Blood is not for sale, and yet we still pay

A video recently went viral on social media showing a father carrying a child who had apparently died in hospital.

According to the write up, the child needed a blood transfusion, but unfortunately, the father did not have enough money to pay, and so the child was supposedly allowed to die. I believe this video tells a very one sided story, but that is not the aim of this article. I want to use this opportunity to talk about what goes into blood donation and transfusion.

I am sure you have heard this statement from many health workers ‘blood is not sold’; and I am sure your response was, ‘then why am I paying money then?’ Very confusing I imagine. The standard response is this ‘you don’t pay for the blood, but rather the cost of treating the blood to make it wholesome for transfusion.’

So what goes into making blood wholesome for transfusion?

In an interview with Dr. Ebo Acquah and Mr. Michael Scottie, both of the National Blood Service Ghana, I asked them the situation with blood transfusion services, exactly what happens after blood is donated, and what clients actually pay for if blood is supposed to free?

Ghana needs approximately two hundred and sixty thousand (260,000) units of blood every year. Greater Accra alone requires sixty thousand (60,000) units. In 2015, out of the 60,000 needed, only 32,000 units were received by the Southern Area Blood Centre. Out of the number received, only 51% came from voluntary donors. According to Mr. Sottie, this is a marked improvement over the previous years’ percentage received from voluntary donors, but still falls short of the target. The National Blood Service hopes to achieve 100% voluntary donation. The remaining 49% was received from replacement donors. Whenever a client is given a blood transfusion, the family of that individual is expected to replace the number of units given to that patients. This is certainly not ideal, but it has become necessary due to the inadequate number of voluntary donors. This concept of replacement blood donation was born out of necessity to shore up the number of units available.

As a doctor myself, I have had to counsel patients’ relatives on the need to replace blood after a transfusion, so we can have blood available for the next patient who needs blood. As is usually the case, once the emergency passes, the family no longer sees the need to replace the blood given, and so we always end up with an ever increasing deficit of blood supply. Again, I have had cause to march to the hospital blood bank on more than one occasion because the attendants insisted on a replacement donation even before the unit is dispensed. Can you really blame them when this is the situation they face?

“We are in August of 2016, and so far we have received 18,000 units of blood, 9,000 of which came from voluntary donors,” said Michael Sottie.

It is quite obvious from the current situation with our blood service, that if we do not support the efforts of the National Blood Service to shore up our supplies, there will be a catastrophe in the near future.

When blood is collected from an individual, it needs to be done under very strict aseptic conditions, meaning the risk of contamination must be at the barest minimum, to prevent the transmission of contaminants from the environment. To achieve this, specialized tubes and bags must be used. After the collection, several tests must be carried out to ensure that infection is not transferred from one person to another. Some of the tests done include hepatitis B and C, HIV 1 and 2 as well as syphilis. Other tests such blood grouping and cross matching need to be carried out to ensure that the right blood is given to the right recipient. A patient can die from a transfusion reaction if the wrong blood is given, therefore the importance of grouping and cross matching cannot be over emphasized. To keep the blood well whilst in storage, specialized refrigeration units are also required. All this is to let you know the stages that donated blood goes through to ensure safety and protection of clients. Without funding, it would be nearly impossible to run such an operation.

At the Korle Bu Central Lab, I asked for the price of the various labs carried out on donated blood:

Hepatitis B 24 cedis
Hepatitis C 36 cedis
VDRL (Syphilis) 30 cedis

This is a list of 3 out of the many tests carried out, not including the cost of the bags and tubes as well as anticoagulants and other consumables used. As you can see the total cost is already at 90 cedis. These tests are carried out on each unit of donated blood. To answer the question, if blood is free, what are we paying for, Dr. Acquah points out that the money clients pay goes into financing these processes and tests that are carried out to make sure the blood is safe for transfusion.

Doesn’t National Health Insurance (NHIS) cover these expenses?

According to Dr. Acquah, the NHIS does not directly reimburse the National Blood Service for services rendered. The NHIS is supposed to cover cost of pregnancy care, including delivery. Yet, it appears that the amount reimbursed does not factor in cost of any transfusion that may be required. Mr. Sottie, who is in charge of Blood Donations in the Southern Blood Centre, claims that they occasionally receive donations in cash or in kind particularly in relation to the National Blood Donor Day, which is usually held on the first week of November each year, but for this particular year, will be held in the 3rd of October, due to the impending general election. These donations are however inadequate for the running of the institution; therefore, they have no choice than to transfer the cost of processing blood onto the clients.

So the challenge:

How do we stock our blood banks?
How do we fund the processing of blood for transfusion?
How do we get the blood to the clients who may die without transfusion?

To these questions, I have no immediate answer, but the National Blood Services is definitely in the forefront of trying to change perceptions about blood donation and with the support of the many health workers across the country as well as NGOs in health, we hope that significant strides will be achieved in this regard.

I have sought to bring out some of the issues facing the service, however, this is in no way an exhaustive expose on the myriad of issues the service has to overcome. I do hope that this can kick start a conversation that will result in an improvement in access to blood by the people who need it most. IT COULD BE YOU!!

By Dr. Kelvin Owusu | Medical Director, Optimacare Diagnostics, Ridge Accra| Email: [email protected] | Facebook: Optimacare Diagnostics| Twitter: OptimaCDL

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