When Sankalp got it's first request for platelet apheresis, little was known and understood about the procedure. We got the volunteers to donate platelets first and then gradually made progress towards educating the regular blood donors as well as building the country's first voluntary platelet database. The volunteers of the organisation spent good amount of time learning the use case and benefits of single donor platelets (SDP) in particular and apheresis technique in general.
However, since 2010, the organisation has noted a marked change in the pattern of demand for SDP. The demand for SDP is being placed by the medical teams at platelet counts way above those which are scientifically acceptable. The pattern of origination of such requests (which we track using our software systems) clearly indicate unjust motivation for such demands. However, from a patients perspective the choices are few. If the doctor says you must get platelets - you must get platelets. The cost of SDP platelets has skyrocketed and the market associated with the procedure is booming.
In context of voluntary blood donation, platelet apheresis continues to remain a replacement based procedure. Only when the doctor prescribes the demand for a unit of SDP, the search for a donor commences. Often there is a tight deadline associated with these requests causing panic and frantic search. Thanks to the increased awareness about SDP among regular blood donors and numerous donor registries which have mushroomed, the donors are located or some friend or family members donates. So let us examine this:
- The whole concept of making blood available on shelf before the need arises has remained alien to platelet apheresis.
- The concept of replacement based blood donation is the order of the day - though in many cases the donors who are located to replace have voluntary intent by themselves.
- The good ideals of maintaining anonymity between the blood donor and the patient's family have no space in the current apheresis context.
In summary, people involved with voluntary blood donation have a long way to go so-far-as single donor platelets is concerned.
Keeping the larger gaps associated with voluntary blood donation in apheresis aside for a moment, there is a difficult question which remains to be answered. In the context that a large number of requests for platelets are irrational and medically unjustified, the demand appears to be guided by financial motives. Often the patients are being asked to get blood donors even when platelet counts are above 50,000 platelets per microliter. In this situation should a voluntary blood donation organisation continue to send donors to the blood bank every time there is a demand? Does it not amount to being a party with the medical team to loot the patient? More importantly, if the voluntary blood donors were to know the magnitude of profits that the blood banks are making, would they continue to go and donate platelets there?
Any voluntary blood donation organisation would confirm that the blood donors are okay with the processing charges of blood as long as they do not see an intent for profiteering. A single unit of SDP in Bangalore today costs Rs 11,000/- upwards and goes up to Rs 18,000/-. Doing a sum total of all involved costs including cost of kit, the cost of platelets test, the spot serological tests, the compensation to the technician for extended duration of time and the facility costs there is no way such high costs can be justified as necessary processing charges.
So, where does this leave us. Voluntary blood donation organisations have the responsibility of giving an option of voluntarily donated single donor platelet units to the patients right off the shelf. However, they also need to raise the voice of concern towards misusing single donor platelets to mint money from helpless patients and massive profiteering involved in the process. This clearly highlights the need for more centers which involve in collection and processing of platelets at a no-profit no-loss basis. Unfortunately, unlike regular blood donation, Sankalp India Foundation so far has not been able to find a single centre involved in platelet apheresis following the no-profit no-loss principle.
Sankalp is working with some organisations to open up the roads for non-profit truly voluntary single donor platelet apheresis. The delay of each day in this ensures that the patients continue to suffer and the concepts of voluntary blood donation continue to be undermined. This is a largely unmet need of a modern and just society which we want to fulfill at the earliest.
Until the solution is arrived at, we walk the thin line between reducing patient's suffering and preventing them from being looted.
If any blood bank is willing to establish a single donor platelets facility at a no-profit no-loss basis, we would be happy to help streamline the voluntary blood donation aspects. Please send an email to email@example.com or call 9880132850.