Unbanked direct blood transfusions should be legal, say Indian surgeons

Surgeons and health activists have called on the Indian government to make the practice of unbanked direct blood transfusion legal again to meet the needs of people living in rural areas.

The Association of Rural Surgeons of India, Jan Swasthya Sahyog (JSS), a non-governmental organisation serving in rural and tribal areas, and the Christian Coalition for Health in India say that unbanked direct blood transfusions (UDBTs) are vital in some parts of India. UDBT involves testing potential donors for blood type and screening the blood for infections and then transfusing directly to the patient without any banking or storage.

Raman Kataria, a doctor serving in rural Chhattisgarh, and a cofounder of JSS, told the BMJ, “This [unbanked direct blood transfusion] is especially effective [in saving lives] in emergency situations, in rural areas and small towns where no licensed blood banks exist.”

India collects eight million units of whole blood annually, leaving it short of about four million blood units a year according to targets set by the World Health Organization.1 2 Since 1998 blood donations must all be voluntary and cannot involve payments.3

The shortages are especially acute in rural areas, as most of India’s 2433 blood banks are located in urban or semiurban areas. Blood storage centres were set up by the government to improve the reach of blood in rural areas.

But Yogesh Jain, a doctor in rural Chhattisgarh, and a cofounder of JSS, told the BMJ that there are still too few of these centres.

Unbanked direct blood transfusion used to be practised by many rural physicians in India but was banned in 1999 when an amendment to Part XB of the Drugs and Cosmetics Rules, 1945 made it mandatory for all blood collection, storage, processing, and distribution in India to be done though licensed blood banks. Only the Armed Forces Medical Services in field and mobile units and other inhospitable situations are exempt.4

Kataria told the BMJ, “Doctors and healthcare facilities in Robertsganj, UP [Uttar Pradesh] and Sivakasi, Tamil Nadu, have been targeted and penalised by the government for practising UDBT in life threatening emergencies. Such ethical but ‘illegal’ acts need to be condoned while the necessary changes are brought in the rules.”

He said that the same safety standards and regulations in licensed blood banks can be applied to UDBT. “Unbanked blood should be tested for all the infections in much the same way as banked blood. What we are saying is have it regulated by licensing health facilities in rural areas and small towns where a responsible physician is ready to undergo short training on donor selection, testing, bleeding, and transfusion. A lab technician from the facility should also undergo training for testing of blood, including grouping and cross matching.”

Kataria added, “We propose that blood bags should be provided only through licensed blood banks to such facilities and these bags should be prepacked with rapid testing kits of good quality so that there is assurance that these tests will be performed before transfusion. Also, the physician trained and responsible for UDBT will send a report to the blood bank which trained him and to the drug controller of the state. Each blood bag would be accounted for on the basis of this report.”

Jain said that the current standards for blood banks were far too expensive and impractical for most of rural India. “Of course blood banks are desirable, but the best should not be the enemy of the good. In any case, the blood starved rural population needs some bread if there is no cake,” he added.