We’ve come a bloody long way from rejecting black donors
The number of black blood donors has grown almost six-fold from the days of racial profiling
“We won’t take blacks’ blood.” If it had happened in the social-media era, it’s easy to imagine the outrage.
But news that the South African National Blood Service (SANBS) was racially profiling donors emerged in late 2004, just before Facebook went global and two years before Twitter was launched.
Aids-denialist health minister Manto Tshabalala-Msimang said the policy “smacks of racism”, and the ensuing furore led to the introduction in 2005 of a new test that allowed the blood service to eliminate race‐based collection policies.
Now it has been revealed that the number of black blood donors grew almost six-fold in the ensuing decade.
There’s more good news from Marion Vermeulen, senior manager: operations testing at the blood service. “Over the 10-year period, HIV was detected in 0.2% of the donated blood ... and there was only one confirmed case of HIV transmission via blood transfusion,” she said.
“This is a substantial improvement over the one to two confirmed cases per year between 2000 and 2005.”
Vermeulen said the introduction of nucleic acid testing for every blood donation had had a dramatic impact on blood banks nationwide.
“The increase in black repeat donors is particularly encouraging, given that repeat donors provide the bulk of the blood in our blood service, with 76.4% of the total donations from 2005 to 2015,” she said.
The 43,269 black blood donors in 2005 had grown to 246,686 by 2015, and at the same time the safety of SA’s blood supply had been “significantly enhanced”.
Estimates of the overall risk of HIV transmission through blood transfusions halved over the decade.
Vermeulen teamed up with other scientists from SA and around the world to analyse 10 years of data from the blood service, and their findings have been published in the journal Transfusion.
In December 2004, the blood service admitted it racially profiled blood donations. Vermeulen said the policy grew out of a 1998 estimate that for every million donations, 34 contained “window-period” infections.
Robert Crookes, then medical director of the blood service, said profiling was necessary and in line with international practice. He said all blood donations were tested for HIV and hepatitis B and C, but no test was failsafe.
For this reason, donors were assigned to risk categories, ranging from regular donors in category 1 to coloured first-time donors in category 3 and black first-timers in category 4.
Crookes said that was the “most logical, medical, ethical and legally defensible system available”, but his comments sparked an uproar and then SA Medical Association Kgosi Letlape chairperson said: “We would like to hear a scientific rationale for the profiling. They need to find a system of classification that is non-racial.”
That is exactly what happened in October 2005 when a R60m investment made the blood service the first in the world to implement a highly sensitive molecular test that detects small amounts of viral nucleic acid even before the body has started to produce antibodies.
The test is specifically targeted to detect hepatitis B and C and HIV in the 800,000 blood donations the service receives annually, which in turn are used to provide transfusions for 400,000 patients.
Vermeulen’s analysis shows that after the implementation of nucleic acid testing there was a substantial increase in the number and proportion of donations from black South Africans.
The proportion of first-time blood donors in this group increased from 19% in 2005 to 54% in 2015. Over the same period the proportion of regular blood donors also showed a five-fold increase from 5% to 26%.
However, more donors are still needed. “During 2018, less than 1% of South Africans donated blood. For most of this year, we had less than three days of blood in stock,” Vermeulen said.
“We need regular donors, but we also require an increase in our first-time donors to expand the small donor base.”