What's next for Lebanon's blood shortage?

Donner Sang Compter, a Lebanese nongovernmental group, has staged hundreds of blood donation events to take some of the pressure off patients who need blood.

al-monitor A photograph of Donner Sang Compter's moblie blood bank, Beiurt, Lebanon. Photo by Donner Sang Compter.

Apr 4, 2019

BEIRUT — In an upscale area of downtown Beirut at the luxury Le Gray Hotel, staff and members of the public lay on folding beds in a conference room, giving blood at a drive organized by Donner Sang Compter (DSC), a Lebanese nongovernmental organization (NGO).

The organization, founded in 2006, plays a unique role in Lebanon’s blood donation system organizing blood drives, creating a database of donors and engaging with the many actors in the country’s health-care system.

The April 2 blood drive in Beirut is only one of the 200 events DSC holds each year, filling an important gap in the decentralized blood donation system.

Lebanon primarily uses replacement donations, where patients who need blood have to find it themselves, putting pressure on families already dealing with a medical emergency. To complicate matters further, Lebanon’s health-care sector is made of public and private hospitals often acting independently.

DSC has been working to address this, promoting a volunteer donation system, where individuals give blood to be stored and used without requiring involvement from those who need it.

This model is supported by the World Health Organization (WHO), which has called for a global transition to 100% volunteer blood donations by 2020. In a 2010 report, WHO found that “hospitals that are dependent on replacement donors are rarely able to maintain a sufficient stock of blood to meet the transfusion needs of all their patients.”

Despite this, Lebanon is still far from achieving a volunteer-based system. While there are no national statistics, Yorgui Teyrouz, the head of DSC, estimates that 90% of Lebanon’s blood is acquired through replacement, with even the modest achievement of reaching 10% voluntary donations in large part due to the work of NGOs and civil society groups like DSC and the Lebanese Red Cross (LRC).

Founded by Teyrouz, DSC was a project a long time in the making, as he told Al-Monitor. “When I was 17, I volunteered at the LRC, and it was there I realized there was a need to organize the whole sector. I was in the first aid team, and in that team we were trying to procure blood, but that was not our job; our job was to help people [involved] in accidents," he said.

This realization carried through into other aspects of Teyrouz’s life including his work in the Scouts movement, where he formed a database of donors from his troupe.

“In 2006, the grandfather of one of my Scouts needed 5 units [2,250 milliliters] of AB-negative, the rarest blood type. At that time I had a small database in the Scouts with members’ phone numbers, names and blood types to help him, he said.” Teyrouz still keeps a copy of this database on a laminated card in his wallet.

“As I dug deeper, I realized the real problem, which is that we have a super-decentralized system in this country,” Teyrouz explained.

Around 84.66% of Lebanon’s hospitals are private, according to a 2013 report by the Lebanese Banque BEMO. Many of these hospitals operate independently and have their own small blood bank supply based on replacements from patients, which is often insufficient.

One of the largest suppliers of blood is the LRC, which covers approximately 15% to 20% of the estimated national blood needs.

Dr. Rita Feghali, director of blood transfusion services at LRC, told Al-Monitor, “The Ministry of Public Health delegates the LRC blood transfusion services and its 13 branches — present in six governorates in Lebanon — to collect blood and to provide health institutions with safe blood for patients in need.”

The LRC has increased its voluntary blood donations from 10% of all available blood in 2013 to 43% in 2018, with the aim of reaching 80% in 2023. However, Feghali said, “People are struggling to find blood donors for patients and the transfusion system is still based on replacement donation in the country.”

She said she supports Teyrouz’s opinion in regard to the fractured nature of the Lebanese system, explaining, “The blood supply in Lebanon is highly fragmented and relies on the service provided by over 100 private and governmental hospitals as well as the service provided by the LRC blood transfusion services.”

The Lebanese government has attempted to standardize the system, seen in the 2013 guidelines set by the Ministry of Public Health for good blood transfusion practices, but the decentralization and reliance on replacements still maintains pressure on patients and their families.

Furthermore, per the law the responsibility for blood transfusions rests on the party that administers blood to the patient, and as such hospitals are still wary of accepting blood from a third party.

Teyrouz offers an answer to this, saying, “My solution, is you [the hospital] want to [take] the blood yourself. Fine, I will provide all the services, I will organize the blood drive, the equipment, the volunteers, the marketing, the connections, everything. You bring your staff to supervise the drive, take blood and increase your stock.”

In doing this, the DSC navigates the fragmented health-care system while avoiding donors getting turned away, a situation Teyrouz warned of. “Say today you wake up and you want to give blood. The first question [the hospital] would ask is ‘To who?’ And if you don’t have a name, they wouldn’t take it, which is creepy and crazy. We have zero motivation for donors … and [then] we say we don’t have blood.”

However, the work of institutions like DSC are changing this and offering the public a place to donate blood and hospitals a safe, quality supply. 

Amira Ayoub, a student who gave blood for the first time at the drive in downtown Beirut, told Al-Monitor, "Think about it, how many people get into an accident or need surgery? And you ask yourself whether your family will need it, or you yourself. Then you see how important it is.”

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