The scenario discussed in "Tackling disinterest towards blood donation" (1) is not an uncommon one. What is disturbing is that irrespective of the progress in the field of transfusion medicine, the problem faced by this resident mirrors what I faced in my residency in Mumbai, two decades ago. Fifteen years of working in a transfusion medicine centre allows me to say that the lack of public awareness and our dependence on blood donation by relatives are interrelated and remain the bane of our blood donation system.

The basic fact is that in this branch of medicine, society plays a direct role in the patient’s well being. The trend should change from blood donation being not just a "gift of life" but also a "way of life", a social responsibility of every healthy human being who is eligible to donate blood. This attitudinal shift will also take us closer to setting up an infrastructure based on a more systematic and collective response to illness by society as a whole, rather than just on family obligation.

Social awareness campaigns regarding blood donation should start early and aim at dispelling the myths and misconceptions surrounding blood donation, while promoting the concept of regular voluntary blood donation. Anyone working in this field will vouch for the fact that the most wholehearted response to blood donation camps is always from the young student population and once motivated they are donors for life. Camps in colleges bring to the forefront students’ spirit of unity, their humanity and their creativity, all of which are seen in their spirited response, as well as in their captions and slogans. It also brings to light the glaring gender inequity in voluntary blood donation. We do see an equal number of girls enthusiastic about donation but with woefully low haemoglobin values. Motivating blood donors can be coupled with promoting awareness about the importance of an iron rich diet. This, in turn, can help in the prevention of anaemia and increase the percentage of female donors, over time (under 2% in our set up at present).

The lack of awareness relates not only to being misinformed but also to being unaware of the need to donate. Many times we have heard the refrain: "I have never been asked to donate." Frequent messages displayed in prominent public places, supported by famous personalities, can go a long way towards inspiring "walk in" voluntary blood donors. Camp organisers can also adopt the policy of an ongoing programme where a certain number of donors are sent to donate every month. This will ensure a steady supply instead of the "flood" and "drought" situations that blood banks often have to cope with.

Another key area where apathy has to make way for a more positive approach is at the level of the treating physician and hospital. In our country the treating physician is still held in the highest esteem by the patient’s relatives. If he encourages the healthy relatives to donate as a goodwill gesture, it will be a step forward in voluntary blood donation. This should be a continuous process and it definitely is not easy.

Managing without familial donors is still an improbability in the majority of blood banks in our country. It is an uphill task to have a steady supply of voluntary donors to cater to the requirement for blood throughout the year. Today, in a city like Visakhapatnam, where the requirement is 50,000 units per year, to be met by three non-governmental organisation (NGO) blood banks, it translates into a need for 50 to 60 volunteers to walk in each day of the year to each blood bank. But we do have blood banks in the country which have achieved this with sustained, dedicated effort; hence, 100% voluntary blood donation should be the goal of every blood bank in the country.

Here, it would help if government guidelines were used to set up a procedure for designating well-managed blood banks as regional blood transfusion centres and setting up multiple-tested blood storage centres to improve the quality and increase the accessibility of safe blood in all parts of the country, especially the rural areas. The recent National Blood Transfusion Council guidelines should have helped push for more awareness programmes in the community; instead they have broadened the definition of voluntary blood donors to include family members. This will only blur the line between voluntary and relative donors and make our figures look better without any real achievement in mobilising and increasing voluntary blood donation.

What we need is an integrated, positive and sincere effort from the government, NGOs, blood banks, hospitals and the media to promote and make regular voluntary blood donation a social responsibility and, one hopes, a reality. For a start, it would be nice if all of us in the medical fraternity would have our donor certificates in our consulting rooms and take pride in the fact that we are regular blood donors. "Practise what you preach," still remains the easiest way to convince someone to donate.