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Voluntary non-remunerated donations remain the cornerstone for a safe and sustainable blood supply. According to the World Health Organization and other international scientific committees, all nations must switch their system of blood collection to voluntary non-remunerated donation. Several other types of blood donations still exist nowadays that will be discussed. Lebanon, similarly to other developing countries, is struggling to achieve 100% voluntary non-remunerated donations for the many existing social, demographic, cultural and economic problems. Replacement donations remain the predominant type, which creates huge burden on both hospital blood banks and patient families. Despite the limited resources, some improvements have been made recently in this field and Lebanon seems to be on the road of achieving 100% voluntary non-remunerated blood donation as requested by the World Health Organization. The Lebanese experience is worth sharing so that neighbouring countries facing similar problems could benefit from it., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Background: In Iran blood products had been available to health care centers on free order to reduce the wastage they were tariffed in 2016. Thus, health care centers must pay for the blood products and take back the payment from the insurance. The aim of this study was to examine the effects of the tariff on consumption, wastage and return rates of blood products in health care centers in Kerman province., Materials and Methods: In this retrospective cross-sectional study, demand, delivery and return rates of blood products (fresh frozen plasma, red blood cell and platelet) were examined in 23 health care centers and hospitals before and after the tariff., Results: After the tariff in 2016, the return of unused units of fresh frozen plasma and platelet to the blood transfusion organization was increased and the increase was not statistically significant, but a significant increase was observed in red blood cell return rate and return/delivery ratio., Conclusion: Fresh frozen plasma and platelet return rates increased after the tariff resulting in less wastage of unused products but were not statistically meaningful. Tariff was highly effective on the wastage and return of red blood cell therefore it can be considered as a sparing action in the management of red blood cell., (Copyright © 2017. Published by Elsevier SAS.)

Access to blood components is required for healthcare establishments, particularly for emergency situation and hospital blood bank was often a response to this requirement. However, the complexity of regulation and economic pressures lead healthcare establishment to review regularly their need for a blood bank. This assessment requires analysis of need for transfusions in terms of delay, quantity and clinical situations to which they must respond. When a blood bank is required, three kinds could be under consideration: emergency blood bank, intermediate blood bank and issuance blood bank. According to requirements, advantages and disadvantages of each kind, healthcare establishments would select the most suitable one., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

The French Military Blood Institute is responsible for the entire blood supply chain in the French Armed Forces. Considering, the high exposition rate of military to malaria risk, blood donation screening of plasmodium infection must be as efficient as possible. The main aim of our study was to assess our malaria testing strategy based on a single Elisa test compared with a two-step strategy implying immunofluorescence testing as confirmation test. The second goal was to describe characteristic of malaria Elisa positive donors. We conducted a prospective study: every malaria Elisa positive test was implemented by immunofluorescence testing and demographical data were recorded as usual by our medical software. We showed a significant risk of malaria ELISA positive tests among donor born in endemic area and we estimate the number of abusively 3-year rejected donors. However, based on our estimations, the two-step strategy is not relevant since the number of additionally collected blood products will be low., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Commercial companies or public service mission, today all organizations must manage their brand. For a public service organization, also, the brand is an asset that enhances its visibility to the various partners. A brand is a collection of signs that distinguishes it, it or the products and services it offers. In recent years, we are witnessing the valorization of public service mission brand in an objective of visibility but also for internal cohesion. Developing a brand brings benefits in its identification and knowledge by users but also within the institutional environment. This value can also be an economic booster. With a strong brand, the organization may reduce communication expenses. In recent years, we attend an important development of the territory marks. Concerning the Établissement français du sang (EFS) when it was created in 2000, it is the act of donation of blood, which was enhanced by the "Don du sang" logotype and not the institution. As a consequence, the logotype "EFS" was very discreet. But more than 10 years after, this situation has to evolve. The EFS is not just a blood transfusion organization. Beyond blood donations, the EFS has developed other activities (cell and tissue therapy, IHR, clinics, research, etc.). With the "new generation" blood centers, it is an opportunity to think over the brand EFS. This is why EFS has decided to develop a brand strategy, the ground of all communication policies., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

