Health: Why blood donors are drying up

Health Check

IT IS remarkable how freely people open their veins for the sake of others. Ordinary men and women still queue in their dozens at church halls and clinics across the country to make what the eminent social policy academic Richard Titmuss defined more than a quarter of a century ago as "the purest gift of all".

About 10,000 such gifts - of blood - are made each day without fuss, without drama and without expectation of any return (no one would wish to become a hospital patient). Even Tony Hancock finally yielded his "armful". Those who despair of the human condition should take heart. Altruism is far from dead.

But if it is not dead, it is slowly dying, according to the National Blood Service. Attracting new donors is becoming increasingly difficult in the face of rising demand for blood.

The service denies that this is, as yet, a serious problem. It says: "There is no evidence that the donor pool is shrinking dramatically [my emphasis]." It does admit, however, that increasing numbers of would-be donors are being rejected because of more stringent checks, because they may be at risk of HIV or hepatitis.

At the same time as donor support is waning, the pressures on the service are increasing. Ministers have a manifesto pledge to cut waiting lists, and have committed hundreds of millions of pounds to the cause. That means more patients to be treated, more operations performed and more blood used.

The National Blood Service is sufficiently worried to have commissioned a survey on attitudes to altruism, presented to a King's Fund conference last week. It found people were still ready to give, so long as they could do it easily with the minimum of effort - the kind of conclusion a couple of students might have come up with after a quick check round the college bar.

Professor Titmuss argued in his influential book, The Gift Relationship, published in 1970, that altruism was essential to a healthy society and created social cohesion and social wealth. He added that voluntary blood giving was safer, and cheaper, than paying donors (because of risks that payment would encourage donors to conceal health risks).

The survey did detect signs of a decline in altruism. Since the mid-Seventies, there has been a small but steady fall in the proportion of households that give to charity, from 34 per cent in 1974 to 29 per cent in 1996. There was a more marked decline in volunteering during the Nineties among the under 65s, although it is still higher than in 1981.

What was missing from the survey was any question about attitudes to the blood service itself. It has been through turbulent times in recent years with rows about the sale of blood plasma abroad, a scandal involving leaking blood bags, fears about new blood-borne viruses and a hugely unpopular (with the staff) reorganisation. This was the subject of a damning report earlier this year which led to the sacking of the chairman, and the subsequent departure of the chief executive, John Adey.

We know that these problems have damaged public confidence and turned existing donors away. The blood service has to rebuild that confidence if it is to meet the growing demands.

It may also mean that other avenues, including autologous blood transfusions, in which patients donate their own blood in advance for use in their own operation, need to be explored. In its 50-year history, the NHS has got by, despite shortages of every description. But it cannot do without blood.