Blood safety and voluntary donations

Fact sheet
9 June 2004

Global overview

The majority of the world's population has an urgent need for safe blood. Of the estimated 80 million units of blood donated annually worldwide, only 38% are collected in the developing world where 82% of the world's population live.

Despite efforts to rectify this imbalance, the average number of blood donations has not improved significantly in developing countries. The average number of donations per 1000 people is 12 times greater in high Human Development Index (HDI) countries than in low HDI countries.

The lack of safe blood has a severe impact on mortality. Unsafe transfusions and a lack of access to safe blood have a particularly severe impact on women with complications of pregnancy; trauma victims and children with severe life-threatening anaemia as a result of malaria or poor nutrition. For example, up to 150 000 pregnancy-related deaths could be avoided each year through access to safe blood.

Too many countries still rely on family replacement or paid donors: 42% of blood collected from new donors in medium and low HDI countries comes from family replacement or paid donors. This blood often contains a higher seroprevalence of transfusion-transmissible infections than blood from voluntary, non-remunerated donors

Most countries still lack a nationally coordinated Blood Transfusion Service. Despite some recent improvements in this important area, less than 30% of countries have a well-organized service in place

Not enough blood is tested for transfusion-transmissible infections. Despite significant improvements, annually some six million tests that should be done for infections are not done.

Many blood transfusions are unnecessary. Patients around the world risk being infected during blood transfusions when alternatives to transfusion- such as intravenous replacement fluids - would be effective.

However, much progress has been made in the past years in increasing the global supply of safe blood.

By 2001, 123 countries were monitoring the prevalence of transfusion-transmissible infections among blood donors, compared with 98 countries in 1998-1999. This enables them to focus their blood donor education and recruitment activities on people who are likely to be the safest blood donors.

In 39 countries, 100% of blood is collected from voluntary unpaid donors.

Voluntary blood donor organizations have been set up in over 50 countries. These organizations, which are managed by blood donors themselves, play an important role in blood donor recruitment and retention through peer education and promotion.

Well-organized blood donor programmes based on voluntary blood donation can prevent a high incidence of HIV infection in the general population. South Africa has an HIV prevalence of 23.3% in the adult population, but only 0.02% among its regular blood donors.

The Pledge or Club 25 Model

The spread of HIV in the 1980s caused blood transfusion services across the world to seek new strategies to collect safe blood. In 1989, Zimbabwe started targeting a new pool of low-risk donors: students aged 16-19. The first of these students became so committed to the venture that when they completed their schooling they decided to create the Pledge 25 Club, committing to make at least another 25 blood donations before the age of 25.

The initiative was particularly successful in keeping these young people protected from HIV and other illnesses since part of their pledge was that they would maintain a healthy lifestyle in order to give safe blood. Indeed, statistics show that HIV infection rates among blood donors fell from 4.45% in 1989 to 0.61% in 2001, in a country where the infection rate in the sexually active population was 33.7% at the time.

Today, Pledge 25 clubs are still going strong in Zimbabwe. As well as promoting healthy lifestyles and setting a good example to other young people, the experience seems to have had positive effects on the members' personal development. Many Pledge 25 members have become successful professionals and leading figures in their communities. Some of the original members are planning to set up a Pledge 50 Club.

The model has now been adopted in several other countries: Haiti, India, Indonesia, Malawi, the Philippines and Uganda. The Club 25 programme, which will be widely promoted on World Blood Donor Day through the international media, is a model for every country striving to ensure that all patients requiring transfusion have access to safe blood.

A particular spotlight will be placed on South Africa this year, which started its own version of Pledge 25 -called Club 25 - in 1999. Club 25 now counts more than 35 000 members, providing 15% of the blood supply nationally. In South Africa, 80% of new infections occur among 16-28 year-olds. The prevalence of HIV infection among Club 25 members is only 0.04%.

To thank these people and other donors publicly, World Blood Donor Day partners, the Nelson Mandela Foundation and the South African National Blood Service will hold a major public event at the Mosaïek Auditorium, a concert hall in Johannesburg, on 14 June. There will be a concert featuring several local artists; stories from Club 25 members and recipients of blood donations whose lives were saved by the generosity of donors; and a video made about Club 25s from several countries, also featuring the story of a married couple who met through the Club.

For further information please contact: Daniela Bagozzi, Media Communications, Health Technology and Pharmaceuticals, World Health Organization. Tel. 41 22 791 45 44, mobile 41 79 475 54 90, email:

More on World Blood Donor Day, the campaign "Blood, a Gift for Life" and activities in different parts of the world can be found on the web site

All WHO Press Releases, Fact Sheets and Features can be obtained on the WHO home page

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