To face known and emerging threats to public health, all countries have to overcome the challenges of providing sufficient supplies of blood and blood products of the highest quality and safety. Unfortunately, self-sufficiency is not yet a reality in many countries. In 2011, experts from WHO addressed the urgent need to establish strategies and mechanisms for achieving this goal. A summary of these recommendations is further discussed., (Copyright © 2013 N. Dhingra. Published by Elsevier SAS.. All rights reserved.)

The Marseille public hospital system (APHM) has expressed its willingness to pool its services of immunohematology and delivery of labile blood products with those of the French blood institute Alps Mediterranean division (EFS AM). An agreement setting out the terms of this partnership was signed between the two parties. The users of the APHM and EFS AM blood watch wished to preserve the channels of distribution. Implementation of this reorganization has focused on ensuring transfusional safety, reinforcing harmonization of APHM practices, and finding ways to reduce costs. Despite joint information campaigns (to medical and paramedical personnel) carried out by the APHM and EFS AM blood watch, problems have arisen during start-up and adjustments have been necessary on both sides. The success of this project hinges on the involvement of the EFS AM in our transfusional practices, deployment of a system for diffusion of information, and consolidation of physical and human resources at the level of the APHM blood watch.

A rare blood group is usually defined as the absence of a high prevalence antigen or the absence of several antigens within a single blood group system, if its prevalence in France is 4/1000 or less in the general population. An individual with a rare blood phenotype can develop a naturally-occurring or immune antibody corresponding to his rare specificity. In case an extremely low stock of compatible blood is available at the national level, a so-called "transfusion deadlock" is described. Most of the individuals with a rare blood group are coincidently identified when a routine pretransfusion testing or pregnancy follow-up is performed, if the antibody(ies) corresponding to the rare specificity is(are) present. Other individuals are discovered following a systematic red cell typing, or family investigations in siblings. One hundred and twenty-one rare blood specificities and 42 rare blood genotypes are currently defined at the French National Reference Laboratory for Blood Groups (CNRGS-Paris). The French national registry of individuals with a rare blood phenotype/genotype includes about 9600 people, who are urged to regularly donate blood for the National Rare Blood Bank. This bank, based on a homologous blood transfusion program, is in charge of the long-term storage of rare frozen blood units, that can only be delivered after receiving authorization from the CNRGS. The global and individual care management of the individuals with a rare blood group, concerning potentially several hundred thousand people in France, requires a close cooperation between all the protagonists within the transfusion chain.

The European Union and many transfusion international organizations and societies held the unpaid blood donation as an imperative for enrolling donors, not always providing the means for implementing this regulation, in particular induced by the (pharmaceutical) industry's hesitations. In spite of this, all available data, whatever former or recent, prove that the unpaid blood donation has a higher transfusion safety level than the remunerated donation's. The author also stresses that blood industrialization, while considerably improving the transfusion safety, has also destroyed the past vicinity between donor and receiver within the hospital environment, detrimental to enrolling donors. He also evokes challenges to be coming up soon in transfusion centres as well as changing the role of Red Cross and Red Crescent societies to refocusing their activities on the promotion of blood donation and donor enrollment.

The viral safety of the blood supply provided by serological tests alone decreased the residual risk of viral transmission to less than 1:250,000 for hepatitis C virus (HCV) and 1:1.3 M for HIV in the EU and the USA in 2000. This was further improved to 1:2-4 M by the introduction of nucleic acid testing (NAT) for HCV and HIV RNA that considerably reduced the risk of window period transmission. However, over the past 20 years, the successive introduction of up to 10 direct or surrogate viral markers enormously complicated the screening process and testing errors have become the main residual risk of viral transmission by transfusion. At over $ 2 M per QALY, the very low cost-effectiveness of NAT and some other tests overburdens limited funds that might be better used for other health care priorities. At the same time, haemovigilance programmes have shown that blood transfused to the wrong patient and a range of immunological consequences of transfusion caused two deaths per million transfusions and little is done to prevent them. There are means of limiting these serious hazards of transfusion that should become the priority in blood safety.

