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SHORTAGE AND WASTAGE AT
THE SAME TIME: THE BLOOD
DONATION LEGAL AND ETHICAL
ISSUES INVOLVE.
SIMRAN KAPLISH ( 17BBL049)
ABSTRACT
Blood donation is a very necessary element of one’s life that is used to save lives of other people. Voluntary blood donation is the pillar of adequate and safe blood donation. Donors are of 3 types, they are voluntary donors, professional donors and replacement donors. In these the last 2 types of donors are compelled to donate blood. The success of the blood campaigns depends on the people who organize the camp. The aim of this essay is to explore on the legal and ethical issues involved in blood donation. the essays show in detail the dilemma faced by the patients, donors, blood donating organizations, blood banks and government. It focuses on the laws of blood donation in India and also on the criteria and eligibility of giving blood. The first part of the essay focuses on the major blood shortage all around the world especially India. It also explains the reasons for such blood shortage. Later the essay emphases on the wastage f blood and the reasons for blood wastage.
“a single pint can save three lives, a single gesture can create a million smiles”
Today shortage and wastage has become a crunch in India, where people are dying just due to a shortage of blood in blood banks. Health ministry says that India relinquishes 1 million units of blood per year. The yearly requirement of blood in India is reckoning to be 10-12 million units, but India can only collect 9.9 million units in 1 year. A single unit of blood is said to save 3 lives by the world health organization. Moreover, according to WHO, 6 units of bold is required to carry out an open-heart surgery, more than 100 units of blood are needed for a roadside victim. In an approx., 40 units of blood are needed for organ transplantation. And 20 units for a single bone marrow accident.
WHO STATES THAT EVEN IF 1% OF THE POPULATION DONATED BLOOD, IT WOULD BE SUFFICIENT TO MEET THE BASIC REQUIREMENT OF BLOOD IN THE NATION, TODAY WE FALL SHORT OF 2.5 – 3 MILLION UNITS SHORT.
The blood can be divided into 4 parts before use, i.e. the whole blood, packed cells, platelets and plasma. All the 4 elements are discarded in huge quantities. In the year 2016-2017, 1.5 lakhs. Units of whole blood have been discarded, this has reduced from 2.09 lakhs. Units 2014-2015. Discarded Packed cells in 2016-2017 have been 1.7 lakhs unit, in this, there is an increase in discard action of 40 units from 3014-2015. On an average 5.2 lakh platelets are discarded in the year 2016-2017, it was 3.2 lakhs in the year 2014-2015. The plasma deposition has increased from 2.8 lakh units in 2014-2014 to 3.3 lakhs units I n 2016-2017.
These are the yearly statistics, but now coming on to daily statistics 230 million major operations are conducted daily, 331 cancer-related procedures like chemotherapy and 10 million pregnant women suffer due to a blood shortage. Mostly a lot of blood is needed after a miscarriage or after a childbirth. Apart from this anaemic, leukaemias, hemophilic and thalassemic patients need blood in great quantities. Just because of such shortage of blood 2.8 lakhs. Women die each year
collection followed by Uttar Pradesh, keeping in mind that India is one of the most populous states.
Many states fall short of blood in mainly June, July, August when summer vacations are going on because educational institutes are one of the major sources for collection of blood.
Blood banks, where blood is stored and transported to various hospitals when needs. There are 2903 blood banks in India, out of which 1043 are public banks run by government and 1860 are private banks, run by charitable trusts. Maharashtra has 328 blood banks, Uttar Pradesh has 294 and Tamil Nadu has 291, still falling short and on the other Assam has 12 blood banks and Arunachal Pradesh and Telangana has 10 blood banks each.
CHANDIGARH HAS ONLY 4 BLOOD BANKS BUT JHAS HIGHEST NUMBERS OF DONERTSA ND LARGEST COLLECTION OF BLOOD WHICH EXCEEDS THE TARGETED LEVEL WITH 74408 UNITS.
Wastage (mechanics inside the world bank), on an average 200000 units of blood is collected from 53 blood banks in Delhi, out of which 50% of the donors are relatives and remaining are voluntary and paid donors. There is a man-made shortage, the price of the blood increases when there is an acute shortage i.e. from rs.800 to rs.2000, depending on blood quality and blood group. According to a general survey, 30% OF THE BLOOD COLLECTED from camps should be directly transported into the hospitals. But this does not happen 60%-70% of the blood is wasted because the blood does not reach the needy on time even when there is a deficiency in shortage facilities. In the last 5 years, Mumbai the early bird of India have wasted 2.8 million units. The cumulative wastage is approximately 6% i.e. more than 6 lakhs litres. The major drawback is that the whole blood is discarded which contains various elements. In the previous year, it was recorded that 6.57 lakhs of blood were discarded with all its components. 50% of the plasma was discarded, which has a larger shelf life. RBC and Whole blood are to be used within 35 days. West Bengal and Andhra Pradesh were on the top list who discarded plasma, apart from this 3 lakhs units of frozen plasma were discarded from Maharashtra, UP and Himachal Pradesh. This frozen plasma is imported by pharma companies and organizations to produce albumin.
On larger basis blood is wasted by the blood banks itself.28 lakh units of blood were wasted in the last 5 years there are various sever deaths all around in due to a shortage of blood, moreover, there is a shortage of 100000 units of blood in Delhi NCR region. The major drawback in the
coordination i.e. the blood cannot be used on time by the needy and hence gets expired. Maharashtra, Tamilnadu, Uttar Pradesh and Karnataka are considered as offender states.
