As part of the Asia Pacific Blood Network (APBN) comparison of practice program, member countries review blood donor management practices to understand emerging trends in the region, and identify good practice opportunities which may benefit other members.
Our membership includes Australia, Beijing, Hong Kong, Japan, New Zealand, Singapore, South Korea, Taiwan and Thailand. From 2006, we have jointly collected information for a range of donor related measures, including age and sex distribution of donors, criteria for donation, donation volumes and frequencies, transfusion transmitted disease rates, additional donor health screening initiatives and donor deferrals.
Analysis of the donor management information both among member countries, and for individual countries over a period of 4 years, provides a useful window into some of the donor characteristics for our region. Whilst there are significant variations in population size of countries, there are shared trends in donor patterns subsequent to local disasters, reasons for donor deferrals, and the need for continued focus on relevant and effective donor retention and recruitment strategies. We continue to see lower red cell utilisation rates in Asia, in general a younger donor population with higher representation of male donors, and low haemoglobin as the single most common reason for donor deferral for most members.
APBN members are actively pursuing opportunities for shared donor management approaches, and the progress with these strategies in addition to an overview of regional donor measure is provided.
The Asia Pacific Blood Network (APBN) includes representation from nine countries in our region, and was established in 2006 to encourage blood safety and efficiency of blood service operations among members and to promote self-sufficiency in the region based on voluntary non-remunerated blood donation (vnrbd). In 2011 member countries included:
• Hong Kong
• New Zealand
• South Korea
The current strategic initiatives for APBN include the: regional collaboration to improve the organisation of blood supply and product utilisation; health and safety of blood donors; and the development of regional guidelines to address shared issues.
As with the European Blood Alliance (EBA) and the Alliance of Blood Operators (ABO), the APBN uses a balanced scorecard of organisational measures to enable countries to compare practices. Measures are based on common definitions and focused on donor, patient, and organizational effectiveness.
Population and age
Countries represented in the Asia Pacific Blood Network range widely in both total population (4.4–128.0 million) and population density (3–7,257/km2). By comparison, the United States of America (USA) has a total population of 308.0 million and a population density of 32/km2. This gives us the opportunity to understand specific donor recruitment and retention challenges associated with a range of population profiles and demographics that exist in the region. As an example, population or donor density can influence collection strategies and the decision to use fixed rather than mobile collection sites within some members. Successful implementation outcomes are shared amongst the members to improve each member’s own strategic planning.
Anecdotally, the average age of donors in Asia is less than that in the US and Europe. The age profile of donors within APBN reflects the ageing population being experienced globally over the past 3 years, with a small 1–2% increase in the average age of both male and female donors being reported each year. Members have developed specific strategies for recruitment of young donors to address the decline in youth donors experienced locally (as in most countries internationally) to ensure sustainable donors bases are developed for the future. These strategies include tailoring or branding donor centres to appeal to younger donors and the use of social media including Facebook, Twitter, and Youtube in all forms of donor recruitment.
The need for blood donors reflects a country’s blood and blood product requirements, as well as the country policy in regard to self-sufficiency and use of voluntary non-remunerated blood donors (vnrbd). All APBN members have country policies based on vnrbd for fresh blood products, and a shared vision to maximise as far as possible self-sufficiency through vnrbd for plasma products. Whilst red cell demand is viewed as relatively stable across the region, small percentages of growth are being experienced by some members, mostly attributed to increased demand on services. For some countries the increased demand is from medical tourism, as complex patient cases from other countries are referred across borders.
Overall however, red cell issue rates of APBN members are generally lower than those seen in the US and Europe (Fig. 1), and have been the subject of further analysis at a shared red cell utilisation workshop in 2009. For at least two members with red cell utilisation rates at 21 (member C) and 17 (member I), respectively, there is no reported unmet demand and the health care systems are highly developed.
In our region, donor size (height, weight and thus total blood volume) can be significantly smaller than in the US and Europe, and many countries still collect at least a portion of whole blood collections in smaller volume bags (200–350 ml). To allow comparison, all red cell issue data is ‘standardised’ to a 470 ml collection. Without standardising these small volume collections, members C and I continue to show low red cell issue rates, at 26 (member C) and 18 (member I), respectively.
