In December 2016, 10 people at a hospital in Bangalore were booked for allegedly transfusing a woman patient with contaminated blood while operating on her in 2014. Another woman, as told to The Sunday Guardian by a senior doctor of the National Thalassemia Welfare Society, underwent a blood transfusion during a knee surgery in Delhi and contracted Hepatitis C shortly after.
An IndiaSpend investigation, through a series of Right to Information (RTI) requests, reports that as many as 14,474 people contracted HIV through blood transfusion in the past seven years. The National AIDS Control Organisation (NACO), in a reply to an RTI activist in June last year, disclosed that 2,234 contracted HIV through blood transfusion in a year-and-a-half.
While there is no scientific method to corroborate that the infection was indeed transmitted through blood transfusion, experts say that infected blood easily makes its way through a fragmented blood bank industry, comprising untrained or inefficient personnel, who don’t abide by the guidelines, thereby putting the recipients at risk.
UNADDRESSED ISSUES
Much of India’s blood demand is met by replacement donations in which one of the patient’s family members or friends donates blood to compensate for the lack of a donor. Though the Supreme Court directive of 1998 bans paid blood donation, replacement donation continues to thrive, says Dr P. Srinivasan, Founder of the Jeevan Blood Bank.
NACO’s website claims that voluntary blood donations have increased from 54.4% in 2006 to 84% in 2013-14. Experts, however, say the figures are misleading.
“Though several documents from the government talks of over 80% voluntary blood donation, the fact is otherwise. Over 50% of the blood is used by the private sector, especially the corporate hospitals. They insist on replacement donations and do not conduct any blood donation camps. Hence, voluntary blood donation in India cannot be over 50%,” said Dr Srinivasan.
Rajat Agarwal, director of Sankalp Foundation, accused corporate hospitals of taking a convenient route by allowing family donors to donate, in complete violation of the national policy that claims achieving 100 voluntary donations.
Dr Poonam Srivastava, founder of the Lions Blood Bank, said that many come to donate simply to check if they are carrying any infection, which is absurd and puts the patient they are donating their blood to, in danger.
“Many of those who come to donate have their bodies pierced, and are more likely to be infected. Sadly, many banks allow them to donate blood,” she said.
Secondly, India has over 2,760 licensed blood banks, but a lack of a central organisation to monitor their functioning makes it easier for them to bend the rules.
According to Dr Srinivasan, the need of the hour is to have a single “transfusion authority” in every state that would be accountable for all aspects of blood safety.
“No blood bank that collects fewer than 10,000 voluntary blood donations per year can provide safe blood, even if all processes are done right and by qualified personnel. India probably needs one central blood bank per district and a blood storage centre in each major healthcare facility,” he said.
Third, not all blood banks adhere to standards and guidelines laid down by the National Accreditation Board for Hospitals and Healthcare (NABH) for quality assurance and improvement. Out of the 2,760 licensed blood banks, only 78 of have NABH accreditation.
“The quality standards are compromised on, when there is a dire urgency of blood. The banks’ quality control procedures, their donor recruitment and screening strategy need to be checked to establish the real gaps,” Agarwal said.
Much of India’s blood demand is met by replacement donations in which one of the patient’s family members or friends donates blood to compensate for the lack of a donor.
Fourth, no concerted efforts have been put to create awareness about the hazards of paid donations and illegal donor selection and recruitment.
“The reason the US hasn’t witnessed a single case of HIV through donated blood is because of their programmes that recommend mandatory HIV testing. Worldwide, HIV testing drives the allocation of funds for HIV treatment and prevention programmes. That is not the case in India,” said Dr Vanshree Singh, director of the Indian Red Cross Society.
“The problem of replacement donations would be solved if healthier people donate more. The problem is that fitter ones are unwilling and that brings the non-fitter ones to cater to the demand,” said Dr J.S. Arora, general secretary of National Thalassemia Welfare Society.
Nowhere in the world are non-licensed blood banks allowed to run operations. But according to Dr Arora, it has been revealed in “private meetings” that many unlicensed blood banks flourish in India. But there is no government data to ascertain the claim.
IS NAT THE SOLUTION?
Though improved technology has made it possible to screen blood donations using Nucleic Acid Test (NAT), and ELISA (enzyme-linked immunosorbent assay), these tests pass the potentially infected blood as safe if the donor is still in the “window period”—the period between the onset of HIV infection and the appearance of detectable antibodies—which is five to seven days for NAT, and at least four weeks for ELISA. This implies that if a person contracts HIV today, and goes out to donate blood tomorrow, the tests will not identify the bad in his blood.
While the government is pushing all hospitals in the country to adopt NAT, which has a lower window period, but comes at a much higher price, some experts do not support the move.
“There is very little utility of NAT as opposed to investment in ensuring that the blood is sourced only from low risk population, typically genuine voluntary blood donors, with strict adherence to the conventional testing techniques,” Agarwal said.
Dr Srivastava, however, believes that NAT helps to arrest the possibility of the virus at the earliest: “It’s true that you cannot provide a 100%, zero-risk blood anywhere. But NAT helps in shortening the window.”
According to Dr Srinivasan, NAT should be the last step in the process to ensure blood safety.
“Several studies have shown that when blood is donated and tested with 4th generation ELISA (antigen and antibody testing), the safety level is as close to blood tested by NAT. All blood banks have the equipment needed for ELISA testing and all that is required is to make 4th generation kits mandatory. This is the most cost effective way of enhancing blood safety immediately,” he said.
Stressing on the lack of mechanism to track post transfusion viral infection in India, he added: “The United Kingdom has an independent haemovigilance scheme, Serious Hazards of Transfusion (SHOT), which analyses information on adverse events and reactions in blood transfusion from all healthcare organisations involved in the transfusion of blood there. In India, all reports are based on the statement recorded at the time of counselling of an HIV positive individual.”