1. Voluntary non-remunerated Blood Donor Recruitment & Retention Iran Experience Dr Mahtab Maghsudlu (MD, MPH) Assistant Professor in Community Medicine

2. Global Strategy for Voluntary Blood Donation Globally, by 2015 100% voluntary non-remunerated blood donation in countries with high Human Development Indices (HDIs) At least 80% voluntary non-remunerated blood donation in countries with low and medium HDIs

3. Blood Safety The recruitment only of voluntary, non-remunerated blood donors with altruistic motives Retention of donors Laboratory tests Donor selection Why VNRBD?

4. Global challenges in blood availability and safety

5. Major Challenge Increasing requirements for blood and blood products Inadequate blood supplies to meet needs Risk of transfusion-transmissible infections and transfusion reactions Unnecessary transfusions

6. Lack of national clinical transfusion guidelines Variations in prescribing patterns  between countries, within countries and within hospitals Use of blood when not indicated for patient health and survival Failure to use simple safe alternative s Reduced stock of blood available for patients for whom there is no alternative to transfusion Unnecessary exposure of patients to risk of TTIs

7. Blood usage: developed countries Complex surgical and medical procedures –Cardiac surgery, vascular surgery, neurosurgery, orthopaedic surgery, transplantation Cancer chemotherapy Trauma care –Road traffic accidents Haematological disorders –Thalassaemia, sickle cell disease, haemophilia

8. Blood usage: developing countries Complications of pregnancy and childbirth Severe childhood anaemia –Often resulting from malaria or malnutrition –Exacerbated by HIV/AIDS, parasitic infections Trauma care –Road-traffic accidents –Interpersonal violence –War, conflict, disasters Haematological disorders

9. 99% of the estimated 536 000 maternal deaths each year occur in the developing world 19 of the 20 countries with the highest maternal mortality are in sub-Saharan Africa Maternal mortality, 2005

10. Maternal mortality, 2000 Maternal Mortality Ratio, 2000. World Health Report, WHO Legend < = 30 30-110 111-540 >540

11. Blood donation and maternal mortality Legend Donations per 100,000 population Maternal mortality ratio

12. Severe acute anaemia Major causes of severe acute anaemia –Malaria –Malnutrition –Haemoglobinopathies: e.g. thalassaemia, sickle cell anaemia In southern Africa, safe and timely transfusion could help prevent up to 20% of maternal deaths and 15% of child deaths from severe anaemia

13. Malaria and anaemia In malarial areas: –Estimated 30-90% children under 5 have anaemia –60-80% of pregnant women have anaemia –8-15% of child deaths and 8-20% of maternal deaths are caused by severe anaemia due to malaria Malaria and anaemia also contribute to adverse pregnancy outcomes - stillbirth, premature delivery, low birth weight and perinatal deaths

14. WHO Health Statistics 2005 Legend < 25 25-49.9 50-99.9 100-150 >150 Not available Under-five mortality rate, 2003

15. Blood donation rates, 2004-2005 No global standard for assessing a country's requirements for blood Depending on level of development of health care system, blood donation by 1-3% of population is usually sufficient to meet a country's needs Blood donation rates of less than 1% of population (fewer than 10 donations per thousand people) in 80 countries  79 in developing world

16. Blood donation rates, 2004-2005 Average number of blood donations per 1,000 population is 11 times higher in high HDI countries than in low HDI countries 100% voluntary non-remunerated blood donation –2002: 39 countries –2004: 50 countries Family/replacement donors and paid donors remain a significant source of blood for transfusion in many countries

17. National Blood Program in Iran Donor ScreeningBlood TestingQ.C Blood Donor Recruitment Program Blood Centers levelNational level 1)1)Need Assessment in each Province 2)2) performance of SOPs related to “Donor Recruitment” 3) Donor Registry Database 4) Face to face education & Information sessions 5) Blood Donor Recognition 6) National Blood donor day & WBDD 1) Establishment of a national central department responsible for all activities related to blood donors throughout the country in 2002 2) Develop and implementation a continuous national awareness program to lighten the importance of regular donation 3) Broadly partnership with other organizations 4) Training of blood centers’ staff in the field of donor recruitment 5)Research as a tool for blood donor recruitment and retention

