Blood transfusion services: organization is integral to safety.

There are six steps to a safe blood transfusion service. The primary steps are: (i) a national policy for the blood transfusion service with time-bound programmes; (ii) a centrally coordinated, structured and organized blood transfusion service for a country/state under a defined authority; and (iii) a blood transfusion service based on an organized voluntary blood donor programme. The complementary steps are: (i) screening blood for transfusion-associated infections (TAI) appropriate to the region; (ii) rational use of available blood; and (iii) qualified personnel to head and manage the blood transfusion service. None of these steps are in place in India and the high incidence of TAI in our patients is a consequence of this deficiency. Lack of understanding of the issues related to a safe blood transfusion service has led to an emphasis on screening donor blood for infections as a means of ensuring safe blood transfusion. Screening donor blood for TAI without implementing the critical primary steps has little impact, as evidenced by the high levels of post-transfusion hepatitis which ranges from 7% for hepatitis B and C combined in patients receiving approximately 1-7 units of blood to > 50% and > 30%, respectively, for patients receiving multiple transfusions. Basic licensing standards for blood banks with regard to space, and the quality and quantity of medical staff have remained unchanged over the past three decades. This compounds the problem and society pays the price.