2016 ROTARY INTERNATIONAL CONVENTION Family Donors are Critical and Legitimate in Developing Countries Cees Th. Smit Sibinga President RAG GNBD

Safety of the Gift of Life to the World Viral Marker Prevalence Is there a difference between FADs and first time VNRDs?

 Family/acquaintance blood donors (FAD) considered less safe than voluntary non-remunerated blood donors (VNRD);  Pressure and coercion are considered unethical. Assumptions – 3

 FAD are actively discouraged by international organizations (IO);  Affluent countries support these IO;  Existing shortages continues. Consequence – 4

 Viral marker data of 1st time VNRD and FAD, corrected for gender and age show, no significant difference;  Basic motive for VNRD and FAD is benevolence rather than altruism;  FADs are willing to become VNRD and to repeat donation if asked. Viral Markers 5

Type of DonorsN DonorsConfirmed Anti-HIV (%) HBsAG (%)Confirmed Anti-HCV (%) FAD17,449 (68.3%) 550 (3.2)2521 (14.4)583 (3.3) VNR8094 (31.7%) 110 (1.4)1027 (12.7)248 (3.1) First time (2.0)824 (16.8)223 (4.5) Regular (0.4)203 (6.4)25 (0.8) Prevalence in VNR and FA blood donors in Mali – HIV, HBV, HCV From: J-P Allain – ISBT Science Series 2010;5:

Viral Markers CountryType of DonorsN Donorsconfirmed HIV (%)HBsAg (%) CamerounFirst time VNRD (4.0)49 (18.0) FAD (3.7) 233 (7.6) GhanaFirst time VNRD (1.0)919 (13.8) FAD (1.1)649 (14.8) GuineaFirst time VNRD (1.6)259 (14.5) FAD (0.5)1142 (12.8) Prevalence of HIV and HBV in first time VNR and FA donors From: J-P Allain – ISBT Science Series 2010;5:

FAD in the Blood Supply in Four Continents AmericasAfricaAsiaEurope <20%20-79%>80% ArgentinaBeninAlgeriaAngolaChinaAlbania BoliviaBotswanaBurk. FasoCameroonIndiaGreece BrazilBurundiErytreaChadIranMontenegr ChileCARGambiaCongoKuwait ColumbiaCôte d’Iv.GuineaDRCKSA Cost. RicaMalawiKenyaEthiopiaOman CubaNamibiaMoroccoGabonPakistan EcuadorSouth Afr.Mozamb.GhanaThailand El SalvadorRuandaTunisiaGuin. Biss.Turkey GuatamSenegalZambiaMadagasc. HondurasUgandaMali 8

FAD in the Blood Supply in Four Continents (2) AmericasAfricaAsiaEurope <20%20-79%>80% JamaicaMauritania MexicoSierra Leo NicaraguaTanzania Paraguay Peru Surinam Uruguay Venezuela 9

TTI Marker Prevalence in non-SSA Countries post-2009 countrydonors% prevalence Anti-HIVAnti-HCVHBsAg ft VNRDFADft VNRDFADft VNRDFAD Albania52, India47, , Nepal33, Pakistan13, Thailand? Ghana6, Camer Mozamb

Family/Acquaintance Donors  FAD are almost exclusively called upon in countries with considerable blood shortages  In life-threatening situations due to severe shortage, pressures are extended on both VNRD and FAD  FAD blood are cheaper than ‘one time only’ VNRD 11

Statements 1. FADs meet all basic criteria of VNRD; 2. FAD remain a critical source of (regular) VNR blood; 3. At this point in time, FADs are - legitimate and indispensable - should not be discouraged. 12

However – 4. FAD should be encouraged to become regular VNR donors; 5. FAD are a good potential to bridge the gap to reach 100% VNRD. Statements 13

Evidence Base - GNBD Study Proposal There are limited comparitive and reliable studies available to provide a solid evidence base. Objective– To re-open the assessment (evidence base) on whether the ban on FAD in developing countries is justified. 14

Evidence Base - GNBD Study Proposal Developing countries –  Selected countries from Low and Medium HDI (4 continents);  Demographic, logistic and statistical data collection on - blood donor typology (first time VNRD & FAD) ; 15

Evidence Base - GNBD Study Proposal - viral marker epidemiology (TTI marker prevalence) ; - frequency of blood donation (% regular vs first time/one time only for VNRD and FAD); - blood usage/consumption and suppl (supply or demand driven); 16

Evidence Base - GNBD Study Proposal  Focus on 1st time/one time only VNR and FAD donation;  Collection of (confirmed) TTI marker prevalence;  Correction for gender and age;  N = to be determined (statistical significance). 17

Message from RAG GNBD Be a Gift to the World Donate BLOOD on a voluntary and non- remunerated principle Preferably do that regularly! 18