-
CENTRES
Progammes & Centres
Location
India now matches its estimated blood need, yet uneven access, weak repeat-donor culture, and exclusionary rules may keep a reliable transfusion network out of reach.
Image Source: Getty Images
“The blood is the life.” The phrase first appeared in the Bible and was later lifted into Victorian Gothic imagination in Bram Stoker’s Dracula (1897), where Renfield, maddened and entranced, repeats the words as he craves vitality. In Stoker’s time, blood transfusion was still a dangerous gamble: Karl Landsteiner’s discovery of blood groups lay just ahead, and Victorian medicine hovered uneasily between superstition and emerging science. Blood meant life, but it also meant risk.
Today, the phrase still feels uncannily apt, but the challenge has shifted from mystical dread to systemic delivery. Only weeks ago (August 2025), the government announced that India had collected enough blood in 2024–25 to exceed national demand. This signals progress and modern capacity. Yet on the ground, research maps vast 'blood deserts' across northern India, and hospitals still struggle to match patients with the right blood at the right time. Reliable blood depends not just on collection drives. It requires a steady culture of year-round voluntary donation and an equitable, modern system to move each unit where it is needed most.
In Parliament this year, the government reported that India’s annual blood requirement is estimated at 14.6 million units. In 2024–25, the country collected 14,601,147 units, a 15 percent rise over the 12,695,363 units collected the previous year. Around 70 percent of this supply came from voluntary, non-remunerated donors, a marked improvement over past decades. They also noted no official reports of deaths directly attributed to a blood shortage.
Human Blood (covered under the definition of ‘Drug’ under the Drugs and Cosmetics Act, 1940) is a time-sensitive and perishable resource, and is used primarily in emergency care and planned procedures, such as in cases of trauma, obstetric haemorrhage, major surgeries, cancer therapy, and chronic transfusion for disorders such as thalassaemia and sickle cell disease. Platelets are critical during dengue outbreaks; plasma and red cells sustain accident victims and surgical patients. Yet safe blood is only life-saving if it is present in the right form, at the right time, and within reach.
Only ~26 percent of residents reside within 30 minutes of a blood bank, and even extending the catchment to an hour still leaves nearly 40 percent without timely access.
A recent British Medical Journal (BMJ) Global Health study mapped eight Empowered Action Group (EAG) states (Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttarakhand, and Uttar Pradesh) and revealed striking access gaps. Only ~26 percent of residents reside within 30 minutes of a blood bank, and even extending the catchment to an hour still leaves nearly 40 percent without timely access. Availability in stock was also meagre: a median of 0.6 units per 1,000 people, far below the World Health Organization (WHO) frequently quoted benchmark of 10 donations per 1,000 and the Lancet Commission on Global Surgery’s 15 per 1,000. These regions effectively form 'blood deserts', areas where timely transfusion is unlikely, despite national claims of sufficiency.
India’s blood is sourced mainly from voluntary, non-remunerated donors, but the remainder (30 percent) still comes from replacement donors, family or friends who donate to offset a patient’s transfusion. While voluntary donations are seen as safer and more reliable, their seasonal and regional fluctuations make the system vulnerable. A headline of national surplus can therefore coexist with local crises.
India’s blood ecosystem faces certain structural and behavioural challenges, which can cause insufficiency in the system despite a headline of national sufficiency. Most donations are on an occasional basis and are reactive in nature. National drives are successful in attracting new donors, especially students. However, the level of repeat donation continues to remain meagre. It is still widely believed/accepted/rumoured in some circles that blood donation weakens the body, causes infertility or leads to long-term health problems; hence, the number of healthy adults who take up the challenge is minuscule. Several potential donors believe they are ineligible due to their age, weight, or minor medical history, even though they may, in fact, be eligible. This unstable donor base makes the system vulnerable to seasonal slumps: exams and vacations empty university campuses, festivals and fasting reduce participation, and summer heat or monsoon-borne illnesses further suppress turnout.
Blood donation camps—especially in colleges and universities—are still the primary source of donations. When academic calendars are on break, collections reach their lowest point. Replacement donation, where a patient’s family or friends donate to 'replace' transfused units (a common practice throughout India), fills gaps, creating a reactive, unsafe culture rather than a steady volunteer pool.
This unstable donor base makes the system vulnerable to seasonal slumps: exams and vacations empty university campuses, festivals and fasting reduce participation, and summer heat or monsoon-borne illnesses further suppress turnout.
