Prof. Dr Usman Waheed
World Blood Donor Day (WBDD), observed annually on 14 June, pays tribute to millions of people worldwide who voluntarily donate blood to save the lives of strangers. It is also an opportunity for countries to assess the strength of their blood systems and identify the challenges that remain.
Pakistan has made significant progress in blood safety and regulation over the past two decades. Modern blood centres have been established, donor screening has improved, quality standards have strengthened and regulatory oversight has expanded. Yet one major challenge remains: the country’s continued reliance on replacement blood donors and the low proportion of regular voluntary unpaid donors.
According to recent estimates, voluntary non-remunerated blood donors contribute only around 18 percent of Pakistan’s blood supply, while the remaining donations come largely from family and replacement donors. This dependence on replacement donors continues to limit the development of a safe, sufficient and sustainable blood system.
Every day, thousands of patients across Pakistan require blood transfusions. Blood and blood components are essential for women experiencing severe bleeding during childbirth, victims of road traffic accidents, patients undergoing major surgeries, cancer patients receiving chemotherapy and individuals living with blood disorders such as thalassaemia.
Among the largest consumers of blood are patients with transfusion-dependent thalassaemia. Pakistan is estimated to have more than 100,000 people living with thalassaemia major, many of whom require lifelong regular blood transfusions. Meeting these needs places a considerable burden on the country’s blood services.
Blood is unique because it cannot be manufactured. Every unit depends on the willingness of an individual to donate. The strength of any blood system therefore depends on the availability of regular, healthy and committed blood donors.
Few Pakistanis are aware that the subcontinent was among the pioneers of organised blood transfusion services. During the Second World War, one of the world’s earliest coordinated blood transfusion services was established in 1942, with centres in Lahore and Calcutta. Following independence, the Lahore service evolved into the blood transfusion service of West Pakistan and later became the Institute of Blood Transfusion Service (IBTS), Punjab, which continues to serve patients today.
For many years, however, blood transfusion services in Pakistan remained fragmented, with hundreds of hospital-based blood banks operating under varying standards. Recognising the need for reform, Sindh introduced Pakistan’s first blood transfusion legislation in 1997, followed by similar laws in other provinces.
A major turning point came in 2008 when the Government of Germany supported Pakistan’s National Safe Blood Transfusion Programme. The initiative helped establish modern Regional Blood Centres, strengthen donor screening, improve laboratory infrastructure, develop human resources and introduce national standards and guidelines.
The reforms transformed Pakistan’s blood system. Screening practices improved, blood component therapy expanded and regulatory oversight became significantly stronger. Unfortunately, much of that momentum slowed after 2020 when the programme was no longer continued in its original form. While provincial institutions have continued important work, the absence of a dedicated national coordinating mechanism has created gaps in leadership, planning and long-term strategy.
Despite improvements in infrastructure and regulation, Pakistan still depends heavily on replacement donors who donate blood only when a relative or friend requires transfusion. While such donations are often made out of compassion and necessity, they do not provide a stable or predictable blood supply.
International experience consistently shows that regular voluntary unpaid donors provide the safest and most sustainable source of blood. Because they donate repeatedly and undergo regular health assessments, they generally have lower rates of transfusion-transmissible infections and help blood services maintain adequate inventories before emergencies occur.
The World Health Organization recommends a blood donation rate of at least one percent of the population, equivalent to ten donations per 1,000 people annually, to meet a country’s basic requirements. Equally important, these donations should come from regular voluntary unpaid donors rather than replacement donors.
Pakistan’s young population presents a significant opportunity. With a median age of just 20.8 years, the country has millions of potential donors who can help build a stronger culture of voluntary blood donation. Universities, colleges, medical institutions, student organisations, the Pakistan Red Crescent Society, the armed forces, civil society groups, religious leaders and community organisations can all play a role in promoting regular blood donation. Social media and digital donor registries can further help transform occasional donors into lifelong voluntary donors.
There is also a pressing need to strengthen national coordination of blood safety activities. Blood safety is not merely a provincial concern; it is a national public health priority. The federal government should consider establishing or revitalising a national institution responsible for coordinating blood safety policies, surveillance, donor recruitment strategies, research, standards and emergency preparedness across the country.
Pakistan has a proud history in transfusion medicine and has achieved notable progress in blood system reform. Yet the journey remains incomplete. A safe and sufficient blood supply cannot be built during emergencies alone. It requires sustained investment, strong leadership and, above all, a culture of regular voluntary blood donation.
By promoting voluntary blood donation and strengthening national leadership in blood safety, Pakistan can build a resilient blood system capable of meeting the needs of every patient, every day.
About the Author
Assoc Prof Dr Usman Waheed holds a PhD and Fellowship in Transfusion Medicine and teaches at Islamabad Medical & Dental College. He is a founding member of Pakistan’s National Safe Blood Transfusion Programme and currently serves as Secretary General of the Blood Bank and Transfusion Medicine Society of Pakistan (BBMT-Pakistan).