China bungles changes to its blood-donation system
PU BAOZHEN sold her house and car and moved to Beijing to seek treatment for aplastic anaemia, a rare blood disease. In early February, just minutes into her first session of chemotherapy, the hospital pulled the plug. Writing on Weibo, a Chinese social-media site, Ms Pu says doctors were worried that they would not have enough blood to support her through a gruelling bone-marrow transplant. A sudden change to the city’s blood-donation rules had given them a fright.
Blood shortages are common in China—particularly around Spring Festival, when lots of potential donors leave the cities to holiday in their hometowns. Only about 1% of Chinese give blood each year, slightly below what might be expected given its level of development (see chart). Some people worry that even a modest loss of blood is unhealthy, and no one has forgotten a grim scandal that began in the 1980s, when middlemen paying for blood infected hundreds of thousands with HIV.
Paying people to give blood was outlawed in 1998. Instead, to encourage donations, the government gave volunteers the right to certificates meant to grant them priority access to blood, should they ever need it. More significantly, it allowed donors to transfer this privilege to someone else—in effect allowing them to donate blood directly to family or friends in need. The idea was that blood donated this way would help to supplement stocks provided freely and altruistically.
This kind of reciprocal-donation system is common in less-developed countries, and in large part it succeeded in China. Blood donations rose from about 5m units a year in 1998 to more than 20m in 2011, according to data published in Transfusion Medicine Reviews, a journal. But lately its flaws have become apparent. First, growth in donations has slowed, and now lags behind hospital admissions, which are rising by over 15% a year. The reciprocal-donation system makes it harder to persuade people to donate regularly and freely, says Yu Chengpu of Sun Yat-sen University, though that is essential if China is to meet demand in years to come.
A second problem is that presenting blood-donation certificates has become more or less essential for patients seeking transfusions in some big city hospitals (blood stocks are particularly stretched in such places, because lots of people travel from outlying towns or even different provinces to be treated in them). Patients who require frequent transfusions but whose needs are not considered an emergency—such as those undergoing chemotherapy—are worst affected. They end up having to ask crowds of friends and relatives to donate on their behalf. That is especially tricky for people without lots of well-wishers, and for out-of-towners.
The inevitable consequence has been a resurgence of black-market blood-selling of the type officials had initially intended to stamp out. Patients who are on the mend sometimes sell unused blood entitlements to those who are still ill. For a fee professional blood merchants will herd a gaggle of impecunious strangers to a donation centre, where they pose as acquaintances of the patient in need. Some of these criminals hang around hospitals, but increasingly introductions are made through WeChat, a messaging app.
Many provinces have scrapped reciprocal donations. The health ministry wants the rest to phase them out. Last year it told local officials that they had until the end of March to do so. The holdouts are places where supplies are tightest, and the straitened spring months are the worst time to be tinkering with the system. For some reason city officials gave hospitals in Beijing only a few days’ notice that the rules would change. Hospitals postponed long-scheduled operations at short notice and patients who were caught in mid-treatment panicked. Blood-sellers made huge profits catering to patients who had counted on getting friends and family to donate for them, but realised they no longer had time to do so before the rules changed.
In the end blood imported from neighbouring provinces helped carry Beijing’s clinics through the holiday (Ms Pu’s transplant is under way). Officials say that, although donors may no longer pledge blood to particular patients, they can still donate to specific hospitals. In the long run, though, they will have to try harder to promote altruistic blood-giving.
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