• blood donor;
  • blood supply;
  • replacement;
  • sub-Saharan Africa;
  • volunteer

The dogma that volunteer non-remunerated blood donors (VNRD) are safer has been a cornerstone of world transfusion, including developing countries, for WHO and other major transfusion organizations although the data supporting this dogma has never been convincing. It was supported by data collected without regard for the basic rule of epidemiology, which is to compare what is comparable. In this case, first-time and repeat VNRD were amalgamated, and genuine replacement/family donors (R/F) were mixed with paid donors. In sub-Saharan Africa (SSA), VNRD and R/F donors have a median age of < 20 and around 30, respectively. In VNRD, the proportion of females is considerably higher than in R/F donors further distorting the comparisons. In epidemiological terms, only first-time VNRD can be validly compared to R/F donors.

When such valid approach is taken, as published by three SSA countries (Cameroon, Ghana and Guinea), no significant difference in the prevalence of anti-HIV and HBsAg is apparent. In each study, first-time VNRD > 20 years of age have higher prevalence of HBsAg and sometimes of anti-HIV than R/F donors. These confirmed preliminary data strongly suggest that first-time VNRD and R/F donors are epidemiologically undistinguishable and equally safe for viral infections.

This collective data should directly impact three critical factors: the cost of blood, the availability of blood and the efforts put in recruiting repeat donors. R/F blood costs 2–5 times less than VNRD blood, and collecting R/F blood should no longer be discouraged. VNRD-only policy not only costs more but also limits blood availability for acute anaemia, potentially endangering patients’ lives. Collecting R/F blood as a legitimate supplement to VNRD blood may help reaching 10 units/1000 inhabitants, a level considered adequate for developing countries’ blood supply.

Only repeat donation significantly improves blood viral safety. As a result, not only first-time VNRD but also R/F donors should be actively encouraged to repeat donation. Evidence should take precedence over a moribund myth.