Blood transfusions are important medical procedures whereby a donor’s blood is infused into a recipient intravenously. Transfusions can be lifesaving for recipients experiencing massive blood loss after surgery, injury or other medical conditions. Furthermore, screening of blood composition is extremely vital, as similarity between donor blood and recipient blood must be closely matched to avoid detrimental immune reactions. The key to successful blood transfusion is compatibility. Blood compatibility is based on the eight major blood groups including A, B, O, and AB – each either containing or lacking Rhesus factor protein, denoted as a + or – respectively. Blood groups are categorized based on the complex combinations of cell identification markers present on red blood cells (RBCs). Although the complexity of blood classification and screening itself represents a challenge for healthcare workers, blood also contains powerful intrinsic properties that relate to health and disease. For example, individuals with the genetic disease Sickle Cell Anemia have malformed RBCs, but also carry resistance to Malaria disease. An additional key challenge regarding blood transfusion is the deep intersectionality between race and blood donation, stemming from a history of inequality, with sustained barriers present today.
Blood Transfusion and Race
Discriminatory practices in healthcare still exist around the world today, from accessibility and privilege, to patient care and funding practices. Similarly, blood transfusion and donation practices also have roots in inequality. This history is worth acknowledging to raise awareness and advocacy for equal healthcare opportunities everywhere. During World War II, one of America’s first blood banks – Cook County Hospital, Chicago – segregated the collection of blood by race. Similarly, some of the first blood bank centers in Canada also racially segregated blood as to ensure certain white soldiers do not receive blood from people of colour. These segregations, of course, were not based on scientific evidence but on prejudice and discrimination.
Interestingly, individuals of the same race have a higher likelihood of sharing the same blood type. For example, 27% of Asians have type A blood, compared with 40% of Caucasians. Additionally, the Ro subtype – a variation of Rhesus factor positive blood types (O, A, B, AB) – is considered rare in the overall population but reported to be ten times more prevalent in Black populations compared to Caucasians. These findings have important implications especially given the increase in demand for diverse blood banks. But statistics have shown that ethnic minorities are underrepresented as blood donors in community blood banks. A study conducted in Atlanta, Georgia by Shaz and colleagues demonstrated that in a single collection center, more than 75% of donors were from Caucasians, with the remaining ~25% from African Americans, Asians, and Hispanics. This broad historical trend is supported in multiple studies in various centers. The question remains: Why are there disproportionate representations in blood banks?
The Blood Barrier
A systematic review by Spratling and Lawrence in 2019 identified medical mistrust and misunderstanding as a key barrier. Exclusion of ethnic minorities from past programs due to erroneous beliefs that their blood was disease-ridden has contributed to mistrust. For example, a common misperception was that all African blood contained HIV, the causative agent for AIDS (Acquired Immunodeficiency Syndrome). Moreover, when ethnic minorities were given vague medical reasons for deferrals without clear explanation, this could in turn prevent future attempts to revisit. This medical misunderstanding reinforces pre-existing barriers to donate and promotes community misconceptions regarding minority blood donations. Additionally, a separate multi-center investigation by Shaz in 2009 revealed that the motivations to donate were similar between African American and White donors. Common motivations to donate between both groups included “because it is the right thing to do” and “because I want to help save a life”. Both groups also agreed that receiving frequent mailed reminders would promote higher donation frequency. However, it was reported that poor staff treatment and behavior resulting in a negative donation experience was a more prominent reason for African Americans to choose not to partake in future donations.
Such barriers are difficult to eradicate and overcome but are important to purposefully acknowledge from the top-down. Immediate solutions must be put into action. Blood banks must show sensitivity towards the roots of this issue in hopes to successfully recruit diverse donors and strengthen donor trust in healthcare professionals. Acknowledging the dark history and systemic barriers in this context begins with proper staff training, as well as community-based approaches aimed at encouraging donations within various ethnic minorities.
Donating blood can be simply overlooked as a common medical procedure as most individuals may not think about the underlying complexity of blood donation. However, it is important to acknowledge the politics, the medical racism, and deep history behind blood donations. Starting this conversation and taking action to rebuild fairness in healthcare across all domains will only serve to improve the wellbeing of patients in need, public attitudes towards healthcare, and ultimately save lives.
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