Platelet demand is primarily met with a mix of whole blood and plateletpheresis donations, with a range of plateletpheresis from 5 to 100%. Platelet issues range from 3.7 to 10.6 issues per 1,000 population.
While countries share an aim of plasma derivative self-sufficiency where possible, those members who are close to achieving this still rely on some level of imported plasma products such as Albumin (Japan) and IVIg (Australia).
Donor base trend and participation
Donor management is tailored to match demand as closely as possible. In our region, countries are showing a positive trend of building a donor base, with the exception of member B, where the influx of donors in response to a natural disaster in 2009 was followed by an erosion of the donor base in the subsequent 12 months (Fig. 2).
This positive donor trend is seen across all donor types, whole blood, plasmapheresis and plateletpheresis. The growth in each APBN member donor base compares favourably with Europe, where countries have found it more challenging to sustain year on year increases in donor numbers.
Donor participation rates in APBN range from 3 to 8% with a general correlation seen with red cell issue rates (Fig. 1), noting however that for some countries a national aim of self-sufficiency for plasma derivatives affects the participation rate.
Strategies targeted at increasing young (aged between 16 and 24) blood donor participation rates exist in all countries, with differing degrees of emphasis. Three members are achieving young donor participation rates of between 15 and 25% whilst conversely, other members have rates below 7%. New donor recruitment data (Fig. 3) highlights this emphasis some members have on young donor recruitment programs, with some members clearly recruiting more new donors from the younger population, such as members D, A and H.
The impact of a younger donor population on donor management data, such as donor loss, can result in a high level of ‘churn’ in the donor pool and a requirement for effective donor retention strategies to offset this.
Participation rates, donor loss and other donor management data can also be affected by local strategies such as donor frequency rates, availability of a collection venue (mobile versus fixed), availability of facilities for donation type (whole blood, plasmapheresis or plateletpheresis), as well as the potential competition for donor time, both through a donor’s other personal and work commitments, and, in some countries, paid plasma facilities.
The average whole blood donation frequency is 1.6 for APBN with a range from 1.2 to 2.2 whole blood donations per year. The optimal donation frequency is a balance between a stable repeat donor base containing donors from both younger and older generations and managing the potential impact of higher frequency of donation on donor health. To address some of these concerns, some members restrict the frequency of whole blood donation to 2 per year for females or collect smaller volumes from donors, especially those in the youth bracket.
Donor deferral rates vary significantly across APBN with a range from 5 to 30%, compared against an ABO average of 15% (Fig. 4). Analysis of the main reasons for deferral shows low donor haemoglobin (Hb) as the most frequent reason, followed by medication. This area has been explored further through network participation with exchange of information on donation frequency, collection criteria, haemoglobin cut off levels and iron replacement strategies.
Current Hb lower limit cut offs range from 115 to 120 g/l for females and 130 g/l for male whole blood donors. Iron replacement strategies are currently used in Singapore and Thailand and being reviewed by other members.
Productivity and efficiency
One of the drivers for APBN network membership is to understand both good practice opportunities, and scope for improved efficiency. Initial data collection shows a wide range in the area of collection productivity from 1,000 collections per FTE to >6,000, however some data definitions need further clarification, and this area is the subject of a specific project in 2011.
A related measure in the collection area is collection efficiency which is a measure of the ability to successfully produce a complete whole blood donation from an attending donor. Unlike donor deferrals, this measure also captures losses associated with unsuccessful venipunctures, under- and overweight units, and other collection area product losses. The range is from 77 to 96% in those members where data is widely available.
By considering the wider ‘balanced scorecard’ of measures in conjunction with the productivity and efficiency data, members are able to review their existing donor management strategies and identify potential opportunities for their own country.
The area of donor management in the APBN network is an important focus of exchange, and is expected to remain a priority in the near future as blood services respond to donor health and satisfaction requirements, and provide the safest and most effective environment for the conversion of the donor’s gift to meet the country’s patient needs.