Lecture: Blood Donation Program in the AsiaPacific RegionDr S. Thomas

On behalf of the Asia Pacific Blood Network

As part of the Asia Pacific Blood Network (APBN) comparison of practice program,member countries review blood donor management practices to understand emerg-ing trends in the region, and identify good practice opportunities which may benefitother members.

Our membership includes Australia, Beijing, Hong Kong, Japan, New Zealand,Singapore, South Korea, Taiwan and Thailand. From 2006, we have jointly collectedinformation for a range of donor related measures, including age and sex distribu-tion of donors, criteria for donation, donation volumes and frequencies, transfusiontransmitted disease rates, additional donor health screening initiatives and donordeferrals.

Analysis of the donor management information both among member countries,and for individual countries over a period of 4 years, provides a useful window intosome of the donor characteristics for our region. Whilst there are significant varia-tions in population size of countries, there are shared trends in donor patterns sub-sequent to local disasters, reasons for donor deferrals, and the need for continuedfocus on relevant and effective donor retention and recruitment strategies. We con-tinue to see lower red cell utilisation rates in Asia, in general a younger donor popu-lation with higher representation of male donors, and low haemoglobin as thesingle most common reason for donor deferral for most members.

APBN members are actively pursuing opportunities for shared donor manage-ment approaches, and the progress with these strategies in addition to an overviewof regional donor measure is provided.

Key words: Asia Pacific Blood Network, APBN, best practice, blood donormanagement, blood donor safety, emerging trends.

Paper

The Asia Pacific Blood Network (APBN) includes represen-

tation from nine countries in our region, and was estab-

lished in 2006 to encourage blood safety and efficiency of

blood service operations among members and to promote

self-sufficiency in the region based on voluntary non-

remunerated blood donation (vnrbd). In 2011 member

countries included:

• Hong Kong

• Singapore

• Taiwan

• Thailand

• New Zealand

• Japan

• Beijing

• South Korea

• Australia

The current strategic initiatives for APBN include the:

regional collaboration to improve the organisation of blood

supply and product utilisation; health and safety of blood

donors; and the development of regional guidelines to

address shared issues.

Correspondence: Dr Sally Thomas, Australian Red Cross Blood Service, onbehalf of the Asia Pacific Blood NetworkE-mail: sthomas@redcrossblood.org.au

ISBT Science Series (2011) 6, 373–376

STATE OF THE ART 4A-S11-01 � 2011 Asia-Pacific Blood Network.ISBT Science Series ª 2011 International Society of Blood Transfusion

373

As with the European Blood Alliance (EBA) and the Alli-

ance of Blood Operators (ABO), the APBN uses a balanced

scorecard of organisational measures to enable countries to

compare practices. Measures are based on common defini-

tions and focused on donor, patient, and organizational

effectiveness.

Population and age

Countries represented in the Asia Pacific Blood Network

range widely in both total population (4.4–128.0 million)

and population density (3–7,257 ⁄ km2). By comparison, the

United States of America (USA) has a total population of

308.0 million and a population density of 32 ⁄ km2. This

gives us the opportunity to understand specific donor

recruitment and retention challenges associated with a

range of population profiles and demographics that exist in

the region. As an example, population or donor density can

influence collection strategies and the decision to use fixed

rather than mobile collection sites within some members.

Successful implementation outcomes are shared amongst

the members to improve each member’s own strategic

planning.

Anecdotally, the average age of donors in Asia is less

than that in the US and Europe. The age profile of donors

within APBN reflects the ageing population being experi-

enced globally over the past 3 years, with a small 1–2%

increase in the average age of both male and female

donors being reported each year. Members have developed

specific strategies for recruitment of young donors to

address the decline in youth donors experienced locally (as

in most countries internationally) to ensure sustainable

donors bases are developed for the future. These strategies

include tailoring or branding donor centres to appeal to

younger donors and the use of social media including

Facebook, Twitter, and Youtube in all forms of donor

recruitment.

