Behind the shimmering glow of our everyday mirth and bliss, unseen and unnoticed, a handful of organisations and their dedicated workers are keeping the candle of life lighted. Every second, a life is waiting for a bag of blood from them. They are the blood donors and their patrons ushering in a ray of hope to those lying in the thin line between life and death. The donors voluntarily show up at a blood drive and offer their precious blood to lend a hand to someone they may never ever meet. This is the greatest gift one can give.
About 234 million major operations are performed worldwide every year, most of which need concurrent transfusion. Hemorrhage accounts for over 25% of the 530,000 maternal deaths each year; 99% of these occur in the developing world. Road traffic accidents kill 1.2 million people and injure or disable about 30 million more a year, a large proportion of whom require blood during the first 24 hours of treatment; 90% of deaths occur if blood is not available then. About 4.5 million Americans would die each year without life saving blood. Every year approximately 85.6 million people need single or multiple blood transfusions for life saving treatment.
Worldwide over 88 million units of blood are collected annually. The quantity is sufficient to fill 32 modern Olympic swimming pools but not enough for the 7 billion world population, which requires 150 million units annually. In the African region, blood requirement was estimated at about 8 million units in 2006, but only 3.2 million units were collected. South-East Asia accounts for about 25% of the world's population, but collects only 9% of the world's blood supply -- 7 million units a year against an estimated requirement of 15 million units.
Globally, it is estimated that only 20% of the 150 million units of blood amassed annually are collected in the developing world, where 80% of the world's population lives. Some countries having high levels of voluntary blood donors per 1,000 population figures are Switzerland (113/1,000), Japan (70/1,000), while India has 4/1,000 and Bangladesh has 5/1000. Around 362,000 units of blood were collected in Bangladesh in 2009, of which only 29% were from voluntary donors.
Safe blood saves lives but, for too many patients around the world whose survival depends on blood transfusion, the required quantity is neither available nor adequately safe. World Health Organization (WHO) recommendation for safe blood transfusion is provision of compatible blood which are cross matched and screened for at least five WHO recommended, transfusion transmitted infections -- Human Immunodeficiency Virus (HIV), Hepatitis C virus (HCV), Hepatitis B Virus (HBV), syphilis and malarial parasite. When blood is collected from a professional donor, it may be hazardous. Instead of saving life, it may introduce deadly infections which cause suffering and premature death. Donors who earn by selling blood usually come from very low socio-economic stratum, in whom alcohol and drug abuse, nutritional and infective medical conditions are prevalent.
In a study at Dhaka Shishu Hospital, HCV became a serious problem where 19.4% multi- transfused thalassemia patients incurred HCV infection from transfusion. Red Crescent data of Bangladesh showed Hepatitis B was positive in 29% of professional donors, Hepatitis C in 6% and syphilis in 22%. Globally, up to 4 million people have been infected with HIV through transfusion of unsafe blood. In Latin America and the Caribbean, around 240,000 units of blood were discarded in 2005 because laboratory screening tests showed evidence of infection. At an estimated cost of $ 56 per unit, this represented wastage of $ 13.4 million.
The Hippocratic principle of "primum non nocere" (first do no harm) is breached by the proviso of paid transfusion. The commercialisation of blood donation is in violation of the fundamental principle of altruism, which voluntary blood donation enshrines. Voluntary donors are recognised to be the safest donors because they are motivated by humanity and longing for helping others and by a sense of moral duty and social responsibility. They have no reasons to withhold information about their lifestyles or medical conditions that may make them unfit to donate blood. They are not placed under any compulsion by hospital staff, family members or the community to donate, and they entrust their blood donations to be used as needed, rather than for chosen patients. The only reward they receive is self-satisfaction, self-esteem and pride.
To effectively address the global demand of safe human blood, a realistic target will range from 1030 donations per 1,000 people per year. Appallingly, donation rates are still less than 1% of the population in 77 countries, including Bangladesh. Until and unless a motivated social culture of voluntary blood donation can be inculcated, an unsafe source will always fill in the gap between demand and supply to threaten the health of the patients already at stake by diseases. Although the need for blood is ever-increasing and there are still periods of blood shortages, so long as every individual continues to give, promote or motivate, there will be enough blood for all. After all, it is the little drops of water that make the mighty ocean.
To encourage voluntary blood donation we need to recognise donors with due accolade and respect. The media, specially, need to lay emphasis on their humble generosity. Anyone donating blood for someone unknown and unseen, without any material benefits, deserves our open-hearted gratitude and due acknowledgment. Our recognition is their badge of honour. In doing so, we thank them and encourage other eligible aspirants to be part of this humanitarian endeavour. Heroes are not born in a nation whose people cannot praise their idols.
World Blood Donor Day (WBDD), which is observed annually on June 14, provides a special opportunity to promote a culture of voluntary blood donation. The theme of the 2012 World Blood Donor Day campaign, "Every Blood Donor is a Hero," recognises the silent and unsung heroes who save lives every day through their blood donations and in tandem strongly focuses on young donors with the hope that a new generation of idealistic and motivated voluntary blood donors will rise to form a pool that will provide the safest blood possible for use wherever and whenever it is needed. "You give but little when you give of your possessions. It is when you give of yourself that you truly give" -- Kahlil Gibran. So, smile when you give, to ensure that others can smile and live.

The writer, a physician and specialist in Hospital Management, is Deputy Assistant Director of Medical Services, Comilla Cantt.