- Email: [email protected]
Blood shortages and donation in China
Correspondence
precisely into the tumour bed while the wound was open after lumpectomy. The next morning I was discharged from hospital. I was at my desk 2 days later and have continued in excellent health since then. Hence, I was dismayed to find that, in their Comment (Jan 16, p 201),1 Coles and Yarnold make no mention of intraoperative radiation therapy as a treatment option. Intraoperative radiation therapy is available in the UK and is being considered by the National Institute for Health and Care Excellence. Effective, fast, and easy for patients, it spares the skin and critical organs from the effects of radiation exposure. An estimated 20 000 patients have received this treatment in 250 centres in North America, Europe, the Middle East, and Asia.2 It has been incorporated into the Australian health-care system. It is much cheaper than external beam radiation therapy and less arduous to undergo than brachytherapy. In their Comment, 1 Coles and Yarnold completely ignore this widely accepted treatment, which is both straightforward and gentle for the patient, and the demand for which is increasing. The fact that competent clinicians fail to acknowledge a treatment that is highly regarded by the informed consumer is, at the very least, ungenerous. Patients deserve better. I declare no competing interests.
Marcelle Bernstein [email protected] 49 Queen of Denmark Court, London SE16 7TB, UK 1
2
Coles CE, Yarnold JR. Accelerated partial breast irradiation: the new standard? Lancet 2016; 387: 201–02. Vaidya JS. Worldwide adoption of TARGeted Intraoperative radioTherapy TARGIT IORT for breast cancer. http://jayantvaidya.org/breastcancer-surgeon/worldwide-adoption-oftargeted-intraoperative-radiotherapy-targitiort-for-breast-cancer/ (accessed April 15, 2016).
Blood shortages and donation in China In China, blood shortage is an important issue that has not been adequately addressed. Insufficient blood donation www.thelancet.com Vol 387 May 7, 2016
in China is regarded as the main reason for the shortage. Statistics from the Ministry of Health of China suggest that only 9·5% of the eligible Chinese population donated blood in 2014,1 which is lower than the rate recommended by WHO. Coupled with the high demand for blood in clinical medicine at present, the blood shortage presents a serious challenge to blood supply and public health in China. The blood donation law, which has been in place since 1998, bans all paid whole-blood donations for clinical use and encourages Chinese citizens who meet the conditions of donation to donate blood voluntarily. To encourage donation, the law provides volunteers with several days off work, a nutrition allowance, and priority access to blood transfusion in “medical emergencies requiring blood”. Additionally, the present blood law allows for mutual donation (ie, donations made specifically to permit transfusions to family, friends, and colleagues) to safeguard emergency blood needs.2 However, such provisions, although stimulating blood donation, also increase the severity of the Chinese blood shortage and generate several other negative effects. First, the so-called priority services do not protect the right to blood transfusion of people who do not meet the requirements for blood donation, such as the chronically sick, the childless elderly people, and individuals who have hepatitis B or HIV. Second, in the present situation of blood shortage, the priority services cannot guarantee blood donors access to blood, and donors are often still required to resort to mutual donation. This means that patients’ relatives or friends have to donate blood for the patient to receive a transfusion. This situation increases people’s distrust of voluntary blood donation and affects the quality and safety of donated blood.3 Third, mutual donation can stimulate the blood-selling market. In cases involving relatives and friends who do not wish to donate blood, or
involving patients who need more blood than their acquaintances can donate, patients are likely to seek people who want to sell blood. We believe that priority services and mutual donation should be banned in China. The government should promote voluntary blood donation unconditionally. The relevant departments need to attract additional blood donors by promoting the health benefits of blood donation and providing a comfortable donation environment and first-rate service. Additionally, medical practitioners need to reduce blood waste in clinical transfusion.4 Finally, blood stocks in every blood centre should be disclosed, promoting public awareness of the blood reserve situation, which could promote blood donation. We declare no competing interests.
Rui Xue, Yan Chen, *Jianguo Wen [email protected] Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450002, China 1
2 3
4
Chen L, Ma Z. The construct and measurement of perceived risk of nonremunerated blood donation: evidence from the Chinese public. Biomed Res Int 2015; 2015: 302043. Shan H, Wang JX, Ren FR, et al. Blood banking in China. Lancet 2002; 360: 1770–75. Sun N, Zhang G, Guo H, Zhang R. Analysis of directed blood donation and voluntary blood donation in Changsha region in 2012. Practical Preventive Medicine 2012; 21: 115–18 (in Chinese). Lin Z, Liu H, Cai X, et al. Analysis of the results of literature of clinical blood transfusion rationality. Medicine & Philosophy (B) 2015; 2: 213–17 (in Chinese).