EXPLORING OUT OF INDIA, the condition is horrific. Various surgeries are being cancelled due to an acute shortage of blood in Los Angles, Atlanta, Philadephia etc. as told by the American red cross society. The red cross society and America's blood centres collectively represent the blood banks of united states. As per the records donation has increased by 3% but on the contrary, the demand has also increased to 6%, which is still behind by 40,000 units. The red cross society needs to keep 80000 units of blood in hand, but at present, it only has 36000 in hand. There are many people who receive calls for such donations but very fewer people turn up, on applying for urgent needs there is an increase in just 30% donors in mid-July when institutions are closed, still the donors are not up to the mark.
WHO CAN DONATE BLOOD LEGALLY:- mostly individuals are eligible to donate blood every 8 weeks. The person should be minimum 16-17 years. And must weigh at least 110 pounds. The person must not suffer from any disease and must be in healthy condition. People with low blood cell count cannot donate blood. During pregnancy and even after 6 months of the birth blood cannot be donated. A person with ratio cannot give blood. Recent travelers to some disease prone area cannot give blood. Any person suffering from HIV aids cannot give blood. It can anyone who have spent 3 months or more in the United Kingdom from 1980 through 1996, and 5 months or more in Europe from 1980 to the present. Blood donation reduces the iron level in the body, it identifies adverse health effects, it also helps people feel good about themselves, it also Burns calories. But on the other hand, infections can be spread due to unhygienic management, a person can feel dizzy, can faint, have nausea and some small complications. These symptoms mostly remain for 3 days from blood donation. Our body has nearly 5.5 litres of blood and we donate 350ml-450ml, the withdrawn blood volume can be restored within a day and hemoglobin and other cells are restored with 60 days. A donor must not be above 60 years. And the hemoglobin level must not be less than 12.5%. The pulse rate of the diner must be between 50-100mm. The donor must not consume alcohol before donating blood and also must avoid donating blood for 6 months after any surgery.
Patients also some dilemmas in buying the blood. The patients should be given a half day workshop to get informed about various aspects of blood transfusions. Patients dilemma revolve around which test is better ELISA-test or NAT. How should patients choose between random donor platelets or from a single donor platelet? There are many questions that come in the mind of the patients. The next dilemma faced is that should the patients have informed consent or ill- informed consent, patients have their priority rights but if ‘‘this decision of choosing blood is left onto The patients they will ignore the expensive tests which are designed to Improve blood safety.
The government also faces a dilemma, there is always a tiff going on between the government and blood bankers that should blood be charged or not. The government says to provide free blood, but the banks need to charge some processing charges for functioning. India has made attempts to arrive at a reasonable price, depending on the blood bags, type of test and processing charges. Ethics is considered more important is a blood bank. In the market blood bags range from rs.150 to rs.1500, if the blood bankers take the same quality bag of the same brand, the cost differs on the volume of blood, is reasonable. Blood banks embrace an assortment about tests, for example, rapid/enzyme immunoassay/chemiluminescence/electro fluorescence/NAT to suit of shield their distinctive requirements, In view of that kind from claiming patients they serve, What's more, each for them needs their preferences and Hindrances. Working fetches change widely, relying upon the innovation organization and the level for mechanization over trying. If we chop down ahead mechanization provided for that it includes with cost, alternately ought we Push mechanization clinched alongside testing, provided for that administrative errors need aid A heading reason for mortal sin for Creating countries?
Assent to tolerant blood transfusion is for fundamental importance like whatever viable technique on the human body.
That remark “Every human being of adult years and sound mind has a right to determine what shall be done with his own body and the surgeon who performs the operation without his
(patient’s) consent commits assault for which he is liable in damages” just as applies with blood transfusion.
Blood safety includes a safe donor, safe blood and safe transfusion. Blood transfusion must only be carried out with precise indication and these indications must be mentioned in the files also. A step by step procedure must be adopted which involves the consent also. The records must be kept with the hospital for a particular period of time as per the laws of the land, in France it is kept for a period of 30 years. The transfusion must be divided into 4 cases I.e. normal cases, special cases, emergency cases and urgent cases. THE INDIAN BLOOD TRANSFUSION SERVICE The national blood policy was published by the government in the year 2002. The government has well-documented strategies for blood safety and blood components, for making easily available the resources, technology and training for better transfusion. It provides strategies for the health safety of donors. They establish the requirement for the quality system to maintain the best standards in blood transfusion.
National aids control organization has laid down the minimum requirement of space, equipment and staff for blood safety. The drug controlling authority has been assigned as the main body to regulate the framework. NBTC provides infrastructure development, provides component separation units and promote voluntary and healthy blood donation. It also provides staff training.
The licensing procedure is given in the drugs and cosmetics rule, 1945.there are other acts which regulate the provisions like the change in age from 60 years to 65 years.
A blood bank can be operated by individual or institution on the application. The application is sent to the drug controller and a joint inspection is conducted by state and centre drug control authority, that gives a recommendation letter to the centre licensing approving authority, the last step who grants the license.
than money. In developing countries, the facilities are not much so donors give blood only when the patient needs an urgent transfusion, either with compensation or even without compensation.
So, in India and all over the world, most elements need to be taken into consideration the legal aspects , the ethical aspects and also the needs of the patients and donors. The blood donation rate is growing and people are willfully donating blood. It has become a practice among many in India. The blood processing techniques are evolving day by day and are being advance. Blood donation saves many lives at a single time. The more blood is donated, the more smiles are spread.
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