Imagine that you open the fridge and instead of sausage and cheese you see packs of blood. This is not a nightmare, but a mandatory attribute of any transfusiology department or blood center.

In soviet times, blood donation stood high, especially voluntary donation. "Every donor was given a cup of sweet tea before the procedure and two days-off and a certificate for free of charge lunch after the procedure. There was also paid donation, and one portion of blood cost about 20 soviet rubles. The biggest category of donors was students and young workers," a pensioner from Cherkassy Tetyana recalls. Time has passed and ForUm's correspondent decided to learn about current state of 'bloody' situation. For this, we went to the transfusiology department of the Shalimov's National institute of surgery and transplantology. We met the department's chief and president of the International public organization "Association of disinterested blood donation "PoKroVa" Larysa Vakhnenko, who took us for a tour around.

First we went to the registration room, where potential donors get registered. There was a long line in front of the doors.

"All these people came here to earn money," Larysa Vakhnenko said, and people in the line stared at us.

Not paying attention to them the doctor continued: "The state must pay 160 hryvnias for one liter of blood and provide free of charge lunch. However, the state does not have money for this, but nobody wants to give blood for free. Disinterested blood donation is very rare, one or two volunteers per year. The donors you see here demand 200-300 hryvnias per portion (450 ml) from relatives of patients, who need transfusion. Relatives do not have other choice but to pay, as there is no other way to get blood components."

We decided to support domestic medicine and provide a volunteer. Our volunteer gave his passport and a nurse checked his name in the Kyiv city database of donors to make sure he was not a patient of TB dispensary, did not have any infections and did not donate blood within the last two months. Then there was careful examination of our donor, including determination of his blood group and level of hemoglobin. All blood donors are asked questions about their medical history.

It turned out we were not the only one ready to give blood for free. These military men also did not demand any reward. However, for militaries it is rather an obligation. For some militaries, however, this obligation becomes a tradition.

"I served in Soviet army and made friends with three guys. Back then, all soldiers were sent to give blood every half a year. Today we are 38 and live in different places, but every year we come to Zaporizhya (where we served) and go together to a blood center," a trolleybus drive Vitaly told ForUm.

The very process takes about ten minutes. All needles and systems of blood sampling are single-use and there is no risk to catch some infectious disease. The equipment, though, is far from modern.

The most common method is collecting the blood from the donor's vein into a container. The amount of blood drawn varies from 200 milliliters to 550 milliliters depending on the country, but 450-500 milliliters is typical. The blood is usually stored in a flexible plastic bag that also contains sodium citrate, phosphate, dextrose, and sometimes adenine. This combination keeps the blood from clotting and preserves it during storage.

Donated blood is tested by many methods, but the core tests are these four:

- Hepatitis B Surface Antigen
-  Antibody to Hepatitis C
- Antibody to HIV, usually subtypes 1 and 2
- Serologic test for Syphilis

Is there always honour in taking risks?

The first and biggest problem of donation is viruses. "Domestic testing systems are not perfect and not always reliable. PCR testing, obligatory in European countries, is not made in Ukraine. We do not have statistics of complications and diseases, which may appear after transfusion. We often hear in the press that children get sick with hepatitis after blood transfusions, but there is no exact data about frequency or the total number cases. I would like to know the statistics of similar cases, but firstly, I have no right collect this kind of information, and secondly, we need a proper system of collecting information, developed and approved by the Healthcare Ministry," Larysa Vakhnenko said.
The evil comes from paid donation, she explained. "Potential donors, who badly need these 200 hryvnias, withhold information about earlier diseases, and very often it turns out that these people are from risk groups."

However, there is a reverse side of the problem. Russia, for example, has adopted a law on introduction of disinterested donation only. According to the lawmakers, the law is aimed for getting rid of "blood traders", who are the major carriers of infectious diseases. At the same time, Russian mass media reports that since January, when the law came into force, the haematological scientific center, which treats grave cases of blood disease, has already lost 30% of its regular donors.   
Larysa Vakhnenko believes that proper promotion will improve the situation. She gave examples of foreign countries, where donated blood deficit simply does not exist. "In Italy there is a public organization AVIS responsible for promotion of disinterested donation, in Germany - the Red Cross. In Japan, for example, there are various promotion actions for disinterested donors 0 free of charge tea and sweets, massage or fortunetelling."

Ukraine, though, has a problem with adequate promotion. The Red Cross abandoned the mission long time ago, and public organizations do not have enough money for proper TV or radio commercials. Storylines, being shown on TV and picturing sick bald children, are not efficient, the doctors says.
"Watching such stories, people do not feel compassion, but fear. Effective propaganda has nothing to do with sick images and horrification. Storylines about donation must speak about blood, its functions. It must explain that donation is the only way to save people's lives and that someone of the audience, who is watching this program right now, can be the next in need of blood transfusion. Right now, I have a request for 30 liters of blood components (20 liters of plasma and 10 liters of RBC) for a patient who needs liver transplant."

The risk group also include drivers and pedestrians: 14 people die in car accidents every day (about five thousand people per year). The most common cause of death is blood loss. If doctors had sufficient amount of donated blood, these people could have undergone blood transfusion right in the ambulance car. 

In the strictest confidence

The explosion in "April" restaurant, happened in February, injured 11 people. Four of them were in very grave condition. Back then, mass media spread information with a request to come and donate blood. Does it mean that all hospitals of Kyiv could not provide enough blood for four patients? 

The problem is that in hospitals and medical institutions of Ukraine do not have a common database of blood reserves. If a hospital runs out of blood, it simply does not know where to run to take more. To solve the problem, the country needs a centralized database on blood bank. "A patient can die just because a hospital does not know where it can take more blood or where there is sufficient amount of needed blood component. It can be right next door, but without the centralized system, hospitals will never know," Vakhnenko pointed out.

According to her, several months ago the information about blood requests and donors was under SBU secrecy label. Thanks to appeals of doctors and "PoKroVa" organization to the parliament and Healthcare Ministry, the data was unclassified, but it does not help much anyway. There is no agency or department, which would analyze and systemize the data.  

Mercy and sharing is the only way for the society to fight the problem. If you want to become a donor, but are afraid of the process, you can find like-minded fellows in social networks. Groups of volunteers usually include young people, who gather in large groups to go together. An adult person has about five liters of blood, and if you donate 450 ml your organism will not suffer, while those two glasses of blood may save someone's life, may be even yours.

Alina Yeremeyeva, photos by Viktor Kovalchuk


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