Key facts on Blood Safety and Availability

Key facts

  • Of the 118.5 million blood donations collected globally, 40% of these are collected in high-income countries, home to 16% of the world’s population.

  • In low-income countries, up to 54 % of blood transfusions are given to children under 5 years of age; whereas in high-income countries, the most frequently transfused patient group is over 60 years of age, accounting for up to 75% of all transfusions.

  • Based on samples of 1000 people, the blood donation rate is 31.5 donations in high-income countries, 15.9 donations in upper-middle-income countries, 6.8 donations in lower-middle-income countries and 5.0 donations in low-income countries.

  • An increase of 7.8 million blood donations from voluntary unpaid donors has been reported from 2013 to 2018. In total, 79 countries collect over 90% of their blood supply from voluntary unpaid blood donors; however, 56 countries collect more than 50% of their blood supply from family/replacement or paid donors.

  • Only 55 of 171 reporting countries produce plasma-derived medicinal products (PDMP) through the fractionation of plasma collected in the reporting country. A total of 90 countries reported that all PDMP are imported, 16 countries reported that no PDMP were used during the reporting period, and 10 countries did not respond to the question.

National blood policy and organization

Blood transfusion saves lives and improves health, but many patients requiring transfusion do not have timely access to safe blood. Providing safe and adequate blood should be an integral part of every country’s national health care policy and infrastructure.

WHO recommends that all activities related to blood collection, testing, processing, storage and distribution be coordinated at the national level through effective organization and integrated blood supply networks. The national blood system should be governed by national blood policy and legislative framework to promote uniform implementation of standards and consistency in the quality and safety of blood and blood products.

In 2018,72 % of reporting countries, or 123 out of 171, had a national blood policy. Overall, 64% of reporting countries, or 110 out of 171, have specific legislation covering the safety and quality of blood transfusion, including:

  • 79% of high-income countries

  • 63% of middle-income countries

  • 39% of low-income countries.

Blood supply

About 118.4 million blood donations are collected worldwide. 40% of these are collected in high-income countries, home to 16 % of the world’s population.

About 13 300 blood centres in 169 countries report collecting a total of 106 million donations. Collections at blood centres vary according to income group. The median annual donations per blood centre is 1 300 in the low-income countries, 4 400 in lower-middle-income countries and 9 300 in upper-middle-income countries, as compared to 25 700 in high-income countries.

There is a marked difference in the level of access to blood between low- and high-income countries. The whole blood donation rate is an indicator for the general availability of blood in a country. The median blood donation rate in high-income countries is 31.5 donations per 1000 people. This compares with 15.9 donations per 1000 people in upper-middle-income countries, 6.8 donations per 1000 people in lower-middle-income countries, and five donations per 1000 people in low-income countries.

62 countries report collecting fewer than 10 donations per 1000 people. Of these, 34 countries are in the WHO African Region, four in the WHO Region of the Americas, six in the WHO Eastern Mediterranean region, three in the WHO European Region, six in the WHO South-Eastern Asia Region, and nine in the WHO Western Pacific Region. All are low- or middle-income countries.

Blood donors

Age and gender of blood donors

Data about the gender profile of blood donors show that globally 33% of blood donations are given by women, although this ranges widely. In 14 of the 111 reporting countries, less than 10% of donations are given by female donors.

The age profile of blood donors shows that, proportionally, more young people donate blood in low- and middle-income countries than in high-income countries. Demographic information of blood donors is important for formulating and monitoring recruitment strategies.

Types of blood donors

There are 3 types of blood donors:

  • voluntary unpaid

  • family/replacement

  • paid.

An adequate and reliable supply of safe blood can be assured by a stable base of regular, voluntary, unpaid blood donors. These donors are also the safest group of donors as the prevalence of bloodborne infections is lowest among this group. World Health Assembly resolution WHA63.12 urges all Member States to develop national blood systems based on voluntary unpaid donations and to work towards the goal of self-sufficiency.

Data reported to WHO shows significant increases of voluntary unpaid blood donations in low- and middle-income countries:

  • An increase of 7.8 million blood donations from voluntary unpaid donors from 2013 to 2018 has been reported by 156 countries. The highest increase of voluntary unpaid blood donations is in the Region of the Americas (25%) and Africa (23% ). The maximum increase in absolute numbers was reported in the Western Pacific Region (2.67 million donations), followed by the Americas (2.66 million donations) and South-East Asia (2.37 million).

  • 79 countries collect more than 90% of their blood supply from voluntary unpaid blood donations (38 high-income countries, 33 middle-income countries and eight low-income countries). This includes 62 countries with 100% (or more than 99%) of their blood supply from voluntary unpaid blood donors.

  • In 56 countries, more than 50% of the blood supply is still dependent on family/replacement and paid blood donors (nine high-income countries, 37 middle-income countries and 10 low-income countries).

  • 16 countries report collecting paid donations in 2018, around 276 000 donations in total.

Blood screening

WHO recommends that all blood donations should be screened for infections prior to use. Screening for HIV, hepatitis B, hepatitis C, and syphilis should be mandatory. Blood screening should be performed according to quality system requirements. Of reporting countries, 12 are not able to screen all donated blood for one or more of the above infections.

99.8% of the donations in high-income countries and 99.9% in upper-middle-income countries are screened following basic quality procedures, as compared to 82% in lower-middle-income countries and 80.3 % in low-income countries. The prevalence of transfusion-transmissible infections in blood donations in high-income countries is considerably lower than in low- and middle-income countries

These differences reflect the variation in prevalence among population who are eligible to donate blood, the type of donors (such as voluntary unpaid blood donors from lower risk populations) and the effectiveness of the system of educating and selecting donors.

Blood processing

Blood collected in an anticoagulant can be stored and transfused to a patient in an unmodified state. This is known as ‘whole blood’ transfusion. However, blood can be used more effectively if it is processed into components, such as red cell concentrates, platelet concentrates, plasma and cryoprecipitate. In this way, it can meet the needs of more than one patient.

The capacity to provide patients with the different blood components they require is still limited in low-income countries: 37% of the blood collected in low-income countries is separated into components, 69% in lower-middle-income countries, 95% in upper-middle-income countries, and 97% in high-income countries.

Supply of plasma-der