You can save a life by donating blood. Sri Lankans have come to know this all too well in the wake of bomb blasts and terrorist attacks. Blood donation campaigns are often held throughout the country. People also donate blood to commemorate special events.

One could also walk into the blood banks and donate blood at any time. But what happens to the blood collected by the blood banks?

It is important to make sure that the precious gift of blood should be a safe gift of life. The Central Blood Bank, Sri Lanka's principal blood transfusion service is spending large sums in its efforts to ensure that the blood in storage is safe for the patient. The Central Blood Bank is aiming to make the blood donation system in the country a 99 percent voluntary system.

Dr. R.M. Bindusara, Director, National Blood Bank explained that at present, there are two methods of replenishing the stocks in the Blood Bank. "One is the replacement system where relatives of patients in need of blood are requested to replace what is used by way of donors. I feel this is not a good system as the relatives or the patients are harassed to find donors. There is also the voluntary donation system, which is far better and needs to be strengthened."

In 1995, the collection of blood was 60 percent through replacement and 40 percent through voluntary donation. Today, in Colombo, 80 percent of blood is donated voluntarily.

Dr. Bindusara, who is in charge of the 64 blood banks in the country said there were logistical problems in the provincial blood banks switching fully to voluntary donations. "We have to support them by giving vehicles and staff to enable them to do this. One major blood bank in each of the nine provinces in the country has been identified and improved. There needs to be a voluntary flow of blood. We are trying to develop among our people, the concept that it is their duty to donate blood. A normal person can donate blood once in four months without a problem. People must be encouraged to walk into a blood bank periodically and donate a pint of blood."

At the Central Blood Bank within the National Hospital, blood donations are taken daily between 8 a.m. and 8 p.m. The first stage is the filling of a "Donor Declaration Form", which is a confidential questionnaire, regarding the donor's lifestyle, diseases contracted, treatment taken and so on. An educational brochure is also given to each donor. Having completed the questionnaire, the donor goes to a registration table, where trained nursing staff check the haemoglobin level and weight. Only donors with HB level of over 80 percent and a minimum weight of 50 kilograms are accepted. If accepted as a donor, all relevant details of the donor, including last date of blood donation if any are recorded.

The next stage is counselling, where questions are asked very confidentially to determine if there are any risk factors. "We try to find out if there has been a history of jaundice in childhood, whether the donor has had Hepatitis B or C or Diabetes, and the medications he is on," explained Dr. Ramani Ranasinghe, the Counsellor.

"If the donor has a history of these diseases, he should not donate blood. We also check the donor's heart, lungs and blood pressure. If the donor is fit, he goes back to the registration desk, where his name and details are noted in a large register. Then he is given a booklet, a blood pack and three stickers with his number written on it."

The donor then goes into the blood donation room, with a row of beds along both sides. When the blood is taken from the donor, small samples are taken into a tube and three bottles. One of the samples is attached to the blood pack for blood grouping. The other three samples are used to test for HIV, Syphilis and Hepatitis B.

Blood is taken on a slide for the malaria test at the point of taking the HB levels. If the donor is found to test positive for any one of these diseases, the blood is discarded. At present, the blood is discarded after chemical disinfection. However, with a new project that is in the planning stages, discarded blood will be incinerated.

According to the registration staff, an average of about 40 people come in daily to donate blood to the CBB. The most common age group is between 20 to 30 years. It is found that more males donate blood than females. It has also been found that a low HB level is more common among females.

T.M. Ranasinghe, 34, was one of the donors present that day. "I heard on the news yesterday that an engineering student warded at Karapitiya Hospital suffering from dengue, was in urgent need of A positive blood. "I came to donate blood for that purpose." Ranasinghe said he had donated blood once before when a relative of a colleague needed blood. I only come when there is a specific need," he said.

Another donor, 42-year-old Weerasena Silva, said he had come to donate blood to replace what was used for his aunt warded at the National Hospital. He has donated blood six times, twice when his father was hospitalised and the rest during blood donation campaigns in his village.

Dr. Bindusara stressed the importance of counselling the donors. "We try to screen them as much as possible during counselling because some of them often do not realise the effect of a past disease on the donated blood," she said. "Furthermore, a positive case may not be detected in the window period of the infection, so there is an element of risk."

Voluntary blood donations cut down the risk to a large extent, the director said. In the replacement system, when relatives have to find donors, they may call people off the streets and perhaps pay them for donating blood. Such donors may not disclose diseases they have had or are having.

"When we issue blood to the private sector, we charge Rs. 500 for a pint, which is the cost incurred in collecting and testing the blood," Dr. Bindusara said. "For patients in government hospitals the blood is issued free of charge. We are cutting down on replacement for both sectors. If it is a rare blood group we ask them to bring donors but otherwise we try as far as possible to provide the blood."

They are targeting a collection of 300,000 in the future.

A draft for a National Blood Policy that would regularise all blood banks in the country has been formulated and is awaiting approval.

Young blood

The Central Blood Bank has initiated Young Donors Clubs in schools to encourage students to be future blood donors. Director of the Central Blood Bank Dr. Bindusara explained that there was a need to change people's attitudes toward blood donations. Many were satisfied with donating blood once in their lifetime. While the war in the north was going on people willingly donated blood. With the end to fighting, blood donations have lessened.

Doctors of the Blood Transfusion Services developed the idea of appealing to the younger generation and the Young Donors' Club now targets A/L students in schools.

Awareness programmes were organised in some of the leading schools and Dr. Denham Paul, a WHO Consultant, who is in Sri Lanka to advise on developing the National Blood Transfusion Service in the country, spoke to senior students on the voluntary donation systems in the west. Impressed and enthusiastic, students have been eager to join in the Young Donors' Club. Members are enrolled from the age of 16 but blood donations are accepted only from students over 18 years.

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