A report on Jashpur district in Chhattisgarh, published by the Observer Research Foundation (ORF) and authored by the erstwhile district collector, highlights how technological advancements can bridge distances. Officials developed a daily online blood availability dashboard and a donor registry for the community. Nonetheless, this type of openness remains unusual. The e-RaktKosh platform of the government can amalgamate the stock of blood banks and establish direct contact with donors; however, there is a lack of uniformity in reporting, whereby around 22 percent of banks update rarely or not at all, according to the BMJ study discussed earlier.
India’s National Blood Transfusion Council guidelines still exclude entire groups: men who have sex with men (MSM) and transgender persons, based on identity rather than behaviour-based risk assessment. This approach, while criticised as identity-based, reflects a population-level risk management strategy: when individual risk assessment is hard to execute reliably and laboratory capacity for rapid nucleic acid testing is patchy, systems may rely on group-based deferrals to minimise transfusion-transmissible infections. WHO guidelines only emphasise that donor selection should balance risk assessment and fairness.
At present, a petition in the Supreme Court contends that such an action conflicts with Articles 14 and 15 of the Constitution, relying on obsolete stigma rather than scientific facts. The government has given guarded support to the policy before the Supreme Court, stating that implementing a fully personalised risk-based screening approach is not yet feasible or safe due to epidemiological risks, testing restrictions, and system capacity. Globally, countries are moving on: Australia is transitioning to gender-neutral screening, asking all donors the same behaviour-based questions, with its national blood service, ‘Lifeblood’, allowing gay and bisexual men and transgender women to donate without wait times. Belgium and New Zealand are among the countries which implement a short deferral period model. These systems do not have permanent bans, but they give people the possibility to donate after a short waiting time, which is usually a few months, counting from the last sexual encounter.
India has made visible progress: the recently launched national rare donor registry (RDRI) now hosts more than 4,000 carefully screened donors tested for over 300 rare blood markers, helping doctors locate uncommon matches quickly. The registry is also aimed at integrating with e-RaktKosh, creating a single national platform. Recent research has demonstrated how geospatial analysis can reveal blood deserts. India could build on such work to plan new centres and improve supply equity.
These advances highlight that India has the tools to transform blood security; the next task should be to make the system consistently voluntary, inclusive, and data-driven. First, India must build a stable base of repeat donors. One-time campus drives cannot protect against shortages or the emergence of a ‘red’ market, where families under pressure buy blood. Behavioural nudges, workplace health programmes, donor recognition, and dependable follow-up after donation are some of the means that could help transform first-time donors into lifelong givers.
Globally, countries are moving on: Australia is transitioning to gender-neutral screening, asking all donors the same behaviour-based questions, with its national blood service, ‘Lifeblood’, allowing gay and bisexual men and transgender women to donate without wait times.
Second, the policy framework must catch up with contemporary science and rights. Globally, countries such as Australia now use behaviour-based, gender-neutral screening, supported by advanced nucleic acid testing and other technologies that better ensure safety. India’s guidelines remain constitutionally vulnerable without individualised risk assessment or wider adoption of newer testing methods.
Third, the supply chain must become more transparent and efficient. Wastage (blood discarded due to expiry, breakage, or poor component management) still accounts for 5-15 percent of collected units according to some studies (1, 2, 3, 4). Updates to e-RaktKosh that are both routine and compulsory, as well as the linking of ABHA (Ayushman Bharat Health Account) IDs, could enable real-time monitoring of blood units, minimise the chances of expiration, and facilitate the quicker matching of rare units to patients.
Lastly, India requires a change in its social mindset. The giving of blood ought to be regarded as a duty of citizenship and not charity. A dependable source of blood on a national scale cannot be formed by calling for help only in times of emergency; it, rather, necessitates the existence of a contribution ethic that is ingrained in daily life. Quantity is not security. A modern blood system must rely on steady voluntary donors, proactive youth action, inclusive and science-based eligibility rules, transparent technology, and social solidarity. Only then can blood, which has long been treated as a symbol of life itself, become a guaranteed lifeline for every patient.
K.S. Uplabdh Gopal is an Associate Fellow with the Health Initiative at the Observer Research Foundation.
The views expressed above belong to the author(s). ORF research and analyses now available on Telegram! Click here to access our curated content — blogs, longforms and interviews.
Dr. K. S. Uplabdh Gopal is an Associate Fellow within the Health Initiative at ORF. His focus lies in researching and advocating for policies that ...
Read More +
PREV