Demand

The need for blood donors reflects a country’s blood and

blood product requirements, as well as the country policy

in regard to self-sufficiency and use of voluntary non-

remunerated blood donors (vnrbd). All APBN members

have country policies based on vnrbd for fresh blood prod-

ucts, and a shared vision to maximise as far as possible

self-sufficiency through vnrbd for plasma products. Whilst

red cell demand is viewed as relatively stable across the

region, small percentages of growth are being experienced

by some members, mostly attributed to increased demand

on services. For some countries the increased demand is

from medical tourism, as complex patient cases from other

countries are referred across borders.

Overall however, red cell issue rates of APBN members

are generally lower than those seen in the US and Europe

(Fig. 1), and have been the subject of further analysis at a

shared red cell utilisation workshop in 2009. For at least two

members with red cell utilisation rates at 21 (member C) and

17 (member I), respectively, there is no reported unmet

demand and the health care systems are highly developed.

In our region, donor size (height, weight and thus total

blood volume) can be significantly smaller than in the US

and Europe, and many countries still collect at least a por-

tion of whole blood collections in smaller volume bags

(200–350 ml). To allow comparison, all red cell issue data

is ‘standardised’ to a 470 ml collection. Without standardis-

ing these small volume collections, members C and I con-

tinue to show low red cell issue rates, at 26 (member C) and

18 (member I), respectively.

Platelet demand is primarily met with a mix of whole

blood and plateletpheresis donations, with a range of plate-

letpheresis from 5 to 100%. Platelet issues range from 3.7

to 10.6 issues per 1,000 population.

While countries share an aim of plasma derivative self-

sufficiency where possible, those members who are close to

2.00%

3.00%

4.00%

5.00%

6.00%

7.00%

8.00%

9.00%

0

10

20

30

40

50

ABO averageHEFGACID B

APBN combined red cells + whole blood issues per 1000 population (standardised to 470 mLs) &donor participation rates (%)

2006–072007–082008–092009–10Donor participation rates 2008–09Donor participation rates 2009–10

Fig. 1 APBN Red Cell + 1 Whole blood issues per 1,000 population, standardised to 470 ml, and participation rates. 1Some members issue a small number

of red cells as whole blood units, this ranges from 0 to 4.5%.

374 S. Thomas

� 2011 Asia-Pacific Blood Network.ISBT Science Series � 2011 International Society of Blood Transfusion, ISBT Science Series (2011) 6, 373–376

achieving this still rely on some level of imported plasma

products such as Albumin (Japan) and IVIg (Australia).

Donor base trend and participation

Donor management is tailored to match demand as closely

as possible. In our region, countries are showing a positive

trend of building a donor base, with the exception of mem-

ber B, where the influx of donors in response to a natural

disaster in 2009 was followed by an erosion of the donor

base in the subsequent 12 months (Fig. 2).

This positive donor trend is seen across all donor types,

whole blood, plasmapheresis and plateletpheresis. The

growth in each APBN member donor base compares

favourably with Europe, where countries have found it

more challenging to sustain year on year increases in donor

numbers.

Donor participation rates in APBN range from 3 to 8%

with a general correlation seen with red cell issue rates

(Fig. 1), noting however that for some countries a national

aim of self-sufficiency for plasma derivatives affects the

participation rate.

Strategies targeted at increasing young (aged between 16

and 24) blood donor participation rates exist in all coun-

tries, with differing degrees of emphasis. Three members

are achieving young donor participation rates of between

15 and 25% whilst conversely, other members have rates

below 7%. New donor recruitment data (Fig. 3) highlights

this emphasis some members have on young donor recruit-

ment programs, with some members clearly recruiting more

new donors from the younger population, such as members

D, A and H.

The impact of a younger donor population on donor

management data, such as donor loss, can result in a high

level of ‘churn’ in the donor pool and a requirement for

effective donor retention strategies to offset this.

