Voluntary non-remunerated Blood Donor

Recruitment & RetentionIran Experience

Dr Mahtab Maghsudlu (MD, MPH)

Assistant Professor in Community Medicine

Global Strategy for Voluntary Blood Donation

Globally, by 2015

• 100% voluntary non-remunerated blood donation in countries with high Human Development Indices (HDIs)

• At least 80% voluntary non-remunerated blood donation in countries with low and medium HDIs

Blood Safety

The recruitment only of voluntary ,

non-remunerated blood donors with altruistic motives

Retention of donors

Laboratory tests

Donor selection

Why VNRBD?

Global challenges in blood availability and safety

Major Challenge

• Increasing requirements for blood and blood products

• Inadequate blood supplies to meet needs

• Risk of transfusion-transmissible infections and transfusion reactions

• Unnecessary transfusions

Unnecessary transfusions• Lack of national clinical transfusion guidelines

• Variations in prescribing patterns between countries, within countries and within hospitals

• Use of blood when not indicated for patient health and survival

• Failure to use simple safe alternatives

• Reduced stock of blood available for patients for whom there is no alternative to transfusion

•Unnecessary exposure of patients to risk of TTIs

Blood usage: developed countries

• Complex surgical and medical procedures– Cardiac surgery, vascular surgery,

neurosurgery, orthopaedic surgery, transplantation

• Cancer chemotherapy

• Trauma care– Road traffic accidents

• Haematological disorders– Thalassaemia, sickle cell disease, haemophilia

Blood usage: developing countries

• Complications of pregnancy and childbirth

• Severe childhood anaemia– Often resulting from malaria or malnutrition– Exacerbated by HIV/AIDS, parasitic infections

• Trauma care– Road-traffic accidents– Interpersonal violence– War, conflict, disasters

• Haematological disorders

• 99% of the estimated 536 000 maternal deaths each year occur in the developing world

• 19 of the 20 countries with the highest maternal mortality are in sub-Saharan Africa

Maternal mortality, 2005

Maternal mortality, 2000

Maternal Mortality Ratio, 2000. World Health Report, WHO

Legend

= <3030-110111-540

>540

Blood donation and maternal mortality

0.00

500

1000

1500

2000

2500

0.3 0.4 0.5 0.6 0.7 0.8 0.9 1

HDI value

Donations per 100,000

population

Maternal Mortality Ratio, 2000

Legend

Donations per 100,000 populationMaternal mortality ratio

Severe acute anaemiaSevere acute anaemia• Major causes of severe acute anaemia

– Malaria

– Malnutrition

– Haemoglobinopathies: e.g. thalassaemia, sickle cell anaemia

• In southern Africa, safe and timely transfusion could help prevent up to 20% of maternal deaths and 15% of child deaths from severe anaemia

Malaria and anaemiaMalaria and anaemia• In malarial areas:

– Estimated 30-90% children under 5 have anaemia

– 60-80% of pregnant women have anaemia

– 8-15% of child deaths and 8-20% of maternal deaths are caused by severe anaemia due to malaria

• Malaria and anaemia also contribute to adverse pregnancy outcomes - stillbirth, premature delivery, low birth weight and perinatal deaths

WHO Health Statistics 2005

Legend

<25 25-49.950-99.9100-150

>150Not available

Under-five mortality rate, 2003Under-five mortality rate, 2003

Blood donation rates, 2004-2005• No global standard for assessing a

country's requirements for blood

• Depending on level of development of health care system, blood donation by 1-3% of population is usually sufficient to meet a country's needs

• Blood donation rates of less than 1% of population (fewer than 10 donations per thousand people) in 80 countries 79 in developing world

Blood donation rates, 2004-2005Blood donation rates, 2004-2005

• Average number of blood donations per 1,000 population is 11 times higher in high HDI countries than in low HDI countries

• 100% voluntary non-remunerated blood donation – 2002: 39 countries

– 2004: 50 countries

• Family/replacement donors and paid donors remain a significant source of blood for transfusion in many countries

National Blood Program in Iran

Donor Screening Blood Testing Q.C

Blood Donor Recruitment Program

National levelBlood Centers level

1) Establishment of a national central department responsible for all activities related to blood donors throughout the country in 2002

2 )Develop and implementation a continuous national awareness program to lighten the importance of regular donation

3 )Broadly partnership with other organizations

4) Training of blood centers’ staff in the field of donor recruitment

5)Research as a tool for blood donor recruitment and retention

)11(Need Assessment in each Province

)22 (performance of SOPs related to “Donor Recruitment”

3 )Donor Registry Database

4) Face to face education & Information sessions

5 )Blood Donor Recognition

6) National Blood donor day & WBDD

Establishment of national central department responsible for all activities related to blood

donors throughout the country

• Planning• Providing SOPs• Monitoring- the total number of donors.

