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New donor registrations are bloody terrible!

Blood donations from men are on the decline but a social benefit spin could kickstart a wave of new registrations.

My first blood donation wasn’t something I thought too deeply about. As a young motorcyclist, a fellow (more experienced) rider suggested I become a donor, "you never know when the shoe might be on the other foot," he proclaimed.

Fortunately despite a few ‘offs’ I never needed to call on the life-saving powers of donated blood. Few of us give it, or its origin much thought, that is until we are faced with a situation where we call upon its miracle properties.

In England alone, we require around 1.8 million units of whole blood a year to satisfy the needs of patients up and down the country. This was provided by around 830,000 donors last year each donating twice on average. Fortunately, whole blood needs (the type used for blood transfusions, during operations or in emergencies), are largely met by domestic-supply, but as veteran donors hang up their boots younger donors are required to fill their spaces.

Young male donors are particularly appealing (because male blood often contains fewer antibodies and more iron), yet men are outnumbered 2 to 1 by women in new donor registrations. So why are men less keen to donate?

Marketing could be a factor. NHS Blood and Transplant (NHSBT) spend £1.8m a year on advertising with social media becoming an increasingly popular medium used to recruit new donors. Women are more receptive to these adverts, but the NHSBT believes the lack of new male donors is because young men are less inclined to give blood if they don’t know who is specifically going to benefit from it. That’s not something I can personally relate to, I consider my responsibility as an eligible donor to be fulfilled when I have successfully completed a donation, the rest is out of my control, but if the absence of a defined beneficiary is causing young adults to think twice about donating blood can we approach the problem from a different angle?

Whilst adverts by the NHSBT often put a name and face to blood recipients (an attempt to humanise the action), the actual recipient of a donation is never passed on to the donor. Whole blood has a shelf life of ~40 days, and other blood products significantly less, so whilst every effort is made to carefully manage blood stocks it is inevitable some blood will go to waste. Informing a donor that the dustbin is most grateful for those precious hours they dedicated to giving blood is unlikely to result in repeat appointments, perhaps this is the reason donors are kept in the dark about the final destination of their precious blood. In instances where the benefits of altruistic actions are questioned a solution is to express the benefit using something easier for people to conceptualise, a financial one. If blood donors were able to walk out the door knowing that an hour of their time resulted in the NHS being a few hundred pounds better off perhaps there would be more donations.

Blood money - can UK donors impact lives indirectly too?

To determine the value of a blood donation we first need to list its constituents. Blood roughly consists of red blood cells (45%), plasma (54%), and platelets/other (1%). Cryoprecipitate is a derivative of blood plasma. Figures are from a 2014/2015 NHS survey:

NHS cost for one unit of UK sourced whole blood: £127

NHS cost for one unit of UK sourced platelets: £210

NHS cost for UK sourced FFP (Fresh Frozen Plasma): £28

NHS cost for non-UK sourced FFP: £177

NHS cost for UK sourced Cryoprecipitate: £180 (requires 5 units of blood to create)

NHS cost for non-UK sourced Cryoprecipitate: £1,080 (requires 6 units of blood to create)

Based on the figures above we can see that the value of a healthy unit of whole blood ranges between £127 and £210. Out of all the components that make up blood, red blood cells have the lowest economic value. This is because instances, where patients require more red blood cells, are on the decline as blood loss during surgery and major incidents of trauma (where blood transfusions are useful), are falling. Blood plasma, by contrast, is used in the treatment of rare chronic diseases, autoimmune disorders, burns, trauma and other medical emergencies. This makes it a valuable commodity with the market expected to reach $35bn+ by 2023. Blood plasma is harvested either by separating whole blood into its constituents or by using a process called plasmapheresis which separates the plasma from other blood components during the donation and returns the rest back to the donor. With plasmapheresis, a donor can give plasma far more frequently, up to twice a week.

Since the BSE epidemic in the 90’s patients born after 1995 aren’t able to receive plasma from UK donors so the NHS imports this, mainly from the US. In 2013 the firm used by the NHS to import approved blood products was privatised, an 80% stake sold to Bain Capital for £90m with a promise by the firm to spend a further £50m upgrading the facilities. Bain sold the company to a Chinese investment group in 2016 for £820m.

Some of the most relaxed rules on blood donation mean the US is by far the largest producer of processed blood plasma products. With a population of less than half the size of Europe, the US collects 13 times as much plasma

The reason I mention the above is because if we wanted to export UK plasma then it would need to be checked for vCJD (variation Creutzfeldt-Jakob disease). The Medical Research Centre (MRC) is currently developing a blood screening test which they hope will be able to detect these pathogens, but in the absence of any effective blood test, plasma exports would have to be met by people born after 1995.

Population statistics tell us that 5.3 million people in the UK are aged between 18-24, this is our potential plasma donor cohort. Whilst donations can be made up to 80 times a year in the US let's assume a far more conservative 4 for UK donors. If we assume that Cryoprecipitate and FFP can be harvested at NHS cost prices and sold at non-UK purchase prices then the value of a plasma donation ranges between £144 and £149 if used for export, and as high as £177 if used as a substitute for current imported plasma.

The ethical debate on whether people should be paid to donate blood continues to rage, the World Health Organisation advocates non-remunerated blood donations on the grounds donors are a lower risk when they aren’t paid. Given US donors are paid (around $50 per donation), and this is where we source plasma, it somewhat undermines the reasoning for not remunerating donors. If the financial benefit was felt by society as a whole we would avoid the supposed pitfalls of paid donations whilst being able to appeal to prospective donors on an altruistic and defined benefit level.

The average UK household donates £375 to charity each year, by comparison, a single UK plasma donor could raise £576. Generating income from this relatively abundant and ‘renewable’ resource has the potential to be an attractive contributor to the UK economy. Appealing to donors with beneficiaries that are more likely to resonate with them seems wise since the net effect of more donors is the injection of more capital into the economy.

If 5% of the population able to donate plasma did so the potential benefit could be over £150m, this is with a rather sedate donation frequency. Increased donations could also help address another issue. The NHSBT is under pressure to reduce costs as reduced demand for whole blood leads to lower revenues. The economies of scale benefits from increased donations, processing and transportation would not only reduce the cost of blood for domestic use but also increase the margin on blood products exported to other countries. The UK already has one of the best value blood services in the world, improved efficiencies will increase any current competitive advantage.

Obviously, the suggestion has numerous challenges. Can donors born after 1995 be considered sufficiently well isolated from cJVD to be considered safe sources? Does the NHSBT have the capacity to process blood for export? Would donors find the idea of benefiting worthy causes sufficiently compelling to actually sign up and donate? Clearly, a lot of work has to be done, but as globalisation makes it painstakingly clear that we can no longer compete with countries who have far greater natural resources in traditional industries we must thoroughly explore esoteric ways of driving growth. In the case of the blood plasma market, I believe we have every reason to B+.

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