Background: The residual risk of human immunodeficiency virus (HIV) infection from screened blood transfusion was estimated to be 1.7/10(6) between 1993 and 1995 in France. To orient blood safety policies, we have evaluated what would be, from the perspective of blood banks, the best screening strategy in terms of gain in effectiveness and added costs., Methods: A cost-effectiveness analysis compared 20 HIV-testing protocols using (1) available data for performances of the current screening tests; and, (2) national insurance estimates for the cost of tests. Results were expressed as the number of false negative donations that would be avoided and the cost by avoided false negative donation., Results: For 3 million donated blood units a year and a prevalence of 24 per million, there would be 72 infectious donated blood units, 70.56 of which would be detected by the current screening strategy. The number of additional donated blood infections avoided in all other strategies would be low (between 0.25 and 1.28) with a very high cost (280 million French francs per added false negative avoided or more)., Conclusion: A change in screening strategies for blood donations in France is not currently justified. If such a change was to be done, adding p24 antigen detection to the current screening strategy would be one of the worst solutions.

Hematopoietic progenitor cells are present in umbilical cord blood; placental blood (PB) previously considered as waste product now constitutes an alternative source of hematopoietic stem cells for bone marrow reconstitution. This has promoted the establishment of cord blood banks for use in unrelated transplants. The banking of PB offers many advantages: the donors do not require anesthesia, stored PB can be a valuable source of stem cells for patients from ethnic minorities underrepresented in volunteer registers, and stored PB can be made available much faster than bone marrow from unrelated donors. Preliminary clinical experience suggests that, due to the immunological immaturity of PB cells, graft versus host disease might be lower than when using bone marrow from adult donors and HLA restrictions might be less stringent. If the number of nucleated cells in PB often appears low for patients weighing more than 40 kg, clinical data suggest that the number of stem cells may be sufficient for adult transplantation. The number of cord blood banks throughout the world is increasing rapidly. In the USA and Europe, more than 10,500 PB units are stored and available for transplantation. In the next 5 years, a total of 50,000 PB will be reached which may be sufficient to provide for the majority of candidates for unrelated BM transplantation. The practices of umbilical cord blood collection, mother selection, infectious disease screening, cell manipulation and storage must be standardized. Some accreditation process should be mandatory for assessing operating procedures and the quality assurance programs of the banks, and for allowing the international exchange of placental blood between transplant centers.

This paper describes the organizational structure and the economic impact of blood donation and transfusion in Greece and discusses some alternative aspects of its financing and its costing policy. The cost of blood transfusion is rising in Greece and amounts to nearly 15 billion drachmas per year due to the constant increase in demand and consequently, the price of each unit of blood. The production and distribution of blood on national scale involves meeting the demand for 500.000 units. Blood is mostly given by the friends and relatives of patients (55%) and by voluntary blood donation (30%). Approximately 50% of the blood produced is used in surgery, 20% for cases of beta-thalassaemia, 10% for emergencies and 20% for internal medicine cases. The blood transfusion system is totally funded by the state budget and the value to users is free of charge. The way in which blood is collected and processed differs from one geographical area to another and the unit cost depends on the size of the department concerned, ranging from 60-150 $. The need to control costs and restrain expenditure, in conjunction with guarantees of sufficiency and quality, makes it essential that measures should be taken to introduce economies of scale and encourage competition among blood providers, for increased production, components preparation and rational usage of blood. The introduction of a costing policy becomes necessary in this effort to achieve cost-containment techniques.