS for assistance. SANBS is also open to having discussions with patients in financial difficulty..

The donation of blood by voluntary non-remunerated blood donors is recognised globally as crucial for the safety and sustainability of national blood supplies.

Paying for blood opens numerous challenges which pose serious threats to the health and safety of the recipients as well as the donors themselves. Donors who give blood in a volunteer-based system have little incentive to lie about their medical history and risk factors since their primary motivation is helping patients.

This is in stark contrast to donors in a paid system who prioritise monetary gain and may withhold key information when filling out the donor questionnaire during the preliminary screening process. Where some of these paid donors could have been otherwise ineligible to donate, they would bypass the screening possibly giving contaminated blood which is unusable or could infect a patient with a transfusion transmissible disease.

Blood transfusion is a core service within our healthcare system and individuals who donate their blood provide a unique contribution to the health and survival of others.

The blood supply value chain is complex, it starts with the blood donor at collection and ends with the patient at transfusion, but there are several stages in between which affect the process. Transportation, testing, processing, inventory management and distribution are all vital to the process.

Continuous education and understanding of the business of blood by everyone involved in the supply chain is therefore key in ensuring the sustainability of this life-saving resource. When one donates blood, they give patients the gift of a second chance which science cannot create.