China has a relatively low blood donation rate compared with the mean global rate, resulting in long-term blood shortages. Blood shortages are fairly common in regions in which the demand for blood for health-care services is high, such as Beijing, and are seasonal, such as during the winter and summer when college students and migrant workers (the main blood donors) are on holiday. To address the challenges of ensuring that sufficient blood is available, the Chinese Government has released a series of incentive policies, such as 1905
precisely into the tumour bed while the wound was open after lumpectomy. The next morning I was discharged from hospital. I was at my desk 2 days later and have continued in excellent health since then. Hence, I was dismayed to find that, in their Comment (Jan 16, p 201),1 Coles and Yarnold make no mention of intraoperative radiation therapy as a treatment option. Intraoperative radiation therapy is available in the UK and is being considered by the National Institute for Health and Care Excellence. Effective, fast, and easy for patients, it spares the skin and critical organs from the effects of radiation exposure. An estimated 20 000 patients have received this treatment in 250 centres in North America, Europe, the Middle East, and Asia.2 It has been incorporated into the Australian health-care system. It is much cheaper than external beam radiation therapy and less arduous to undergo than brachytherapy. In their Comment, 1 Coles and Yarnold completely ignore this widely accepted treatment, which is both straightforward and gentle for the patient, and the demand for which is increasing. The fact that competent clinicians fail to acknowledge a treatment that is highly regarded by the informed consumer is, at the very least, ungenerous. Patients deserve better. I declare no competing interests.
Marcelle Bernstein [email protected] 49 Queen of Denmark Court, London SE16 7TB, UK 1
2
Coles CE, Yarnold JR. Accelerated partial breast irradiation: the new standard? Lancet 2016; 387: 201–02. Vaidya JS. Worldwide adoption of TARGeted Intraoperative radioTherapy TARGIT IORT for breast cancer. http://jayantvaidya.org/breastcancer-surgeon/worldwide-adoption-oftargeted-intraoperative-radiotherapy-targitiort-for-breast-cancer/ (accessed April 15, 2016).
Blood shortages and donation in China In China, blood shortage is an important issue that has not been adequately addressed. Insufficient blood donation www.thelancet.com Vol 387 May 7, 2016
in China is regarded as the main reason for the shortage. Statistics from the Ministry of Health of China suggest that only 9·5% of the eligible Chinese population donated blood in 2014,1 which is lower than the rate recommended by WHO. Coupled with the high demand for blood in clinical medicine at present, the blood shortage presents a serious challenge to blood supply and public health in China. The blood donation law, which has been in place since 1998, bans all paid whole-blood donations for clinical use and encourages Chinese citizens who meet the conditions of donation to donate blood voluntarily. To encourage donation, the law provides volunteers with several days off work, a nutrition allowance, and priority access to blood transfusion in “medical emergencies requiring blood”. Additionally, the present blood law allows for mutual donation (ie, donations made specifically to permit transfusions to family, friends, and colleagues) to safeguard emergency blood needs.2 However, such provisions, although stimulating blood donation, also increase the severity of the Chinese blood shortage and generate several other negative effects. First, the so-called priority services do not protect the right to blood transfusion of people who do not meet the requirements for blood donation, such as the chronically sick, the childless elderly people, and individuals who have hepatitis B or HIV. Second, in the present situation of blood shortage, the priority services cannot guarantee blood donors access to blood, and donors are often still required to resort to mutual donation. This means that patients’ relatives or friends have to donate blood for the patient to receive a transfusion. This situation increases people’s distrust of voluntary blood donation and affects the quality and safety of donated blood.3 Third, mutual donation can stimulate the blood-selling market. In cases involving relatives and friends who do not wish to donate blood, or
involving patients who need more blood than their acquaintances can donate, patients are likely to seek people who want to sell blood. We believe that priority services and mutual donation should be banned in China. The government should promote voluntary blood donation unconditionally. The relevant departments need to attract additional blood donors by promoting the health benefits of blood donation and providing a comfortable donation environment and first-rate service. Additionally, medical practitioners need to reduce blood waste in clinical transfusion.4 Finally, blood stocks in every blood centre should be disclosed, promoting public awareness of the blood reserve situation, which could promote blood donation. We declare no competing interests.
Rui Xue, Yan Chen, *Jianguo Wen [email protected] Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450002, China 1
2 3
4
Chen L, Ma Z. The construct and measurement of perceived risk of nonremunerated blood donation: evidence from the Chinese public. Biomed Res Int 2015; 2015: 302043. Shan H, Wang JX, Ren FR, et al. Blood banking in China. Lancet 2002; 360: 1770–75. Sun N, Zhang G, Guo H, Zhang R. Analysis of directed blood donation and voluntary blood donation in Changsha region in 2012. Practical Preventive Medicine 2012; 21: 115–18 (in Chinese). Lin Z, Liu H, Cai X, et al. Analysis of the results of literature of clinical blood transfusion rationality. Medicine & Philosophy (B) 2015; 2: 213–17 (in Chinese).
China has a relatively low blood donation rate compared with the mean global rate, resulting in long-term blood shortages. Blood shortages are fairly common in regions in which the demand for blood for health-care services is high, such as Beijing, and are seasonal, such as during the winter and summer when college students and migrant workers (the main blood donors) are on holiday. To address the challenges of ensuring that sufficient blood is available, the Chinese Government has released a series of incentive policies, such as 1905