How Can Eastern/Southern Mediterranean Countries Resolve Quality and Safety Issues in Transfusion Medicine?

Abstract

Unlike their Western counterparts, some of the Eastern/Southern Mediterranean countries lack centralized coordinated blood transfusion services leading to an unequal blood safety level. This was recently highlighted by a recent World Health Organization (WHO) regional committee report in which WHO urges these countries to establish and implement a national blood system with well-coordinated blood transfusion activities and to make attempts to reach 100% voluntary non-remunerated blood donation. The objective is thus to meet the same levels or standards as Western countries in term of self-sufficiency and blood safety. This raises the question whether these countries can either comply with Western countries’ guidelines and experiences or develop their own safety scheme based on proper sociopolitical and economic features. Another option is to identify efficient and cost-effective strategies setup successfully in neighbor countries sharing cultural and economic features. To address this issue—and make an attempt to achieve this goal—we designed a number of surveys specifically addressed to Mediterranean countries, which were sent out to the national authorities; so far, five surveys aim at covering all aspects in blood collection, processing, testing, inventory and distribution, as well as patient immune-hematological testing and follow-up (including surveillance and vigilances). It is anticipated that such practice can help identifying and then sharing the more successful and cost-effective experiences, and be really focused on Mediterranean areas while not necessarily copying and pasting experiences designed for Western/Northern areas with significantly distinct situations.

How to manage transfusion systems in developing countries: The Experience of Eastern and Southern Mediterranean countries

“…Actually, the transfusion financing system either depends on governments' budgets or on cost recovery by public or private health insurance companies (Table ) similarly to what was stated also by the WHO . In both situations, a sustainable organised national transfusion system would require governments' engagement and specific financing at least for the capacity of building national regulatory authorities …”

“…Thanks to a number of initiatives (WHO, ISBT, AABB, EMITm…); it was acknowledged that sharing the progresses and cost effectiveness assessments between neighboured countries is interesting in terms of reducing global costs . For example, Lebanon has implemented Universal leukoreduction for BCs as of 2013; the ongoing evaluation of its impact on patient outcome might be useful for others to implement in case the Lebanese experience turns out to be successful.…”

“…Still from this, first—broad—part of the survey, interesting information is provided on blood collection and BC availability. The profiles of blood sourcing (no paid donations, majority of replacement donations, variations of VNRD between countries)—will not be much commented here as authors have presented the situation in several occasions . It is interesting to note that our data are not fully consistent with the last WHO data .…”

“…In addition, despite that VNRD is recognised as the universal goal for all countries since it fully respects the ethical issues of donation, replacement donation might be regarded as ethically valuable and efficient in some cultures . Indeed, if VNRD system clearly favours intergroup solidarity (region and nation), the replacement system favours intragroup solidarity (village or neighbourhood, family, and work station) which is culturally the case in Eastern Mediterranean countries . What would be interesting in these countries is to assess through large scale multi‐centric studies the safety levels of replacement and volunteer donations.…”

“…A benchmark analysis of the currently available transfusion features in Arabic‐speaking Eastern/Southern Mediterranean countries who responded to five surveys was conducted . Only eight (Southern: Egypt, Morocco, Tunisia, Mauritania, and Algeria; Eastern: Lebanon, Jordan, and Palestine) countries got involved in these surveys.…”