Blood transfusion is an integral part of the national health system in Iran and blood donation is voluntary and not remunerated.
In 1974, following the establishment of the Iranian Blood Transfusion Organization (IBTO), all blood transfusion activities from donor recruitment to production of blood components and delivery of blood and blood products were centralized.
The activities of the IBTO are governed by the laws of the Ministry of Health.
By improving its vast pool of voluntary donors, the IBTO has been successful in excluding “family replacement” donation since 2007 and reached 100% voluntary and free blood donation.
Currently, more than 92% of blood donors in Iran are male and contribution of females in blood donation is less than 8%. All donated blood is also screened for HBsAg (for Hepatitis B virus) and screening for HIV and HCV (Hepatitis C virus) started in 1989 and 1996, respectively.
A comprehensive study was carried out in 28 provinces some years ago to assess the motivation of Iranians for blood donation. The study showed that after altruism, religious beliefs were the most frequent positive motivation for blood donation.
The most important date in this regard is Ashura. The Day of Ashura, the 10th of Muharram in the Islamic calendar, is commemorated by Shia Muslims as a day of mourning for the martyrdom of Imam Hussein (AS), the grandson of Prophet Muhammad (PBUH) and the third imam of Shias.
During Muharram, it is customary to donate blood to commemorate Imam Hussein’s fight against tyranny and oppression.
Every year, on this occasion the IBTO dispatches its blood collection mobile teams throughout the country and blood collection centers are open till midnight. This year, over 37,000 people donated blood on Tasua and Ashura (Oct. 23, 24).
Annual Capacity
Over 2.1 million blood units are donated to the IBTO every year and its annual capacity has currently reached 400,000 liters of plasma production. Earlier studies said that there are 23 people per 1000, donating blood in the country.
As a rule, blood and its components should not be a source of profit in Iran.
However, it is said the IBTO has decided “to sell blood collected free from donors” as alleged by a reader of the Persian language newspaper ‘Sharq’.
Following the reports, Ali Akbar Pourfathollah, head of the IBTO, in an interview with the newspaper, denied the claims. “A unit of unprocessed blood is free, but processed blood products have been priced since the beginning of the current year (started March 21).
The reality is that for now almost everything in the country boils down to economics.
“The economics of blood transfusion has an important role in improving transfusion services and quality of blood products.” Pourfathollah maintains. The fact of the matter is that the cost of preparing and processing blood products is increasing. The costs associated with conducting various tests on blood and blood products have risen sharply in recent years, he says.
His argument is that while the unprocessed blood collected is free, however, there are significant costs associated with collecting, testing, preparing blood components, labeling and storing blood; recruiting and educating donors; and providing quality assurance. As a consequence, processing fees should be paid by patients.
Pourfathollah also said that in 17 developed countries whole blood is free but people should pay for the processed products.
Last year, the IBTO put price tags on 14 blood transfusion services in cooperation with the Majlis (Parliament) Health Commission, the High Insurance Council and the Health Ministry. The move was approved by the council and later by the government in March.
Less for Insured
Some of the blood transfusion services cost less for those who have medical insurance, the IBTO chief points out.
For example, platelets (produced by the ‘pheresis’ method, a procedure in which the blood is filtered, separated, and a portion retained, with the remainder being returned to the individual) cost about $165 per unit. Earlier, people paid the entire amount, but now they pay only 7% of the cost in urban areas and 5% in rural areas and the remaining is covered by insurance organizations.
A service not provided by the IBTO earlier because of the high costs, was the removal of white blood cells (WBCs) in CMV from blood products that today is performed in all developed countries.
“According to a new law, the services are now provided to patients in need and most of the costs are paid by insurance organizations, and not the patient,” he said.
Cytomegalovirus (CMV) is a white blood cell-based DNA virus that causes a mild, transient illness in people that have normal immune systems. CMV transmission can be accomplished through removal of WBCs, which is where the virus lives while in the body.
Pourfathollah explained four other services that were previously provided free but now have to be paid.
“Actually the four services are outdated in the world; and so we are replacing them with new methods which are far more expensive.”
That is one of the reasons why the free blood services of the past have now become paid services, since new technology and advancement in blood transfusion and products have become a costly process, he was quoted as saying.
