If you are involved in an accident or are taken ill whilst you are overseas and require a transfusion before you can be evacuated, can you be sure that the blood you will receive meets the standards of your national transfusion services?

Recent statistics released by the World Health Organisation (WHO) have indicated that less than 35% of the 192 countries, which took part in a recent survey, have a national blood policy (SEE BELOW). However, how many of these top 35% can match the stringent criteria set, for example, by the National Blood Service in England, the Scottish National Blood Transfusion Service, the Agence Française du Sang, the American Association of Blood Banks, or the Swiss Red Cross?

In many countries there is always an acute shortage of blood, which is far worse than anything we ever have to face in the USA or Europe. To overcome these difficulties, the Foundation has made arrangements to provide, in an emergency, blood to expatriates and travellers.

17% of the global population in developed countries benefit from approximately 60% of the 75 million units of blood donated each year in the world. The remaining 83% of the global population, living in developing countries, has access to only 40% of the blood supply.

• Availability of blood and blood products is the first safety issue associated with blood. People are dying because of a lack of donated blood. Each year approximately 150,000 pregnancy related deaths could be avoided if appropriate transfusion therapy were to be carried out.

• 83% of the global population, living in developing countries, has access to only 40% of the available blood supply, which is collected, in 60% of cases, from paid or replacement donors. Moreover these donations are not tested for transfusion-transmissible infection in more than 43% of cases. This is in contrast to the USA and Europe, where the vast majority of donations come from voluntary non-remunerated low-risk blood donors.
  
  
• The avoidance of transmitting infections by blood and blood product is the other major safety issue. World-wide, nearly 5% of HIV infections are transmitted through the transfusion of contaminated blood and blood products.
  
  
• Although millions of lives are saved by blood transfusion, the availability and safety of the blood supply must be guaranteed to all.

In 1975, Resolution WHA 28.72 of the Twenty-eighth World Health Assembly urged Member States to promote the development of national blood services based on voluntary non-remunerated blood donation. Unfortunately. because of a lack of national co-ordination and the fragmentation of services, in the year 2000 only 35% of the 192 Member States have a national blood policy, the relevant legislation and one specific organisation responsible for their national blood programme.

The national co-ordination of a blood programme remains an essential component of the WHO strategy for blood safety, because it is a prerequisite for the preparation of blood and blood products to optimal standards of quality and safety, including:

• The implementation of a national quality system for all aspects of the transfusion process.
  
  
• Blood collection only from voluntary non-remunerated blood donors in low-risk populations.
  
  
• The screening of all donated blood for transfusion-transmissible infections, including HIV, HBV and HCV, syphilis and other infectious agents, such as Chagas disease and malaria.
  
  
• Good laboratory practice in blood grouping, compatibility testing, component preparation and the storage and transportation of blood products.

A nationally organised and/or co-ordinated blood transfusion service requires formal government commitment, support and recognition as a separate, identifiable programme. It also requires a budgeting and finance system that can ensure a sustainable blood programme through cost recovery and/or annual budget allocation.

A well-organised blood transfusion service is safer and more cost-effective than a hospital-based system. The co-ordination of services promotes adherence to quality standards, minimises duplication and achieves economies of scale through national systems for blood donor recruitment, blood screening and processing, and the central bulk purchasing of essential consumables and other supplies.

A national programme for the education, motivation, recruitment and retention of low-risk blood donors, for instance, can achieve substantial cost savings in the collection and screening of blood compared with systems of family/replacement or paid donation. This is because a significantly lower proportion of donated blood from regular voluntary non-remunerated donors needs to be discarded because of evidence of transfusion-transmissible infection.

Further information on the WHO initiative can be found at:  
http://www-nt.who.int/world-health-day/en/ts/index.cfm