1. Family or Family Replacement Donors

In this system, the blood needed by a patient is supplied by one or more donors within the patient’s own family or community. There are two basic forms of this system. The first is where the family donates the same quantity of blood as that given to their relative. In turn, this blood is added to the general pool in the blood bank and is then used as required. The donor is not told the identity of the blood transfusion recipient.

“Directed donation” is the second variation of this system whereby a donor specifically requests that their blood is given to a named patient. It should be noted that this form of donation is strongly discouraged by WHO. In Minimum Targets for Blood Transfusion Services (WHO, 1989) it is clearly stated that:

“If family or “replacement’’ donors are used their donations should be to the transfusion service and not “directed” to named recipients. Care must be taken to ensure that this is not a hidden (remunerated) system.”

• Advantages

• It helps to meet a need for blood where voluntary non – remunerated donors are not available.
• Once replacement donors recognise that their blood helped save the life of their relative, they may be willing to become regular, voluntary donors so that other patients will also benefit in future.

• Disadvantages

• Patients or their relatives are expected to find replacement donors which puts additional responsibility and stress on them at a time when they are already under strain because of the patient’s illness.
• There is pressure on members of the family to give blood, even when they may be ineligible to do so, either because of their health status or because of the risk of transfusion – transmissible infection (TTI).
• The blood given to patients will not necessarily be replaced in type or quantity. Where a transfusion is required for an adult, it is likely that several units of blood will be needed. A donation from one or two family members may not be sufficient to replace the blood used. Consequently, the blood needs of the community may not be met adequately.
• Relatives who cannot find suitable donors within the family unit – or who are unwilling to give blood – may seek donors who are prepared to give their blood for payment which poses TTI risks to the patient.

In essence, research undertaken in a number of countries has shown that blood from family replacement donors is found unsuitable more often than blood from unpaid voluntary donors. This is to be expected as people who give blood under pressure or for payment by the patient’s family are less likely to reveal any reasons why they may be unsuitable as donors. Therefore, they present a potentially greater risk to the safety of the blood supply.

1. Commercial or professional donors

These type of donors receive money or other rewards for the blood that they donate. In essence, they are usually motivated by what they will receive for their blood rather than by a wish to help other people.

2.1 Disadvantages

• Paying donors to give blood undermines the voluntary non – remunerated donation system which is the foundation of a safe blood supply.
• Many commercial donors come from the poorer sectors of society where the need for money drives them to sell their blood. They may be in poor health, undernourished or at risk of transfusion – transmissible infections which would endanger the lives of the recipients of their blood.
• Commercial donors may donate their blood more frequently than is recommended. This may have harmful effects on their own health, with the result that they may supply substandard units of blood which could either present a risk to the recipients or provide little or no benefit.

1. Voluntary non – remunerated donors

These are donors who give blood, plasma or other blood components of their own free will and receive no  money or other form of payment for it which could be considered a substitute for money, such as time off work except that reasonably needed for the donation and travel. Their primary motivation is to help unknown recipients and not to obtain any personal benefit.

The following items are not normally considered payments or substitutes for money:

• Small tokens of recognition or appreciation, such as badges or certificates that have no commercial value.
• Reimbursement of the direct costs of travel that was specifically undertaken in order to donate blood.
• Light refreshment immediately before, during or after a donation.
  • Advantages
• Voluntary non – remunerated donors are not under pressure to give blood and are therefore more likely to meet the national criteria for low – risk donors.
• They are more likely to be willing to donate blood regularly, which is important in maintaining adequate supplies of blood.
• Regular donors are more likely to be free from transfusion – transmissible infections because they have been educated about the importance of safe blood and are screened each time they attend to give blood.
• They are more likely to respond to an appeal for blood donors during an emergency because they have already expressed a commitment to voluntary blood donation.

World Health Assembly Resolution 28.72 of 1975 urged Member States to:

“Promote the development of national blood services based on the voluntary non – remunerated donation of blood”.

This is to say that the target for every country should be to ensure that all blood donors are voluntary and non – remunerated.

ADDITIONAL TYPES OF BLOOD COLLECTION

1. Therapeutic phlebotomy

This is the collection of blood from patients in order to improve their own health, usually because of a blood disorder leading to an abnormally high red cell count (haemoglobin level). Patients with such disorders do not qualify as being medically fit to be blood donors, even though their high haemoglobin level may be their only clinical problem. Blood from these patients is therefore not normally used for transfusion.

1. Autologous transfusion

The term describes the transfusion of any blood component that was donated by the intended recipient.

Credit: Safe Blood And Blood Products: Safe Blood Donation (Module 1), World Health Organisation, Geneva, 2002.