Sunday, Jun 25, 2017, 3:12 AM CST – China

Society

Blood Shortage

Pennies for Plasma

Chronic seasonal blood shortages have created a huge black market for blood across China.

When Beijing Hospital blood bank director Gong Jiwu went back to work in late February after the annual Chinese New Year break, he issued an immediate “blood shortage alert” to all departments. The hospital’s stocks of type A and B supplies were low, a Level III alert, while supplies of type O blood were at critical levels, necessitating a Level II alert.

“A Level III alert from the Beijing Hospital indicates the cancelation of all elective surgeries requiring over two units [in China one unit is 200 milliliters] of blood, while a Level II alert means refusing new admissions of surgical patients,” Gong, who also serves as the head of the Beijing Blood Transfusion Quality Control and Improvement Center, told our reporter.

When NewsChina visited, the Beijing Hospital blood bank had only 30 units of blood in storage. A single liver transplant operation requires up to 100 units of blood. Therefore, when supplies are low, only Gong decides when the hospital can spare its precious reserves.

“[Our stocks] are reserved for emergency use only,” commented one orderly, who chose to remain anonymous. ”A single case of postpartum hemorrhage could use up our entire supply.”

A blood shortage occurs when on-hand blood products in blood banks cannot satisfy surgical demand. The phenomenon is commonplace in many Chinese provinces, particularly Jiangsu, Anhui, Henan and Shandong. According to media reports, some hospitals have canceled over 80 percent of elective surgeries, and 50 of 70 major cities across the country were facing severe blood shortages immediately after Chinese New Year.

Lured by the potential to profit from China’s lack of legitimate blood stocks, an underground black market for donated blood products has boomed. “In our hospital, over 80 percent of donated blood has come through scalpers,” admitted one staff member at a top-tier Beijing hospital who chose to remain anonymous.

Chronic

In early March, in an inpatient ward of Peking University People’s Hospital, 63-year-old Li Huize was waiting for her scheduled knee replacement surgery. Her operation had already been postponed for a week due to a shortage of type O blood. With a sufficient blood supply, People’s Hospital can conduct some 15 double knee replacement surgeries, each of which requires an average of 400 milliliters of blood every day. In the month prior to Li’s arrival, a total of 100 surgeries had been canceled.

“Many surgeries were canceled the day before at the behest of the blood bank,” Lin Jianhao, chief physician at the People’s Hospital orthopedic department, told NewsChina. “This situation makes it very difficult for us to treat patients.”

“In the last few days, type O blood levels have not been on alert, but our blood bank informed me not to admit type B patients,” said Liu Qiang, head of admissions at People’s Hospital. Liu had to call each patient individually to persuade them to agree to postpone. “They have to wait anyway, so why not just wait at home?”

Wang Hongjie, head of the Beijing Red Cross Blood Center, the capital’s largest supplier of legally donated blood and a provider to virtually all the city’s blood banks, confirmed the existence of a shortfall, but described it as a “seasonal issue” that, he claims, began in 2010.

 “In the worst situation in our history, our center’s reserve fell to 3,800 units [the center usually stores an average of 10,000 units of blood], enough to supply all Beijing hospitals for three days,” Wang explained, adding that blood shortages are common during the Chinese New Year season each year, when blood drives cease and large numbers of non-local residents return to their home provinces.

In 2012, Guo Yanhong, then deputy director of the medical administration department of the Ministry of Health, told a press conference that since the end of 2010, blood shortages had already become “the norm” in several localities. The general consensus is that China’s number of blood donors, while growing, cannot keep up with rocketing demand. Total donations increased from 1,000 liquid tons in 1998 to almost 4,400 liquid tons in 2014, while the total number of registered blood donors went from 328,000 to 1,299,000 in the same period.

According to data from the Ministry of Health, in 2014, 95 out of every 10,000 people in China donated blood, far fewer than the average of 454 per 10,000 people recorded in developed countries, and still below the World Health Organization’s optimal “self-sufficient” ratio of 100 to 300 blood donors per 10,000 people.

China’s National Blood Donation Law encourages patients whose conditions allow it to choose a date for their operation and have reserves of their own blood, or that of family members and friends, stored for their personal use. Legislators termed this practice “mutual assistance blood donation,” and the measure was essentially a response to the country’s chronic blood shortages.

According to Zhang Xuan of the oncology and hematology center of Yanda Lu Daopei Hospital in Yanjiao, Hebei Province, his hospital can provide a mere 10 units of red blood cells per day, despite a waiting list of more than 300 patients, essentially making all surgeries dependent on mutual assistance blood donation.

Business

This form of donation was first legalized when the country’s blood donation law was ratified in 1998. It listed mutual assistance blood donation as a “supplementary” measure to voluntary blood donation. However, as supplies have failed to keep pace with demand, hospitals are increasingly dependent on this stopgap option. Worse still, it appears to have opened a back door to black marketeers.

