The whole blood donation index is 26/1000 in the population in Iran. In the last 8 years excluding the last 2 years, the blood donation statistics have stayed at the level of 2 million blood units. In fact, all demands have been met. The only challenge present is the increasing use of platelets by plateletpheresis. It does not seem then feasible for Iran to just push the policy of increasing whole blood donations. As stated by Dr. Tiruneh, “adequate and reliable supply of safe blood can only be assured through a stable base of regular, voluntary, and unpaid blood donors.” The need is to decrease blood demand, not just for donations to be increased.[1]
From 2014 to 2019, the strategies of Iranian Blood Transfusion Organization involved the development of comprehensive donor centers to provide whole blood, apheresis platelets, and apheresis source plasma and the centralization of blood donation testing aiming to increase quality and reduce costs.
The 2.1 million whole blood donations per year meet the blood demand of patients in Iran if the blood supply is managed appropriately and transfusion practices are performed judiciously and patient blood management is practiced.[2] What is known as blood shortage is attributed to the shortage in platelets, especially Rh-negative groups, and periodic or seasonal deficits. These latter shortages can be simply met by the use of the nationally distributed blood supply network as Iran enjoys a single national-wide centralized system. It is the duty of blood centers to meet the necessary demands abiding by the principles of transfusion medicine. The liberal use of blood is normally nonjudicious.
The arbitrary increase in whole blood collection would threaten blood safety that has been safeguarded given the increasing proportion of regular and repeated donors in Iran. We need to focus greatly on and invest in regular blood donation as the risk and incidence of infections are lower. There should be an appropriate ratio in the pool of first-time, repeat, and regular blood donors.[3] We further need to take measures to limit blood collection centers, close blood centers with low blood donation index, and maintain blood safety tests centralized.
The sole increase in whole blood collection with the subsequent expansion of the liberal use of blood leads to a raise in the cost of the health system and care centers.[4] The economy of Iranian Blood Transfusion Organization was on a growing trend following the establishment of a system for the pricing of blood products. However, the high production cost imposed on it emanated from the arbitrary increase in whole blood donations. The policy to increase blood collections arbitrarily by an increase in the number of new blood collection centers would not only harm the cost–benefit ratio in the economy of the blood system but also endanger the safety and quality of blood components, it would also add up to costs exponentially.[5]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
1. Gress KL, Charipova K, Urits I, Viswanath O, Kaye AD. Supply, demand, and quality: A three-pronged approach to blood product management in developing countries J Patient Cent Res Rev. 2021;8:121–6
2. World Health Organization. . The urgent need to implement patient blood management WHO Policy Brief. 2021 WHO Publications
3. Manning FJ, Sparacino LInstitute of Medicine (US) Forum on Blood Safety and Blood Availability. . Blood Donors and the Supply of Blood and Blood Products 1996 Washington (DC) National Academies Press (US)
4. Thomson A, Farmer S, Hofmann A, Isbister J, Shander A. Patient blood management – A new paradigm for transfusion medicine? ISBT Sci Ser. 2009;4:423–35
5. World Health Organization. . Guidance on Centralization of Blood Donation Testing and Processing 2021 WHO Publications: World Health Organization
