Saturday, October 1, 2011
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Better technology, higher voluntary donation and exclusive law can help achieve absolute blood safety

On September 11 this year, 23 children with thalassemia tested HIV positive at a civil hospital in Junagarh, Gujarat, where they were reportedly getting regular blood transfusions. The saddest part is this is not the first incident of its kind. In July 2010, at least 56 thalassemic children had tested positive for HIV, Hepatitis B and Hepatitis C after receiving blood at a government- run hospital in Jodhpur, Rajasthan. Another dozen thalassaemic children met the same fate at a Delhi hospital in 2008-09.

However, despite the rerun of these tragedies, nothing more than denials and talk about “in-depth” inquiries are heard from the authorities concerned. They seem to be oblivious to the fact that we are still grappling with inefficiencies in our efforts to ensure safe blood.

Safe blood, a mirage

The National AIDS Control Organisation (NACO), which has been handling the task of blood safety, admits that there are still 29 districts in the country with no facilities for supply of safe blood. As evident from the recurrent incidents, even the areas which are being officially provided with good quality blood are not fully protected against infection through transfusion. According to the existing regulatory framework, all the blood units should be mandatorily tested against five infections including HIV, Hepatitis-B, Hepatitis-C, Syphilis and Malaria. The blood units which are free from these infections are further used for transfusion.

However, the reality is most of the blood banks in India use outdated testing methods which have long been replaced by new and more accurate techniques across the world. Rapid testing, which is still being used at many blood centres, has been termed as an inefficient technique to detect core antibodies. On the other hand, ELISA testing, which is being projected as the best testing technique by the authorities, takes a lot of time to detect deadly viruses like HIV. Under ELISA testing, the window period of HIV is 23 days which means if someone gets the infection today, ELISA test won’t detect it till the 23rd day. So if a blood unit is tested before this time period, it would be adjudged free of HIV. In contrast, nucleic acid testing (NAT), available at very few hospitals, can reduce this window period to 5-6 days. "Besides HIV, the detection of hepatitis B with NAT is reduced by 30 days and hepatitis C by 77 days," says J S Arora, the general secretary of National Thalassemia Welfare Society.

Most of the blood banks in India use outdated testing methods. Rapid testing, which is still being used at many blood centres, has been termed as an inefficient technique to detect core antibodies. On the other hand, ELISA testing takes a lot of time to detect deadly viruses like HIV.

Currently, a very few hospitals in government sector are equipped with NAT. While officials quote the high cost of implementing NAT as a deterrent (it is 18 times costlier than ELISA testing), Arora refutes the logic. “Many lives are adversely affected through transfusion of unsafe blood and there can’t be any price tag on our lives. Spending Rs 900 on a NAT test is much more logical than putting people at risk of contracting HIV or Hepatitis viruses through infected blood. Why can't we subsidise the test for poor and also provide the option of ELISA testing for those not willing to go for NAT because of price considerations,” he asks. NAT is widely used not only in developed countries of the West but even in several developing nations of South East Asia.

While improvement can be made on the technology front for better results, voluntary blood donation can go a long way in reducing the chances of infected units at the blood banks. Due to shortage of blood, whenever a patient requires blood, his relatives and friends are asked to replenish the units through donation. This concept of compulsory replenishment forces people to conceal any information related to previous infection or unsafe sexual practices lest the patient won’t get the required blood. In contrast, during voluntary blood donations, most of the people who come forward see themselves as healthy individuals capable of helping others. They are unlikely to conceal any information related to infection or unsafe sex because there is nothing to gain from voluntary donation. Currently, there is an annual requirement of around 10 million blood units but only 8 million units are available through voluntary blood donations. Bridging the gap of 2 million units can help ensure safe blood.

Blood as a drug

Besides the lacunae in testing, the regulatory structure is also lacking. There is no singular authority with trained experts dealing with blood control. Blood is regulated under the Drugs and Cosmetics Act with drug controllers being the inspecting authority. On the other hand, the safety of blood is handled by the National AIDS Control Organisation.

There is no singular authority with trained experts dealing with blood control. Blood is regulated under the Drugs and Cosmetics Act with drug controllers being the inspecting authority. On the other hand, the safety of blood is handled by the National AIDS Control Organisation.

In 1996, the Supreme Court had asked the Centre to consider an exclusive legislation for regulation of collection, processing, storage, distribution and operation of blood banks. In fact, the Union Ministry of Health and Family Welfare was in the process of drafting a national blood law to deal with malpractices in blood donation, transfusion and management. The draft bill called for penalty against medical officers and the blood bank staff for violation of rules related to blood collection, storage and transfusion. However, no further progress has been made on the issue and the bill remains in limbo. Meanwhile, many more are getting infected by the same blood which is meant to be a life saviour.

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