“Patients on our ward come from three different provinces, and do not have relatives living in Beijing, so where can they find resources for mutual assistance blood donation?” asked Li Feng, whose 19-year-old daughter suffers from severe aplastic anemia. “We have to seek help from blood scalpers. [In 2015] my daughter needed a transfusion and the doctor told us to go the mutual assistance route.”

Li already had the contact information of seven scalpers in his cell phone. “As soon as I called them, they came. All I needed to do was to inform them of my daughter’s name and bed number,” he said.

Zhang Yongxu, father of a five-year-old boy, showed our reporter a pile of receipts. From December 16, 2015, to February 25, 2016, his son used 37 units of blood platelets and 14 units of red blood cells. “One unit of blood platelets costs 500 yuan [US$77] and one of red blood cells costs 1,200 yuan [US$186],” Zhang recalled, the prices stamped in his memory. Most of the 300,000 yuan (US$46,400) that Zhang spent on blood went directly to scalpers. During Chinese New Year, he added, the price of blood platelets rose to 1,000 yuan (US$155) per unit, while the price of a unit of red blood cells shot up to 2,500 yuan (US$387). 

Due to impressive profit margins, China’s underground blood business, though illegal, has many eager recruits. From covert ad distributors to patient liaisons, scalpers are paid according to their rank within the system’s pyramidal management structure. “On average, a scalper can make 400,000 to 500,000 yuan [US$61,597-76,797] per year,” said an insider. 2,000 milliliters (10 units) of blood, he added, can sell for 10,000 yuan (US$1547), and, when the five donors needed for that amount are paid off with 500 yuan (US$77) apiece, the scalper can pocket 7,500 yuan (US$1,160) in pure profit. China’s black market for donated blood, it is claimed, has developed into a mafia-style organization, with various groups of scalpers in control of different territories, even within individual cities.

Wang Ming (pseudonym), a scalper in his late 20s, is in charge of selling to patients in Beijing People’s Hospital and Jishuitan Hospital. He told NewsChina that in some particularly rich territories, individual scalpers work different departments within a single hospital, and violence can ensue if rival gangs attempt to muscle in.

According to the Stipulations on Criminal Case Prosecution Standards jointly issued by China’s Supreme Procuratorate and the Ministry of Public Security, people who have engaged in illegal blood selling that resulted in a total income of 2,000 yuan (US$309) or more, or who have “organized” blood sellers found selling stocks contaminated with HIV or hepatitis B, will be “prosecuted according to the law.”

According to data collected from 2009 to 2012 by the Beijing Blood Center, HIV infection rates in cases of mutual assistance blood donation cases are twice as high as in voluntary blood donation cases. Since 2014, the National Health and Family Planning Commission began to promote nucleic acid testing technology to blood banks to contain the spread of certain blood-borne viruses.

Despite these “strict,” vague stipulations, it is very hard to prosecute blood scalpers. “In most cases, blood purchasers are not willing to testify since they do not want to anger the scalpers,” Wang Zhaohua, a prosecutor with the Xicheng District People’s Procuratorate in Beijing, explained to NewsChina. “At most, blood scalpers might receive administrative detention. Once released, they normally will resume their business.”

Solution

“During a blood shortage, performing transfusions is like cooking with limited rice,” said Gong Jiwu. “Some hospitals use up all their blood reserves when supplies are ample, while never thinking of managing their stocks in a reasonable way. Then, when the blood supply is already too low, they tell patients to seek mutual assistance.”

A staff member in charge of the blood bank at one Beijing hospital, speaking anonymously to our reporter, complained that despite the precautionary measure of issuing blood shortage alerts, some doctors continued to conduct elective surgeries. “Sometimes, when the patient is already prepped, a doctor will call for blood. We have no choice then but to provide what the patient needs.”

In Gong Jiwu’s opinion, two measures could alleviate China’s blood shortage crisis. One is to improve management systems and set up a standardized alert system for blood banks in order to make supply and demand more transparent. The second measure, he told our reporter, would be to promote voluntary blood donation in an effective way, emphasizing it as a social responsibility.

“The government has given sufficient financial support to voluntary blood drives, yet their effectiveness is very limited,” Gong added.

 Zhou Keda, a researcher with the Guangxi Academy of Social Sciences, speaking in an interview with China Daily in 2012, argued that strictly implementing the law, which provides voluntary blood donors with preferential treatment when in need of transfusions themselves, would also help matters.

Voluntary blood donation, according to Gong Jiwu, is ”self-help.” “The government should guarantee voluntary blood donors with free transfusions, should they need them in the future, creating a virtuous cycle,” he said.

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