Asia Times, June 26, 2002
India: Get your upper-class blood here
By Ranjit Devraj
NEW DELHI - India's notorious social distinctions based on caste and class have spilled into the blood donation sector. Even reputable blood banks now advertise blood that is guaranteed not to come from the dregs of society.
A pamphlet distributed by the Rotary Blood Bank operated in the national capital by Rotary International describes the pathetic situation of blood banking in India. It is marked by acute shortages, lack of volunteer donors, an unimplemented six-year-old Supreme Court ban on professional donors and, worst of all, unscientific social prejudices against certain classes of donors.
Says the pamphlet, "We understand that a large number of replacement donors are paid donors. We want to discontinue clandestine sale of blood. It is well known that several semi-nourished people, rickshaw pullers, drug addicts and other people short of money for smack donate blood."
The Rotary International facility was inaugurated in March by Lal Krishna Advani, home minister in the right-wing, Bharatiya Janata Party (BJP)-led central government.
The "better" blood offered by Rotary comes at US$18 a unit, which is twice that charged by the Indian Red Cross Society (IRCS) that runs the capital's biggest blood-banking facility and accounts for up to 45,000 units of transfusable blood annually.
Volunteer groups involved with the blood-banking sector say that in spite of the high prices and socially discriminatory attitude, the Rotary facility has been accorded the status of a Regional Transfusion Center (RTC) and granted more than $1 million from government sources.
Questioned about the about Rotary's maverick attitude, the Delhi State Blood Transfusion Council has promised action. "We have told Rotary that they should coordinate with other regional blood centers and also reduce their prices. If they do not conform we can withdraw their RTC status," said Dr Bharat Singh, member secretary of the council.
But rights organizations think that the RTC status accorded so far to the IRCS Blood Bank and to government facilities should never have been given to an openly elitist organization like Rotary International in the first place.
"The Rotary Blood Bank is setting a precedent for the commercialization of blood banking in a country where the official policy is that blood should not be traded in," said Purushottaman Mulloli, convenor of the Join Action Council (JAC), an umbrella organization for rights groups that focuses on issues related to public health and HIV/AIDS.
Indeed, it was such a view that was supposed to have guided the Supreme Court into passing an order five years ago banning professional donors from selling their blood.
Buying blood from professional donors goes back to colonial times and was institutionalized during World War II when large quantities of transfusable blood were required and few Indians were willing to donate what they considered to be a precious fluid.
The Supreme Court ban did not appreciably change things and several volunteer organizations have brought out detailed reports showing that the bulk of blood available for transfusion continues to come from professional donors, with the trade going underground and prices shooting skyward.
Iqbal Malik, who runs Vatavaran, a non-governmental organization (NGO) that had the trade videotaped and televised three years ago, says Delhi alone needs an estimated 300,000 units of blood annually and less than half of that is legally collected by various blood banks while the rest is still sourced from professional donors.
The Rotary International pamphlet, apart from outlining social prejudices, testifies to the fact that dependence on professional donors is widespread.
Such are the prejudices that last year, when large quantities of blood were needed for the survivors of the devastating January 26 earthquake in the western state of Gujarat, the IRCS refused to accept blood from the inmates of the Central Jail. Prison authorities complained to the National Human Rights Commission (NHRC) of an attitude that was "highly discriminatory" toward prisoners as well as "derogatory and in violation of human rights", but the NHRC upheld the IRCS decision.
That came as a blow to the prisoners because under existing rules, if they donate blood twice a year they are entitled to a month's remission on their sentences for that year.
But the discriminatory attitude of the NHRC and the IRCS jibed with findings of a study conducted by a leading firm of chartered accountants, A F Ferguson, which opined that professional donors were mostly poor people, many of whom were likely to be drug abusers and engaging in unsafe sex.
Said Mulloli: "What is required to be known is that donated blood is scientifically safe and tested rather than its antecedents and that when the country is facing severe shortages of transfusable blood."
Ramesh Sharma, an activist for the influential Gandhi Peace Foundation, said the real problem was that after the Supreme Court order the government never cared to carry out an awareness campaign to remove prejudices and create a reliable cadre of donors that could be depended on for steady supplies of blood, as in other countries.
In fact, the National Blood Transfusion Council, the nodal regulatory body set up after the Supreme Court directive has not met in the past two years. "Even when meetings are held nothing seems to move. Many decisions have been taken but most remain on paper," said J G Jolly, a council member.
A report published by the International Federation of the Red Cross three years ago on the blood-banking situation in South Asia noted that several factors in the region "frustrate the principle of voluntary non-remunerated blood donation".
The report also noted that recruitment and retention of voluntary blood donors for adequate and safe blood supply presented a tremendous task that called for a massive communication campaign aimed at involving all sections of society in building a reliable transfusion system.
To date no such thing has happened in India, where total requirements are now estimated to be about 8 million units of blood while actual availability is about half that figure. It is not uncommon to read news reports of patients waiting for weeks to get an operation done or actually having died for lack of transfusable blood.
At the All Indian Institute of Medical Sciences, the capital's largest medical facility, doctors look the other way as patients who desperately need blood make deals with "vampires" who arrange the "replacement blood" that is sourced from a network of professional donors rather than from relatives or friends as approved by existing law.
Volunteer agencies such as JAC expect blood shortages to worsen as a result of a new policy announced by the government in April under which blood banks will no longer be allowed to accept replacement blood from even genuine relatives or friends but must get supplies purely from voluntary donations.
"This is next to impossible because of existing prejudices regarding blood and the result will be that India, a country of a billion people, will have to increasingly depend on imported blood or blood products that can only help multinationals in the business," said Mulloli.
Official figures available for the year 2000 show India now importing annually $540 million worth of blood products, mostly from France and the United States, and the trend steadily rising.
"In all this no thought is being given to ordinary people who already cannot afford the prices charged, say, by the Rotary Blood Bank, or those living in rural areas where there are no blood banks and a large number of patients depend on unbanked direct transfusions," said Mulloli.
(Inter Press Service)