Every year, blood transfusions save millions of lives, but still millions of patients needing transfusions do not have access to safe blood because of insufficient donations. China is one of the countries where a lack of donated blood continues to be a problem despite efforts to raise people's awareness of this need. Hospitals in Beijing, and in Shandong, Shanxi, Yunnan and Jiangxi provinces suffer from acute blood shortages, which result in delays to surgical procedures.

According to official figures only 84 out of 10,000 people donate blood in China, in spite of the fact that China's first Law on Blood Donation was enacted in 1998, encouraging all citizens between the ages of 18 and 55 to donate blood. This is far below the 454 people out of every 10,000 people who donate blood in high-income countries.

The problem in China will be solved not only when technical issues are addressed, but also when people's cultural beliefs are also taken into consideration. The concept of blood (xue) as it is used in Traditional Chinese Medicine is different from the way the term is commonly used in Western medicine. According to Chinese medicine, blood is a dense form of body fluids that has been energized by qi, and has a synergistic relationship with it. That is why the Suwen, also known as Basic Questions, a text that covers the theoretical foundation of Chinese medicine and its diagnostic method, states, "blood and qi are the spirits of man." This is one of the reasons that explain why many people in China are reluctant to donate blood.

According to Traditional Chinese Medicine, one can donate blood once every two years without adverse effects, and this may even enhance the body's ability to produce more blood. However, according to Western medicine theory, a person can donate blood every 56 days without fear of adverse reactions. The lost blood will be completely recovered 10 days after the donation took place.

In addition to the belief that donating blood may drain a person's energy, other misunderstandings related to blood donation are that it can undermine men's fertility, it may lead to gaining weight or it can lead to dangerous changes in blood pressure. None of these beliefs has been proved true. The only risks associated with donating blood are the recipient may acquire infections from the donor if proper precautions are not taken.

Fear of transfusion-transmissible infection, notably HIV, is one of the most important factors discouraging people from donating blood. Many people remember the spreading of HIV by contaminated blood in Henan province in the 1990s. To overcome the problem of contaminated blood transfusion, the World Health Organization (WHO) recommends that, at a minimum, received and donated blood should be screened for HIV, hepatitis B, hepatitis C and syphilis.

Because of public concern about risk of infection from donating blood, it is still necessary to overcome popular fear that donating blood is deleterious to a person's health. According to some researchers, in one region in western China, almost 70 percent of the people who were interviewed, said that fear of becoming infected with transfusion transmitted infections prevented them from donating blood.

A complicating factor in the need for donated blood is that several studies have shown that blood transfusions are often given when there is no urgent need, when simpler, less expensive treatments could provide equal or greater benefit. The need for more blood donations, however, is still critical in China, which has made considerable progress in convincing many Chinese to eliminate blood selling and increase voluntary blood donation as a way of stemming transmission of transfusion-transmissible infections.

During a couple of visits I made to China's rural areas in the 1990s, I was able to assess their greater needs when compared to the population in the urban areas. More information and resources should be brought to rural areas and the marginal areas in the big cities.

The WHO has stated some basic conditions to increase access to blood transfusions and to promote blood safety. It has four main elements: establishment of a nationally coordinated blood transfusion service, collection of blood from exclusively voluntary donors from low-risk populations, testing of all blood for compatibility and transfusion-transmissible infections, and reducing all unnecessary transfusions.

In addition, it is important to secure the government's commitment and support for the national blood program and continue public health campaigns aimed at educating the population, particularly in poor, marginal and rural areas. Blood is a gift of life, and should be treated as such.

The author is an international public health consultant.

(China Daily 02/24/2012 page9)