The blood company

The blood that flows through our veins is not to be taken for granted. The National Blood Transfusion Service (NBTS) ensures that this life-saving substance is collected, analysed and distributed in the safest way possible. Claudia Calleja met up with its medical director, Alex Aquilina.

The big difference between a blood donor and a patient is that, if the donor is not satisfied, he may leave and never go back to donate blood. This is why, at the NBTS, the people who walk through the door are treated as customers and not as patients, Dr Aquilina stressed.

Wearing his white lab coat, Dr Aquilina emitted a sense of enthusiastic determination as he explained how the NBTS is run just like any commercial company - the product is the blood and the customer the blood donor.

He started by setting the framework clear and explained how, on the strength of an EU Directive (2001/83/EC), standards have been introduced to regulate the blood transfusion service.

This directive distinguished between two institutions. The first is the blood establishment, which is responsible for the recruitment of donors and the collection, processing, testing and distribution of blood. The second institution is the hospital blood bank that is responsible for clinical issues.

The separation of the two, Dr Aquilina noted, ensures there is a system whereby both sides are better audited.

Although they currently operate under one roof, the blood establishment, headed by Dr Aquilina, is not actually part of St Luke's Hospital but falls under the direct responsibility of the Permanent Secretary at the Ministry of Health. In fact, the NBTS is expected to move to a new donation centre, situated across the hospital's square, that is expected to be inaugurated in May. This will ensure that donors, who are the customers, can give blood in a more welcoming environment.

As Dr Aquilina walked through the establishment, he pointed out the state-of-the-art equipment used to analyse and process the blood according to set standards. It was clear that emphasis is placed on constant monitoring and accurate labelling of the blood samples to ensure donors' anonymity.

Dr Aquilina was quick to add that the department was working towards securing International Standards Organisation (ISO) certification.

Again, as with any business, Dr Aquilina is fully aware that standards have to me met. And just like any respectable company, the NBTS has its aims and objectives. These include the recruiting of new donors and increasing the number of donations from 14,800 last year to 15,500 by the end of next year.

So, a question follows: Why should a person donate blood?

"You can answer that for me," he said in a calm tone. "You have to ask it to a donor," he added, as he went on to give the figures.

"An estimate of 40 to 50 blood bags are needed every day to cope with the demand and, whereas blood has to be used within 45 days, with our usage of blood, it barely lasts four to five days," he said.

Dr Aquilina notes how the NBTS Yearly Report 2006 shows that there was a drop in new blood donors between 2003 and 2006. The reasons could be various.

To start with, in 2003 parastatal organisations stopped giving their employees a day off to donate blood. This reduced the flow of a few thousand people and explained the drop in donors between 2003 and 2005.

Reflecting on the one-day leave concept, Dr Aquilina noted: "I don't feel people need a whole day off to donate blood, but employers should allow reasonable time off to employees wanting to donate blood," he said.

He explained that whereas those who did clerical or office jobs could go back to work after donating blood, in the case of people who operated heavy machinery or had a physically-stressful job, it was not advisable to go back to work.

The second blow to the number of donors was dealt in 2004 when, because of the mad cow disease scare, people who had spent a six-month period in the UK between 1980 and 1996 were banned from donating blood.

Then, last year the SMOM Blood Bank in Floriana, known as the Cavallieri blood bank, closed down but numbers have been recovered.

Since then, blood donations have slowly been catching up. However, although in 2005 there were 600 more new donors than last year, in 2006 there were considerably more donations than 2005 - which basically means donors are becoming regulars.

"So the ones that are donating, are committed. It's a good thing in itself as they're the safest donors. The more they come, the safer they become as the screening is more frequent," he explained.

However, the need to recruit new donors remains.

"In fact, NBTS is currently focusing on two things: Recruiting new donors and motivating them to donate regularly. We are managing to get our donors to give blood regularly but still need to work on recruiting new ones," he said.

Perhaps this is due to the fact that the NBTS has invested into keeping the present donors by helping them feel appreciated. The NBTS, for example, sends out text messages to remind donors to give blood and has also sent out Thank You letters to donors, some including a message by the grateful mother of a boy who benefited from a blood transfusion. Alas, the postage is expensive, so the NBTS has to send such letters to existing donors rather than to everyone.

"Donor recruitment is expensive and time consuming. When it comes to the recruitment of new donors the problems boil down to human resources; we need people and, as yet, we do not have a public relations officer or a customer care section. We need a customer care section that particularly targets the recruitment of donors and donor satisfaction.

"I think that is the way we have to go. After all, the NBTS is run just like a company," he stressed, adding that, to bring in the numbers of donors, the NBTS needed to think on the lines of education - both of children at school and of the adult population through the media.

"It has to be about informing and educating the people. In blood banking you cannot give incentives. Blood donors give because they want to."

Without realising, Dr Aquilina was answering the question I had put to him earlier.

"People tell me they donate to help. There is nothing to gain, it's not enticing... But then, they get so much more out of it," he said.

For more information visit: http://www.health.gov.mt/nbts/.