World Blood Donor Day 2025 | What India needs to do to reform the blood banking system

As we observe World Blood Donor Day on June 14 under the theme 'Give blood, give hope: together we save lives' it is important to recognise that the ability to save lives through blood donation ultimately depends on the strength of the systems behind it.

Each donated unit carries the potential to transform lives, but only if supported by an efficient, equitable, and responsive blood banking infrastructure.

India has made notable strides in improving blood transfusion services, enhancing both safety and availability, as highlighted by the Union Minister of State for Health & Family Welfare, Anupriya Patel. Government initiatives such as mandatory testing for transfusion-transmitted infections (TTIs), expanding Nucleic Acid Testing (NAT), and the establishment of capital blood centres represent significant progress.

Despite these advancements, substantial gaps persist. 63 districts across the country remain without a single functional blood bank. In Tier 2 and 3 cities, inconsistent access to government-provided free blood and chelation therapy leads to delays in care; while an increase in out-of-pocket expenditures places undue strain on families, as the cost of a single blood transfusion can reach up to INR 4,500 in some cases.

Concurrently, nearly 650,000 blood units are wasted annually due to inadequate storage and suboptimal inventory management. Lastly, a fragmented regulatory framework, outdated policies, and inconsistent adherence to safety protocols further undermine the efficiency and reliability of the blood banking system. Addressing these deficiencies is imperative to ensure equitable access to safe and timely transfusions for all patients in need.

Implementing a Hub-and-Spoke model for improved blood banking

The high prevalence of blood disorders and maternal mortality highlights the urgent need for a robust and well-coordinated blood banking system. With an estimated 14.6 million units required annually and a supply gap of one million units, the demand for blood far outstrips availability.

This gap is further exacerbated by the rising burden of hemoglobinopathies, with over 1.2 million individuals affected by sickle cell disease (SCD). By 2026, blood requirements for such conditions are projected to rise to 9.24 million units.

The system also struggles to ensure the availability of specialised blood products. Patients with hemoglobinopathies require leukoreduced and phenotypically matched blood, which is often not readily available. This scarcity disrupts treatment as well as increases the risk of alloimmunisation, complicating future transfusions and adding another layer of urgency to the need for a robust blood banking system.

At the same time, inefficiencies in storage and distribution led to significant wastage, with over 30 lakh units discarded between 2014-17 due to expiration, degradation, or infection-related issues highlighting the need for a more efficient system.

A hub-and-spoke model presents a compelling framework to achieve this efficiency. By designating well-equipped regional blood centres as hubs, blood can be collected, tested, and stored more effectively before being distributed to smaller community health centres and district hospitals—the spokes—based on real-time demand.

This approach ensures a steadier and more predictable blood supply with better inventory management, reducing the likelihood of both shortages and wastage as observed in countries like Spain and Kenya. More importantly, it can enable better access to specialised blood products, ensuring that patients with hemoglobinopathies and other transfusion-dependent conditions receive the precise blood components they require helping build a more resilient system, particularly in rural and underserved regions.

Strengthening treatment pathways through reliable blood supply

While ensuring a sufficient blood supply is critical, its true impact depends on how effectively it is utilised in patient care. For individuals with sickle cell disease (SCD) and other transfusion-dependent conditions, access to timely and appropriate transfusions is critical.

Advanced interventions like red cell exchange (RBCx) offer a promising approach to managing these conditions by reducing iron overload and minimising transfusion-related risks. However, the success of such treatments hinges on a stable and sufficient blood supply, which, in turn, depends on a robust culture of Non-Remunerated Voluntary Blood Donation.

Building a sustainable culture of voluntary blood donation

Despite the life-saving role of blood transfusions, voluntary donation rates in India remain insufficient, with only 70 per cent of the total blood supply coming from willing donors.

Deep-seated misconceptions— from fears of health risks to religious apprehensions—continue to deter participation.  It is therefore necessary to use platforms such as schools and colleges complemented by technology-driven solutions to build awareness and develop a community-driven approach.

A compelling example of this comes from Meghalaya, which, until recently, struggled with one of the lowest voluntary blood donation rates in the country—only 38 per cent of its blood supply came from voluntary donors.

To address this, the state government launched an innovative behavioural change campaign that tackled multiple barriers simultaneously. Through multilingual comics, a missed call facility for easy donor registration, and interactive workshops in schools and colleges, the campaign worked to shift mindsets and make blood donation more accessible.

Improving blood bank systems to maximise impact

While increasing voluntary blood donation is crucial, its benefits can only be fully realised if the collected blood is managed efficiently and safely. Weak enforcement of Standard Operating Procedures (SOPs) has led to administrative lapses, poor documentation, and inconsistent quality control in blood banks, ultimately compromising patient safety.

A striking example of effective reform comes from Sonbhadra, where NITI Aayog and UP-NHM intervened to address severe deficiencies in the district’s blood bank—lack of standardised protocols, low donor participation, and lapses in quality control. By strengthening human resources, upgrading infrastructure, and enforcing strict compliance with SOPs, the initiative led to a 40 per cent increase in donor flow and a 37 per cent improvement in the overall functionality of the blood bank.

This transformation highlights the need for similar structured interventions across India, ensuring regulatory oversight, capacity-building, and adherence to quality standards for a safer and more reliable blood supply.

India's progress in blood transfusion services is commendable, but to truly realise the promise behind this year’s World Blood Donor Day message, 'Give blood, give hope: together we save lives', we must ensure that every drop donated translates into timely, appropriate care.

This means moving beyond donor drives to focus on systemic reform. Implementing the hub-and-spoke model, enforcing rigorous SOPs, and fostering a strong culture of non-remunerated voluntary blood donation are all essential. Equally critical is the need for public-private partnerships that can drive innovation and efficiency, especially in underserved areas. Crucially, we must also guarantee timely access to comprehensive treatment pathways, including advanced therapies for hemoglobinopathies.

By strengthening both the supply and the systems that deliver it, we can ensure that hope, given through donation, is matched by a healthcare system capable of saving lives today and in the years to come.

Dr Mohit Chowdhry is the Sr. Consultant and HOD at the Department of Transfusion Medicine, Transplant Immunology & Molecular Biology at Apollo Hospital Delhi.

The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK

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