18. Establishment of national central department responsible for all activities related to blood donors throughout the country Planning Providing SOPs Monitoring - the total number of donors. - the number of new donors (and their donation profile after 2 months,1 year and 5 years) - the number of regular donors Blood Donation / Blood Donor Ratio - response rate of the donors ( after written invitation to donate phone calls e-mails,….., Evaluation

19. Develop and implementation a continuous national awareness program

20. Adding some topic about blood and blood donation to primary educational curriculum Writing a composition about the importance of blood donation

21. Broadly partnership with other organizations Advocacy for voluntary blood donation Public support Mobilization resource Community involvement Brainstorm idea in order to reduce the gap between planner and people

22. Potential partners Community based organization Educational institutions Private sector Patient association Media

23. Training of blood centers’ staff in the field of donor recruitment

24. Research as a tool for blood donor recruitment Examples of research objectives Donor characteristics: e.g. age, gender, education, socio-economic status,Knowledge, Attitudes and Practice (KAP) of the general public Cultural values that support or discourage blood donation Identify low risk population Responses of different target populations to information and education materials

25. Most effective communication and education strategies to motivate specific target populations Impact of extended operating times on blood donation Waiting times in donor clinics characteristics of lapsed donors and reasons for not returning to donate Research as a tool for blood donor recruitment Examples of research objectives

26. Effect of staff training/qualifications on quality of care provided in the donor clinic Number of donor deferrals and reasons for deferral Number of delayed adverse reactions in donors & risk factor Donor satisfaction & contributing factors Response rates to different donor recall methods

27. Several studies of iron status in Iranian women blood donors Result showed significant percentage of women donors are iron deficient.Result showed significant percentage of women donors are iron deficient.

28. Then another research was designed:

29. Effect of short-term ferrous sulfate supplementation on iron stores 412 childbearing age female Half of them were given 21 doses of ferrus sulfate 150mg in each donation and the other not Result showed Iron deficiency is inevitable in childbearing age female donors without supplementationResult showed Iron deficiency is inevitable in childbearing age female donors without supplementation

30. Blood Donor Recruitment Program in Blood Centers’ level

31. Estimating blood requirements Method 1: based on previous usage Analyse records for a specified period in a defined geographical area, population or hospital: –Number of units of blood/components requested –Number of units of blood/components issued for transfusion –Number of unfilled requests for blood/components: e.g. elective surgeries cancelled

32. Estimating blood requirements Method 2: based on population Used to estimate the number of units of blood needed to meet the blood requirements of a defined population over one year Calculation is based on 1-3% of population requiring blood per year, based on level of development of health care system Can be used to estimate the blood requirements of individual regions or districts within the country

33. Estimating blood requirements Method 3: based on acute hospital beds Used to estimate the number of units of blood needed to meet blood requirements of a defined hospital population Calculate 6.7 units of blood required per acute hospital bed per year

34. Estimating blood requirements Method 3: based on acute hospital beds Example For a hospital with 50 acute beds, calculate: 50 x 6.7 = 335 units of blood per year or approx. 7 units per week Number of donors required will depend on frequency of donation: e.g. –1 donation per donor per year = minimum 335 donors –2 donations per donor per year = minimum 168 donors

35. Performance of SOPs related to “ Donor Recruitment”

36. Face to face blood donor education & Information sessions

37. High school students Education Program

38. Blood donor recognition

39. National Blood Donation Day & WBDD WBDD in Iran 2008

40. Trend of Blood Donation in Iran (1974-2007) Units

41. Trend of Yearly Donation Index in Iran(1974-2007) Per 1000