It is high time unbanked direct blood transfusion been allowed

Maitri Porecha New Delhi | Updated on October 25, 2019

PIL filed in SC by Association of Rural Surgeons

Rajashree Jagtap, a young expectant mother from Donadaicha village of Dhule district in Maharashtra bled to death in a private hospital earlier this year, as blood bags for transfusion could not be arranged. She suffered from severe postpartum haemorrhage.

She could have been saved, had the government allowed unbanked directed blood transfusion (UDBT) -- blood is directly taken from a donor and given to the patient without “banking” or “storing” after first doing proper grouping, cross-matching and the mandatory tests like HIV, Hepatitis B and so on.

Frustrated by the laws which do not allow rural doctors to conduct UDBT, RR Tongaonkar, Jagtap’s treating doctor who runs a small hospital where she was taken, filed public interest litigation (PIL), with the Supreme Court earlier this week.

Tongaonkar had written to the medical officer of the sub-district hospital at 9.30 pm the day she was admitted asking him to arrange one bag of A positive blood urgently, as the patient required immediate transfusion.

Thirty minutes later, the medical officer had replied, “Thanks for referral. According to your requirement—there’s no A+ blood bag available in our Blood Storage Centre of sub-district hospital. Sorry for the inconvenience. Thank you.”

A few minutes later, Jagtap died.

Drugs and Cosmetics Act

The Drugs and Cosmetics Act only allows a blood storage centre (BSC) to supply blood, however, the centre at the sub-district hospital was empty. Tongaonkar’s hospital does not have blood storage facility.

He said, “There is no blood bank in the town. The nearest blood bank is more than 30 km away. A sub-district hospital in the town turns down the demand for blood. The thirty minutes lost between the initial correspondence and the response cut the golden hour, in which doctors had to save this patients life, in half.”

The PIL filed by Association of Rural Surgeons states that in 1999, amendments to the Drugs and Cosmetics Act made UDBT unlawful in India. Following this, standalone village blood transfusion centres, where a qualified doctor drew blood from donors and processed it without banking or storing it stopped working.

In 2001, it provided an exemption in the Act, which allows armed forces to use UDBT in emergencies. Five years ago though, the Drug Controller General of India, GN Singh had noted in minutes of the meeting with Ministry of Health, that the move to re-legalize UDBT will be taken soon. This has yet not seen light of the day, the PIL said.

The doctors argue that it should be legalised for civilians too in case of emergences as countless rural people are losing their lives while placing doctors in the untenable position of having to choose between breaking the law and saving patient lives when emergency blood transfusions are necessary.

The PIL states that UDBT is a common practice around the world and in the United States which historically and still today is used to save lives in cases of emergencies where banked blood is not readily available.

Tongaonkar said that well-meaning doctors in rural areas practice UDBT, illegally, but on humanitarian grounds, risking their necks only because they do not know of a better alternative to save the life of the patients, and their conscience does not permit them to allow the patients to die, even at the risk of punishment.

Scarcity in blood stock

Blood crunch, not only in rural but in urban areas too is an acute reality. Picture this. While World Health Organization (WHO) states that there should be at least 1,420 blood bags available in New Delhi, the stock as on April, earlier this year reflected only 38 bags, a whopping 97 per cent shortage.

In Southwest or Northeast Delhi for example, zero blood bags were available. In other states analysed, like Jharkhand (Ramgarh, Gumlah, Chatra,Narayanpur), Assam (Dhubri, Nagaon, Tinsukia, Darrang, Dima Hasao,Sivasagar, Barpeta) and Gujarat (Surat, Kheda, Dohad), the blood bag stock is zero. Delhi NCR alone faces a shortage of 100,000 units per year. Bihar is 84 per cent short of its blood requirements—more than any other state, followed by Chhattisgarh (66 per cent) and Arunachal Pradesh (64 per cent).

The PIL further states that a country need a minimum stock of blood equal to one per cent of its population according to the WHO norms. This means while India needs 1.2 crore units of blood a year, only 90 lakh units are collected. The number of registered and licensed blood banks in India is low with only 1,700 blood banks across India, which comes to less than 3 blood banks per 10 lakh population and at least 81 districts across India lack a single functioning blood bank or a storage unit.

At the same time, in the last five years, over 28 lakh units of blood and its components were discarded by banks across India. When calculated in litres, the 6 per cent cumulative wastage translates to more than 6 lakh litres of blood – which is enough to fill 53 water tankers.

Also, the shelf-life of donated blood, however, is only 35 to 42 days. Co-ordination and decentralisation is the key to proper usage of blood, hence the PIL argues that storage of blood at times without knowing the blood group that will be required leads to wastage and hence UDBT should be allowed.

Published on October 25, 2019

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