Jing Liu, Ester Cerdeira Sabino, João Eduardo Ferreira, Michael P. Busch, Brian Custer, Anna Bárbara F. Carneiro-Proietti, Fernando Augusto Proietti, Thelma T. Gonçalez, Cláudia Di Lorenzo Oliveira, Divaldo Sampaio, Edward L. Murphy, and George B. Schreiber
To ensure an adequate blood supply, it is crucial to recruit suitable blood donors. These are ideally individuals with low risk for infectious diseases, who are in good health, and willing to spend their time to help someone out of a sense of solidarity and altruism. Prior to the late 1970s and early 1980s, blood collections in Brazil were mainly performed by private blood banks. Cash reimbursement for donation was a common practice, and there were few laws regulating blood bank activities. An assessment performed for the Brazilian Ministry of Health Blood by the World Health Organization (WHO) in early 1970s documented serious problems with the blood banking policies and practices1, which led the federal government to define blood safety as a national security problem. Measures were taken to improve the safety and quality of blood and components, especially after the onset of the AIDS epidemic, when blood transfusion practices became an important political issue.2,3 The Brazilian network of public blood centers was created in the late 1970s and early 1980s, as a response to these blood safety concerns. Although the centers were under the state administrations, federal funds were allocated to support these public blood centers and cooperation with the French government made it possible to train a large number of professionals in blood collection and processing and transfusion practices. Blood transfusion is now regulated by the Federal Government through Anvisa, the national health surveillance agency, and by the Blood Coordination Office in the Ministry of Health which is responsible for the policies of the system. Specific methodologies are defined for donor recruitment, deferral criteria, laboratory tests, cold chain, and related component preparation procedures2. The regulations are very similar to those in place in the US and Europe, and internationally accepted procedures and guidelines are used as reference in the development of Brazilian rules and practice guidelines.1 In addition to establishing “sanitary policies” regarding donor selection, blood testing and handling of blood products, paid blood donations were forbidden.2 The prohibition from paid donations could have had an enormous impact on the blood supply due to the lack of experience of centers in recruiting voluntary blood donors. General concern that this prohibition would dramatically decrease blood availability led Brazilian blood centers to rapidly develop programs to recruit donors among friends and relatives of hospitalized patients, termed “replacement donors”. This procedure had the effect of maintaining the blood supply, following the sudden reduction in collections due to the elimination of paid blood donors, and replacement donors became the major source of blood units in Brazil in the 1980s. One of the main problems in relying on this type of donor is that most of them are first-time blood donors, so the prevalence of infectious disease markers is higher3,4,5, leading to an elevated percentage of discarded units and greater risk of a window-period donation. In addition, families and friends of patients were frequently “asked” to donate in a forceful way. Replacement donations, solicited prior to medical procedures, with numbers determined by the hospitals/procedures, were compulsory before the patient would be treated or undergo surgery. This led to an undesirable situation, where, in the quest for blood donors, the patients and/or their families would recruit potential donors at the entrances of blood banks to donate in the name of a specific donor, sometimes offering to pay these unrelated individuals for blood donation. Hence, some donors were still paid, although not by the blood bank. Recognizing the inherent problem with these practices, concerted efforts were made during the 1990’s to change the blood donor supply from replacement first-time donors to community voluntary repeat donors. However, still today, replacement donors are responsible for up to 50% of blood donations in many regions of Brazil.2 It is estimated that 3 million units of blood are collected per year in Brazil, with approximately 70% of donations in these regions collected through the public system.1,2 However, national studies on blood donation are scarce in Brazil. Data on blood donation and use is now compiled, in a semi-manual way, at the federal level by Anvisa and by the Blood Coordination Office, but these data are usually incomplete and outdated.1,2 Although blood donor systems in Brazil are required by law to store their donor/and donation data, they have been unable to combine data from multiple centers or systematically analyze these data due to lack of computer database systems with the capacity to create and analyze large datasets. The NHLBI International REDS-II study in Brazil started in 2007, and is comprised of three major public blood banks. Two of them are in the Southeast region of Brazil6, where most of the blood is collected, while the third is in Northeastern coastal Brazil. There are considerable regional differences between the Southeastern and Northeastern parts of Brazil7, and differences in blood donor profile and behavior were expected. The present work describes the demographic profile of blood donors in the three centers, how it compares with the general population of the cities where each center is located, and discusses strategies to increase the proportion of the general population that donates blood in Brazil.