Participation rates, donor loss and other donor manage-

ment data can also be affected by local strategies such as

–10%

–5%

0%

5%

10%

15%

H G I C D E A BF

APBN donor base trend - whole blood

2006 2007 2008 2009 2010

Fig. 2 APBN Donor Base Trend—whole blood. (Percentage change in the number of active donors over 12 months compared to the preceding year)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

B D A C F I G H E

APBN new donor recruitment : 16–24 years and ≥ 25 years

2008 16–24 2009 16–24 2010 16–24

2008 >25 2009 > 25 2010> 25

Fig. 3 APBN new donor recruitment 16–24 years old vs. ‡25 years old.

Blood donation in the Asia Pacific Region 375

� 2011 Asia-Pacific Blood Network.ISBT Science Series � 2011 International Society of Blood Transfusion, ISBT Science Series (2011) 6, 373–376

donor frequency rates, availability of a collection venue

(mobile versus fixed), availability of facilities for donation

type (whole blood, plasmapheresis or plateletpheresis), as

well as the potential competition for donor time, both

through a donor’s other personal and work commitments,

and, in some countries, paid plasma facilities.

The average whole blood donation frequency is 1.6 for

APBN with a range from 1.2 to 2.2 whole blood donations

per year. The optimal donation frequency is a balance

between a stable repeat donor base containing donors from

both younger and older generations and managing the

potential impact of higher frequency of donation on donor

health. To address some of these concerns, some members

restrict the frequency of whole blood donation to 2 per year

for females or collect smaller volumes from donors, espe-

cially those in the youth bracket.

Donor deferral

Donor deferral rates vary significantly across APBN with a

range from 5 to 30%, compared against an ABO average of

15% (Fig. 4). Analysis of the main reasons for deferral

shows low donor haemoglobin (Hb) as the most frequent

reason, followed by medication. This area has been explored

further through network participation with exchange of

information on donation frequency, collection criteria, hae-

moglobin cut off levels and iron replacement strategies.

Current Hb lower limit cut offs range from 115 to 120 g ⁄ lfor females and 130 g ⁄ l for male whole blood donors. Iron

replacement strategies are currently used in Singapore and

Thailand and being reviewed by other members.

Productivity and efficiency

One of the drivers for APBN network membership is to

understand both good practice opportunities, and scope for

improved efficiency. Initial data collection shows a wide

range in the area of collection productivity from 1,000 col-

lections per FTE to >6,000, however some data definitions

need further clarification, and this area is the subject of a

specific project in 2011.

A related measure in the collection area is collection effi-

ciency which is a measure of the ability to successfully pro-

duce a complete whole blood donation from an attending

donor. Unlike donor deferrals, this measure also captures

losses associated with unsuccessful venipunctures, under-

and overweight units, and other collection area product

losses. The range is from 77 to 96% in those members

where data is widely available.

By considering the wider ‘balanced scorecard’ of mea-

sures in conjunction with the productivity and efficiency

data, members are able to review their existing donor man-

agement strategies and identify potential opportunities for

their own country.

Summary

The area of donor management in the APBN network is

an important focus of exchange, and is expected to

remain a priority in the near future as blood services

respond to donor health and satisfaction requirements,

and provide the safest and most effective environment

for the conversion of the donor’s gift to meet the coun-

try’s patient needs.

Disclosures

No potential conflict of interests to declare.

0%

5%

10%

15%

20%

25%

30%

ABO averageDIGCHAFEB

APBN percentage of donations deferred

2006 2007 2008 2009 2010

Fig. 4 APBN donor deferral. Definition donor deferrals: percentage of donors who attended a session and did not donate.

376 S. Thomas

� 2011 Asia-Pacific Blood Network.ISBT Science Series � 2011 International Society of Blood Transfusion, ISBT Science Series (2011) 6, 373–376