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OBJECTIVE To evaluate the development of blood transfusion services in Mainland China within the context of health-care system reform. BACKGROUND China launched a health-care reform program in 2009 to redistribute health-care resources, which are currently over-concentrated in well-developed cities. A geographically equitable blood transfusion service is key to achieving this goal. METHODS Based on the national survey of blood establishments in July 2015, total blood collection, whole-blood donations per 1000 population and the supply and demand relationship were analysed at the administrative region level. Areas at different developmental levels were compared in terms of total blood collection and human resources. RESULTS In 2014, Mainland China's 31 provinces showed wide variation, with total blood collection in blood facilities ranging from about 1000 units to over 600 000 units (each 200 mL), and the whole-blood donation rate per 1000 population, ranging from 1·48 to 17·09. 69% of the country's total collection, was concentrated in 29 provincial capitals, and 31% was in 311 non-capital cities. Of 97 personnel with doctorates, 74 worked in 32 provincial blood establishments, whereas the remaining 23 worked at the other 318 blood stations. In most provinces, per permanent resident donation was within 2-4 mL, and blood volume per inpatient was 10-35 mL regardless of the development of the transfusion service. CONCLUSION In 2014, China had an imbalanced development and insufficient access to blood transfusion services. This service must be redeployed at the national level to facilitate health-care reform in China.

BACKGROUND The coronavirus disease 2019 (COVID‐19) epidemic affected blood collection in Guangzhou, China. STUDY DESIGN AND METHODS This paper included three studies. The observational study reported the trends of blood collection during the epidemic in Guangzhou, China. The cross‐sectional survey investigated factors influencing blood donation during the COVID‐19 epidemic, and a self‐administered questionnaire was given to 1,584 street whole blood donors (SWBDs) who donated during the epidemic. The randomized controlled trial involved 19,491 SWBDs who donated in 2019 but did not donate during the epidemic. Trial participants were randomly assigned to two intervention groups: group 1 completed Questionnaire 1, which contained precautionary measures in response to COVID‐19 and other messages about blood donation during the epidemic; and group 2 completed Questionnaire 2, which did not include this information. A control group did not receive any questionnaire. RESULTS As measures implemented, the number of blood donors increased accordingly. Both first‐time and repeat SWBDs perceived the same level of blood need and donated blood because it would save lives. SWBDs who completed Questionnaire 1 expressed a greater intention to donate during the epidemic. Enabling blood donors to perceive a higher level of blood need and a lower level of COVID‐19 infection risk related to blood donation mobilized experienced SWBDs to donate within three weeks. Intention‐to‐treat analyses and average‐treatment‐effect‐on‐the‐treated estimations confirmed that Questionnaire 1 could motivate SWBDs to actually donate blood. CONCLUSION Various measures could ease blood shortage during the COVID‐19 epidemic. Administration of Questionnaire 1 could increase blood donations during the epidemic. This article is protected by copyright. All rights reserved.

SUMMARYObjective The aim of this study was to evaluate the effectiveness of recruitment of inactive donors by telephone call and cell phone short message service (SMS), to assess the causes of donor self-deferral and to determine the appropriate sample size for a formal study Background Blood donor retention is essential for sustaining blood safety and sufficiency. Methods We conducted a single-centre open-label parallel randomised controlled trial in Guangzhou, China. A total of 1188 inactive donors with the last donation between 2009 and 2013 were enrolled and randomly assigned to two intervention groups (telephone call and SMS groups) and one control group without any intervention. Donors were followed up for 7 months; their responses including donation activities were analysed. Results The re-donation rates among the three groups were statistically significantly different (P = 0.044), particularly between the phone call group and the control group (P = 0.017). Within the phone call group, the re-donation rate was positively associated with the frequency of prior donation (P = 0.026), and the age of the donors (P = 0.043). Medical issues, time constraints and group donation were the main causes of self-deferral. The appropriate sample size for each group for a formal study to detect difference between the phone call and SMS groups was estimated to be 1429 participants. Conclusions Our findings suggest that active interventions, especially phone call reminders, can increase blood donation. Further studies are required to compare the efficacy and effectiveness between phone call and SMS reminders using a larger sample size.

Background: Recruiting of sufficient numbers of donors of blood products is vital worldwide. In this study we assessed the efficacy and cost-effectiveness of telephone calls and SMS reminders for re-recruitment of inactive blood donors. Methods: This single-centre, non-blinded, parallel randomized controlled trial in Guangzhou, China included 11,880 inactive blood donors whose last donation was between January 1 and June 30, 2014. The donors were randomly assigned to either one of two intervention groups (received telephone or short message service [SMS] communications) or to a control group without intervention. SMS messages with altruistic appeal were adopted in the SMS group; in addition to altruistic appeal, reasons for deferral of blood donation were also asked in the telephone group. All participants were followed up for 1 year. The primary outcome were re-donation rates, compared by intention-to-treat (ITT) analysis, average treatment effect (ATE) and average treatment effect on the treated (ATT) estimations. Secondary outcomes were the self-reported deterrents. Other outcomes included the re-donation interval, and the incremental cost-effectiveness ratio (ICER) of telephone calls versus SMS reminders on re-recruitment. Results: ITT analysis discovered no significant differences in the re-donation rate among the three groups. ATE estimation showed that participants who were randomly assigned to the telephone group were more likely to re-donate than those in the SMS group. ATT estimations indicated that among compliers, telephone calls significantly increased re-donation compared to both SMS reminders and no intervention. Donor return behaviour was positively associated with receiving reminders successfully, being male, older age, and previous donation history. The SMS reminder prompted donors to return sooner than no reminder within 6 months, and according to ICER calculations, SMS reminders were more cost-effective than telephone calls. Donors reported time constraints as the most main causes of self-deferral in the telephone group, and altruistic appeal had a positive effect on these donors. Conclusions: Interventions to reactivate inactive blood donors can be effective, with telephone calls prompting more donors to return but at a greater cost than SMS messages. SMS reminder with altruistic appeal can urge donors to re-donate sooner within 6 months than no reminder.