Blood donation apps are here to help in medical emergencies. But where does the blood really go?

A few hours before his mother underwent surgery on Thursday, Wahab Siddiqui was busy on his phone, calling people to ask for a unit of AB+ blood. He found one relative with the same blood group who was willing to donate but who, when tested, was found to have low haemoglobin making her ineligible to donate.

Officials at the hospital’s blood bank then told the 25-year-old Siddiqui to try looking on websites or mobile applications for blood donors. Siddiqui, who is doing a post-graduate course in education in Jamia Milia University in Delhi, registered on the website www.friends2support.org.

A cursory search for blood donation apps on Android and IOS phones throws up more than 30 hits. These apps all aim to connect a person like Siddiqui who is in need of blood to a donor who is already registered with the app.

“Looking for blood is a struggle for patients’ families who are busy arranging funds and picking up reports of tests,” said Pratap Chandnani, who launched an app called Donor On Call last year a few months ago through his organisation Green Shakti Foundation. “We want to address people who need blood for an emergency or have a heavy requirement of blood. Our app matches the need according to mobile location.”

But how far do these apps and websites go in addressing the blood shortage in the country or even in the cities they cater to? Activists who are working to increase blood donation in the country say that that these apps promote replacement donation for hospitals who want to stock their banks using patients to get blood for them.

Replacement donation

Every networked person will have got those requests via message or WhatsApp or Facebook or Twitter: a relative/friend is in hospital and urgently needs blood of a certain type – so, please come donate if you have that blood type. Similar requests are circulated on blood donation apps.

The messages, however, are often misleading. Hospitals bank blood to be used in emergencies. Blood that is transfused into a patient during an emergency procedure or a planned surgery needs to be tested for compatibility and safety. It takes about one day to process blood to check for infections and separate it into its different components – one reason why blood that is collected is almost never used immediately on an emergent case.

Hospitals that ask a patient’s caregivers to look for blood donors among their friends and family are looking to replace blood previously stored in their blood banks and now being used to treat the patient.

Blood donation under these conditions is not as urgent as made out to be in the messages or necessary for the medical procedure to be conducted.

“Can a hospital plan a surgery hoping to have blood arranged from the patient?” asked Vinay Shetty from Think Foundation in Mumbai, which organises voluntary blood donation camps. “That is not possible. The donor donates blood thinking it will be used for the patient who called him. But, they are just filling the bank.”

And that’s exactly what happened with Siddiqui. His mother was in hospital for a week during which Siddiqui worried about not finding a blood donor and that the surgery would not take place.

“When I pleaded with a doctor and said that I am unable to get blood before the surgery, he said that they will do the surgery,” said Siddiqui. “But the blood group is short in their bank. I will have to try arrange it by evening.” The hospital had earlier told him that he has to arrange blood for the surgery to proceed.

This practice of asking the family of patient to arrange blood by asking either family or community members is called replacement donation. Even though India’s national blood policy discourages replacement blood donation, there is no law that prevents hospitals from demanding replacement blood.

“Although donors are not paid by the blood transfusion service or hospital, there may be a hidden paid donation system in which money or other forms of payment are actually provided by patients’ families,” the WHO states. Some studies cited by the WHO have even shown a greater prevalence of infections in replacement blood compared to voluntary blood, since donors who are under pressure to give blood may omit important medical information.

The debate over blood wastage

From outside the operation theatre during his mother’s surgery, Siddiqui started making calls to people listed in the database of Friends2support. He made 22 calls to people listed with the app. Many said that they had already donated blood recently or were not eligible for some other reason.”While the website was helpful, it was not easy for me to get these donors,” said Siddiqui. “It took me a long time to get two people who were willing to come after work in the evening to donate blood.”

Shakeel SK, an IT professional in Hyderabad, decided to start Friends2support.org in 2005. He pooled resources with his friends to get the service and app up and running, he said. The website and app – available on Android and IOS – has a database of more than two lakh donors and nearly 1,000 units are donated via the app in a day, claimed Shakeel.

Similar apps are being developed and launched all the time, the latest being Blood United for Android. “We wanted an app which is better as compared to others in terms of usability,” said Parag Gandhi, director of Flying Cursor, a branding agency in Mumbai that developed Blood United. Approximately 150 people have registered on the app since it launched a week ago, said Gandhi.

So, why are these entrepreneurs interested in individualised blood donation and not organised blood donation camps? The four app-makers that Scroll.in spoke to said that they were keen that not a single unit of blood is wasted, which they believed happens at blood donation camps.

“You must have read this article which spoke of how much blood is wasted,” said Chandnani, referring to a report in The Times of India in April that said 2.8 million units of blood had been wasted by blood banks in the last five years. “That’s why our donors need to be mobile and donate where the blood is required.”

But, as Siddiqui’s case shows, even replacement blood is most likely to go into a blood bank.

Moreover, some amount of wastage of blood is inevitable, as Rajat Agarwal, programme coordinator at Sankalp India Foundation in Bengaluru, has explained. This is because blood cells, platelets and plasma all have different shelf lives and because the demand for the three components of blood differs.

Aggarwal regards the blood donation apps with some scepticism and thinks some may be making blood donation a commercial enterprise, even though all the app owners Scroll.in spoke to said that these were non-profit ventures. Aggarwal said that he has heard of blood donation app models involving a fee from the hospital. The Supreme Court in 1998 made professional blood donation for money illegal. Blood donation is supposed to be voluntary and for no payment.

But, a website with an open directory like Friends2support cannot control how its donor database is used.

“We do not want to entertain any misuse,” said Shakeel. “We have told donors to check for patient records and verify that the patient exists before donating blood.”

Blood banks take in walk-in donors. There need not be a patient admitted in a hospital who needs blood for a person to donate blood.

A notice on the website warns donors of the presence of middlemen trying to make money off the site by arranging donors for desperate patients and their families. The notice asks users not to pay any money for blood donations and to inform Friend2support volunteers who can initiate police action against anyone demanding money.

“We cannot control people’s mindsets (about asking for money in lieu of a blood donation),” said Shakeel. “When we get any complaints, we remove the name from the donor list.”

Can apps help fix blood shortages?

The WHO says that the system of getting blood donors for individual patients “cannot meet a community’s requirements for blood and blood products.”

Both Shetty and Agarwal, who work with the National Blood Transfusion Council, said that the idea of running donor directories via apps works against the spirit of voluntary blood donation.

“Blood supply is the responsibility of the government, not the patient,” said Shetty. “This system puts the onus on the patient.”

Dr Shobini Rajan, assistant director of National Aids Control Organisation who handles blood safety, said that blood banks have a duty to maintain sufficient supply of blood. “The government tells blood banks to not turn patients away and that they must arrange blood themselves,” she said. “They must maintain an inventory on how to maintain stock by conducting camps or calling in enough voluntary donors to donate.”

The government itself launched a website and an app called e-Raktkosh last April. This website is an integrated blood bank management information system that provides information about the blood supply in blood banks.

“We are planning to come up with an app which aims to connect voluntary donor to a blood bank,” said Dr Shobini Rajan, assistant director of National Aids Control Organisation who handles blood safety.

Said Agarwal: “We have to make it easy for people to donate. We have to go to their workplace, or near their houses where it is convenient for them to donate blood. Everyone will then be happy to donate.”

Siddiqui is the only caregiver to his mother in Delhi and he had to concentrate his efforts in getting a suitable donor instead of ensuring her safety and comfort. “Itna pressure nahi hona chahiye,” he said. There should not be so much pressure on the patients and their families.