Blood Money: Why Blood Transfusions Are So Dirty in China

During the 1980s, in the United States, Canada, Japan and France thousands of people who underwent blood transfusions were infected with the HIV/AIDS virus. Subsequent national investigations into these scandals revealed that blood collection agencies were under-regulated and ripe with corruption. After approximately five years, increases in government oversight of these agencies and improved blood collection processes eliminated HIV/AIDS contaminated blood stores in these countries.

China’s tainted blood supply problem has proved harder to tame. It’s first tainted blood scandals occurred in the mid-1990s, and just last week Zhao Minggang, a top official at China’s Ministry of Health warned that blood transfusions are still dangerous in China and should be avoided whenever possible.

 

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Current problems stem from the 1980s, when the central government employed a ban on imported blood products. Once local officials found out how much money could be made in blood and blood products, collection clinics were setup all over the country, typically in poor, rural communities. Clinics would pay money to poor farmers for their donated blood.1

In the mid-90s, the now notorious allegations arose, in Henan Provence, about donors being infected with the HIV/AIDS virus.2 In an attempt to cut down on costs of production, the blood of thousands of donors was being pooled into mixtures from which producers would extract plasma, the foundational building block of many blood products.

The remaining mixture of blood was then injected back into donors to aid their recovery and quicken their turnaround time, so they could donate their blood again.3 If any of the donors had HIV/AIDS, the blood pools ensured that the virus would spread upon re-injection into previously non-infected donors.

Since the discovery of these ad-hoc, blood collection clinics, the central government has shut down all commercial plasma centers and enforced the heat treatment of plasma.4 Pandora’s box, however, has already been opened. Blood collectors moved further underground, possibly using even cheaper and/or more dangerous methods of collection.

Still today, blood from these underground blood collection operations is making its way into the public blood supply. But, why?

 

To start with, China is currently lacking resources across the full spectrum of healthcare services. As government funding has been less than adequate, hospitals, especially those in poor, rural communities, are constantly looking for ways to cut costs either legally, or illegally and – it goes without saying, but should be pointed out anyway – unethically.

Blood transfusions happen to be a very expensive and profitable procedure. For example a man was recently charged 5.5 million Renminbi (approximately US$680,000) for one hospital stay including blood transfusions weighing a total of about 115kg, some of which were administered after the man was already dead! In effect, this means that medical personnel wishing to make more money are needlessly draining an already weakened blood supply.

Next, Chinese hospitals continue to knowingly purchase blood and blood products from illegal sources, which has resulted in a multitude of hospital patients being infected with HIV/AIDS from blood transfusions. Twelve years ago at Daye No.2 Hospital in Hubei Province, the largest blood transfusion scandal in China’s history took place when over eighty patients contracted HIV/AIDS from 1996 to 1997. Possibly the hardest hitting fact from this incident is that the last patient found to be infected by the Hubei blood transfusion scandal didn’t find out he had the virus until September of2009, prompting people to think what the true number of infections really is.

In sum, the situation at the hospital level is akin to a double-edged sword. On the back end of the operation, hospital and clinic directors purchase contaminated blood because it’s cheaper, and on the front end, the patient services end, nurses and doctors recommend needless blood transfusions because they are profitable. In Zhao Minggang’s Ministry of Health’s public statement, he stated “Medical staff should make patients more aware of the risks [of blood transfusion].” However, this point is fruitless in a healthcare system where medical personnel are underpaid, and, consequently, negatively incentivized. Isn’t it?

In a fascinating and in-depth research report titled “” by Asia Catalyst, the authors offer a series of recommendations for controlling the nation’s blood supply:

“China should develop a more centralized and robust regulatory system to regulate the national blood supply. Currently, Chinese law mandates a locally-managed identification system that should prevent repeat or at-risk sellers from participating in the blood donation system. Blood is tracked and units later discovered to be contaminated may be sought out and removed. We recommend extending this tracking capability to the national supply.

The World Health Organization, as well as U.S., Canadian, Japanese and French governments, and international hemophilia and HIV/AIDS organizations with related expertise, should all expand existing programs or initiate new ones to provide technical assistance to China in its efforts to perfect its blood safety systems.

Chinese blood centers and other blood-supply related entities should organize under an association that can facilitate the exchange of information and ensure a more uniform application of government regulations.”

It’s critical to note from the report that blood suppliers are only vetted locally, without the benefit of a national-level oversight body. Blood collection agency standards are therefore defined locally, and this, in China, necessarily means that individuals in charge of the agencies define the standards. One can easily see how this sort of haphazard regulation can lead to a situation like the one in Hubei.

So what is the fate of the donors and patients after they’ve been infected with HIV/AIDS from a tainted blood transfusion? Legally, they do not have much recourse. China has no national compensation fund for people infected with HIV/AIDS through transfusions or blood sales. With the central government hesitant to oppose ranking provincial officials and this lack of centralized compensation, local authorities are left to deal with litigation on their own. In areas of the country where the mountains are high and Beijing is far away, local officials sometimes find it best to quiet bad publicity about any local government-sponsored blood clinic operations and impede the payout in millions of Renminbiin pay-off of those directly and indirectly affected.

Going forward the central government needs to address this issue. Having a clean blood supply will only rise on the list of China’s security priorities. And, in the never-ending effort to curtail general public mistrust in China, dealing with the nation’s blood supply problems is a perfect place to start.

Alternatively, a really bad blood scandal has the potential to cause serious unrest. The Ministry of Health’s statement from last week concerning the danger of blood transfusions in China came one day before the Ministry announced their decision to send 200,000 cc of blood to the Qinghai Province earthquake zone. Imagine what would happen if some of those victims contracted HIV/AIDS on top of everything else that happened to them already.

Using China’s established safe and controlled clinics, a rigorous nationwide campaign should be implemented to increase the supply of clean and healthy blood. With an increase in available and legal blood, hospitals will not feel as economically pressured to use other means of acquiring blood.

Sources:

1.  page 14

2. http://www.cbc.ca/news/background/aids/aids-china.html

3. page 15

4.  page 16

Thank you to  and  for their excellent flickr photos.