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Blood transfusion occurs in all parts of the world, but the availability, quality, and safety of the blood depends on the general status of medical care in that area. Approximately 1,215,000 units of blood are collected annually worldwide [1]. The amount of blood collected in relation to the population ranges from 50 donations per 1,000 population in industrialized countries to 0.3 donation per 1,000 in the least developed countries [1]. Thus, there is a concentration of blood transfusions in industrialized countries, with 15% of the world’s population receiving approximately 48% of the world blood supply [1]. Lack of blood is a major problem in many parts of the world.

Blood services are best provided if there is a national, or at least regional, organization [2]. It is important that the government makes a commitment to the nation’s blood supply (Table 2.1). Blood may be collected by individual hospitals, private blood banks, the Red Cross, Ministries of Health, or some other part of the national government. The number of units of blood collected at individual centers can range from a few hundred to thousands per year, and there may be extensive or little coordination and standardization. The adoption of a national blood policy is recommended, along with establishing a national organization [2]. This has been achieved in the developed world, where virtually all countries operate a national blood supply system as part of their public health structure as recommended by the World Health Organization (WHO) [2–5], and is beginning in other parts of the world [6–13]. The United States is essentially the only developed country without a single unified national blood supply organization.

Table 2.1 Key elements of a nationally coordinated blood transfusion service.

Government commitment

A national blood policy

Formation or designation with responsibility to operate the program

Appointment of a suitable director

Appointment of qualified staff

Development of partnerships with appropriate nongovernment organizations

National guidelines for the clinical use of blood

Identification of low‐risk donor populations and development of strategies to promote blood donation

Education programs for physicians, nurses, and other appropriate staff regarding transfusion therapy

Systems for donor notification and counseling

Blood transfusion safety: voluntary blood donation, national blood transfusion services, and safe and appropriate use; World Health Organization website programs and projects.

Although great progress has been made in establishing national or centralized blood transfusion services, some blood is still collected without national control or organization. In many parts of the world, there is little or no organized donor recruitment system and so the blood supply fluctuates. Donors may be friends or relatives of patients, voluntary nonremunerated volunteers (VNRDs), or paid donors. Although the WHO urges the use of VNRD, this source is inadequate in many countries, and VNRD rates range from 0% to 100%, with a median of 45% [1]. In low‐resource countries, more than almost half of blood is donated by friends or relatives of patients who are transfusion recipients (Table 2.2) [13–16]. Although these donors are considered to be volunteers, they may be donating under family pressure or they may be individuals unknown to the family who have been paid to donate blood. This is unfortunate because the risk for transfusion‐transmitted infection from first‐time [2, 15, 17] and paid donors is much higher than from volunteers [18] (see Chapter 3). These risks are further accentuated by the lack of comprehensive testing of donor blood for transfusion‐transmissible diseases that sometimes occurs in developing and least developed countries (Table 2.2). In many countries, blood donations are not tested routinely for the combination of human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus, and syphilis [1]. This is because of a shortage of trained staff, unavailability of or poor quality of test kits, or infrastructure breakdowns. Sometimes transmissible disease testing is not done because the need is so urgent that the blood must be transfused immediately after it is collected. Rapid tests may be useful [19]. The cost of transmissible disease testing is also problematic because it may approach the annual per capita expenditure for all of health care in some countries [20, 21]. This, combined with the use of replacement or paid donors and the low rates of repeat blood donors with their lower rate of positive tests for transfusion‐transmissible diseases, leads to a major concern about blood safety in developing and least developed countries [21, 22]. Impressive progress has been made in establishing testing systems, increasing blood collections, standardizing operations, and increasing the availability of safe blood [3, 5, 7–12]. “Many factors influence the global implementation of self‐sufficiency” [23, 24], and a consensus statement from WHO experts is available defining the rationale [24].

In much of the world, components are not used routinely. The whole blood is converted into components ranging from <25% in low‐resource countries to 97% in high‐income countries, and use of whole blood ranges from 0% to 100% [1].