-the number of new donors (and their donation profile after 2 months,1 year and 5 years)

-the number of regular donors Blood Donation / Blood Donor Ratio

-response rate of the donors ( after written invitation to donate phone

calls e-mails ,..…,

• Evaluation

Develop and implementation a continuous national awareness program

Develop and implementation a continuous national awareness program

• Adding some topic about blood and blood donation to primary educational curriculum

• Writing a composition about the importance of blood donation

Broadly partnership with other organizations

• Advocacy for voluntary blood donation

• Public support• Mobilization resource• Community involvement• Brainstorm idea in order

to reduce the gap between planner and people

Potential partners

• Community based organization

• Educational institutions

• Private sector

• Patient association

• Media

Training of blood centers’ staff in the field of donor recruitment

Research as a tool for blood donor recruitment Examples of research objectives

• Donor characteristics: e.g. age, gender, education, socio-economic

• status,Knowledge, Attitudes and Practice (KAP) of the general public

• Cultural values that support or discourage blood donation

• Identify low risk population

• Responses of different target populations to information and education materials

• Most effective communication and education strategies to motivate specific target populations

• Impact of extended operating times on blood donation

• Waiting times in donor clinics

• characteristics of lapsed donors and reasons for not returning to donate

Research as a tool for blood donor recruitment Examples of research objectives

Research as a tool for blood donor recruitment Examples of research objectives

• Effect of staff training/qualifications on quality of care provided in the donor clinic

• Number of donor deferrals and reasons for deferral

• Number of delayed adverse reactions in donors & risk factor

• Donor satisfaction & contributing factors

• Response rates to different donor recall methods

Several studies of iron status in Iranian women blood donors

• Result showed significant Result showed significant percentage ofpercentage of women donors women donors are iron deficient.are iron deficient.

• Then another research was designed:

Effect of short-term ferrous sulfate supplementation on iron stores

• 412 childbearing age female

• Half of them were given 21 doses of ferrus sulfate 150mg in each donation and the other not

• Result showed Iron deficiency is inevitableResult showed Iron deficiency is inevitable in childbearing age female donors without in childbearing age female donors without supplementationsupplementation

Blood Donor Recruitment Programin Blood Centers’ level

Estimating blood requirements Method 1: based on previous usage

• Analyse records for a specified period in a defined geographical area, population or hospital:– Number of units of blood/components requested

– Number of units of blood/components issued for transfusion

– Number of unfilled requests for blood/components: e.g. elective surgeries cancelled

Estimating blood requirements Method 2: based on population

• Used to estimate the number of units of blood needed to meet the blood requirements of a defined population over one year

• Calculation is based on 1-3% of population requiring blood per year, based on level of development of health care system

• Can be used to estimate the blood requirements of individual regions or districts within the country

Estimating blood requirements Method 3: based on acute hospital beds

• Used to estimate the number of units of blood needed to meet blood requirements of a defined hospital population

• Calculate 6.7 units of blood required per acute hospital bed per year

Estimating blood requirements Method 3: based on acute hospital beds

ExampleFor a hospital with 50 acute beds, calculate:• 50 x 6.7 = 335 units of blood per year or approx.

7 units per week

• Number of donors required will depend on frequency of donation: e.g.– 1 donation per donor per year = minimum 335 donors

– 2 donations per donor per year = minimum 168 donors

Performance of SOPs related to “ Donor Recruitment”

Face to face blood donor education & Information sessions

High school students Education Program

Blood donor recognition

National Blood Donation Day & WBDD WBDD in Iran 2008

Trend of Blood Donation in Iran )1974-2007)

1735000

12,354

1,183,630

1,448,149

746,868

0

200000

400000

600000

800000

1000000

1200000

1400000

1600000

1800000

2000000

1974

1980

1985

1990

1995

2000

2005

2007

Un

its

Trend of Yearly Donation Index in Iran)1974-2007)

25

0.39

19.4

22.1

14.7

0

5

10

15

20

25

30

1974

1976

1978

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

Per

100

0