Is there an alternative to blood for humans? The answer is no.
One of the most vital requirements for a woman experiencing severe bleeding during childbirth is a blood transfusion. It is also the most essential need of a child suffering from severe anaemia due to chronic malnutrition or malaria. Accident victims, organ transplant patients and others often require blood transfusions to keep them alive, and blood transfusion is only possible with the availability of safe blood at the point of need.
It is an open secret that in Nigeria, blood is not always available at the point of need, and sometimes has to be sourced by relatives of individuals who need it. Many gaps exist in the blood supply chain, from inadequate infrastructure for storage, to the high costs of screening. The most challenging gap is finding willing, unpaid blood donors who can donate to either people in need instantly, or to health facilities who have the equipment to screen and store the blood for transfusion to patients.
Promoting voluntary frequent blood donation requires active, sustained sensitisation. Creating a platform that will allow a seamless connection between a willing donor and recipient or relative could encourage a willingness to donate blood in more of the population. This is what Jela Development Initiatives (JDI), a non-governmental organisation (NGO) aims to achieve with the launch of J Blood Match, an Artificial Intelligence (AI) service developed to directly connect willing blood donors and recipients at no cost. The launch, which took place on the November 21, 2019, in Abuja, is a scale up of JDI’s voluntary blood donation drive which focused on creating awareness and organising blood drives for the Federal Capital Territory (FCT) Blood Bank, under the National Blood Transfusion Service (NBTS). The launch was attended by officials of the NBTS, health workers, representatives of the military, representative of the United States Embassy in Nigeria, religious and civil society organisations.
Building a network of voluntary blood donors
The World Health Assembly resolution 28.72 adopted in 1975 identified voluntary, unpaid blood donors as the safest blood donors, urging all countries to work towards obtaining all their blood supplies through these donors. J Blood Match Artificial Intelligence aims to build a nationwide voluntary blood donor network based on geographical location. The application, which is available on Telegram and Facebook, allows willing donors to register using their name, age, gender, location, blood group and phone number. The data is saved such that anytime someone uses the AI to request for a blood donation, the system synchronises the information, matching the recipient with donors with the requested blood group who are in closest proximity.
The matched donors receive a message on their Telegram or Facebook Messenger applications from J Blood Match, alerting them of a need at a hospital close to them. They can either accept or decline the request. Once they accept, the system sends the phone number of the donor to the recipient and vice versa after which the donor can proceed to the hospital to donate blood. To reduce the financial burden on the donor, there is a provision on the system which allows them to choose to request for their transport fare. After receiving the blood, the recipient can go back to the system to acknowledge receipt, and if a donor accepts to donate and does not show up, the recipient can make another request on the AI, and a fresh message will be sent out.
Ensuring safety in blood donation
Blood donation is a sensitive task and should only be carried out at health facilities with the requisite equipment and qualified personnel to ensure the safety of both donor and recipient. To this effect, JDI obtained from the Federal Ministry of Health, a list of verified and accredited health facilities across states in the country, which are imputed into the AI, according to Angela Ochu-Baiye, the organisation’s founder. ‘’We need to make sure that not only the safety of our donors and recipients are guaranteed, but also eliminate any possible fraud while requesting blood’’. This makes it mandatory for any requesting recipient to be at a verified health facility known to the AI before being matched with a donor. In order to adhere to medical standards that allow not more than one blood donation in three months for males and four months for females, the AI does not send donation requests within three months and four months of last donation to males and females respectively.
Blood donation for anyone in need
People requiring blood donation are usually in emergency situations where they may be unable to place a request. Often times, these people are accident victims, women giving birth or children in dire need, which means they need someone to request on their behalf. In any of these scenarios, the individuals can have a request made on their behalf by anybody who is registered on the J Blood Match AI, regardless of whether the recipients are registered or not. The AI has options for the person requesting to say if they are requesting for themselves or others. Also, pregnant women who are told they may require blood transfusion during delivery have the option of placing a request for blood donation at least one month before their delivery date. The AI immediately sends the request to closest registered donors alerting them of the need for blood at a particular date and health facility. Once a donor accepts and numbers are exchanged, the pregnant woman can continue the donor until the said date.
Blood availability and maternal health
Ms. Bayem Joy, a midwife who attended the launch of the AI, said that every day in health facilities across the country, women die as result of blood loss. ‘’What we see every day in the labour room is heart breaking. We see avoidable suffering and death,’’ she said. The challenge is everywhere, from communities to primary, secondary and tertiary facilities. Severe bleeding during childbirth accounts for almost one quarter of maternal mortality cases and if this is addressed, it will undoubtedly lead to significant reduction of preventable deaths.
Research by the Liverpool School of Tropical Medicine has shown that 26% of maternal haemorrhage deaths in Sub Saharan Africa were due to lack of blood transfusion. This is a result of factors such as not being able to afford blood and lack of willing blood donors. Another piece of research by Knight et al., showed the lack of blood for transfusion as a major challenge responsible for maternal mortality in developing countries. Aside severe bleeding, due to conditions such as poor diet and diseases like malaria, severe anaemia has been shown to affect almost half of pregnant women in low and middle-income countries. The odds of a woman dying from pregnancy are twice as high in severely anaemic women than non-anaemic women. This shows just how significant the availability of blood for transfusion could be in the survival of women during pregnancy and childbirth.
The World Health Organisation (WHO) has recommended several measures be taken to reduce the risk of women bleeding and eventually dying in childbirth. These include active management of the third stage of labour, which involves administering uterotonic drugs such as Oxytocin. The WHO also identified availability of safe blood for transfusion as capable of preventing one quarter of maternal deaths due to haemorrhaging, encouraging countries to take concrete steps towards improving timely availability and access to safe blood transfusions as part of a comprehensive approach to reduce maternal mortality. Initiatives like the J Blood Match Artificial Intelligence are some innovations that will aid the timely transfusion of blood to women during pregnancy and childbirth, which will ultimately bring down our high maternal mortality rates.
J Blood Match Artificial Intelligence has the potential of complimenting the efforts of the National Blood Transfusion Services, civil society organisations, and health facilities in bridging the critical gap of blood demand and supply in the country. However, nowhere else will the AI prove more critical than in rural communities where there is a real struggle to keep up with blood demand due to weak infrastructure in health facilities, and where there are higher rates of maternal deaths.
JDI now has the task of creating awareness about their AI among people across all communities in the country. This must make clear to recipients the condition that they, and not donors, will bear the cost required to carry out tests on blood donated to them. This could be a potential barrier to uptake that JDI would need to tackle, in order to make the service accessible to all that need it. Collaborations with state ministries of health, youth and women groups, traditional and religious institutions could prove vital in this regard. The fact that the AI is available on Facebook messenger is already a huge catalyst, as the social media platform is widely popular among Nigerians.
The AI requires internet to work and as it stands, this could be a challenge, especially in rural communities. Going forward, JDI could expand their blood donation drive to explore platforms that do not necessarily require the internet. For now, J Blood Match Artificial Intelligence seems a promising initiative, one which with sustained improvements and scale up could help stop preventable deaths from lack of blood.