Ipsita, 11, was afflicted with thalassaemia when she was three-and-a-half years old. Ever since, she has been getting blood transfusions every month to month-and-a-half. Her current need, however, is every three weeks.

Lucky Rahman, her mother, says, "Initially, I used to take blood from professional donors, but after screening it was found that the blood received from them was not safe. For the sake of my daughter's life, and according to doctor's advice, I have been collecting blood from my friends and relatives."

According to the statistics (2002) of the Bangabandhu Medical University (BMU) Blood Transfusion Department, 51 per cent of the demand for blood transfusion is met by professional donors, 19 per cent by relatives, and 30 per cent by voluntary donors.

The term "professional donors" is largely undefined. While the need for blood for transfusion is extremely high, supply is always inadequate. As a result, the dangerous practice of collecting untested blood from professional donors - from among a legion of the undernourished, the unhealthy and those in need of money - has become the norm. This is the way they earn their livelihoods.

Need creates an association of the exploiters and the exploited. A section of professional blood-sellers, middlemen, and blood bank employees network to keep the 'system' going: the untested blood collected ignores all norms. Instead of being lifesavers, the blood banks spread fatal diseases with contaminated blood supply.

Dr M Ashadul Islam, assistant professor in the Blood Transfusion and Distribution Department at the BMU, says, "A patient can even die after receiving contaminated blood." He says that starting 2000, 45 blood donors were found HIV positive. People often contact potentially fatal diseases such as hepatitis B and C, malaria, anemia, syphilis and AIDS.

A professional blood seller, who obviously does not wish to be named, says, "I'm a drug addict. To buy drugs, I have been selling blood for the past three years. I sell blood once a month, sometimes after every 20 to 25 days."

All this is despite the fact that the criteria for blood donors are set in stone. Dr Musharraf Hussain, president of the Bangladesh Blood Transfusion Society, says that the criteria for a healthy donor is that she or he has to be between 18 and 57 years of age, has to have 75 per cent hemoglobin, and a pulse rate between 60 and 100. The minimum weight has to be 50 kg, with the temperature not exceeding 99 degree Fahrenheit. A healthy person can donate blood every 56 days. He says that the blood collected from professional donors can be harmful as their hemoglobin is very low, and they suffer from various diseases.

Dr Murad Sultan, Bangladesh National Programme Coordinator of the World Health Organization (WHO), says there are 98 government-run "pure blood transfusion centers" in Bangladesh. The government plans to set up another 100 centers, while 19 "important" blood transfusion centers will be modernized with US$3 million from the World Bank. WHO will provide the technical assistance.
In order to regulate the activities of both government and private blood banks, the Safe Blood Transfusion Act 2002 was passed in Parliament on April 10, 2002. It came into effect on August 1, 2004. But implementing laws is another thing altogether: although the new law mandates that all private blood banks have to obtain licenses, no one has so far done so.

Not that there is no punitive provision: the setting up of an unauthorized blood bank invites a penalty of two years of rigorous imprisonment and a fine of Taka 100,000 (US$1=Tk 70). Furthermore, if anybody is afflicted with an infectious disease due to blood transfusion, the guilty person can be imprisoned for up to five years.

Although the National Safe Blood Transfusion Council of the Ministry of Health has formed a committee to run private blood transfusion centers, it has been largely ineffective. People continue to sell and to buy: nothing seems to be able to stop the "blood business".

To make the matters worse, such is the demand that blood is usually sold at a rate much higher than that fixed by the government (Taka 100 per bag). But in the absence of monitoring, blood is sold at different prices at different places.

Abdur Rahim, who is being treated at the Dhaka Medical College Hospital (DMCH) following a road accident, says the attending doctors asked him to get five bags of blood urgently. His blood group is B negative - not a very common blood type. His relatives gave him two bags, the remaining three bought for Taka 5,000.

To get people out of the network of impure blood, various social and cultural organizations have been working all across the country. The Bangladesh Red Crescent and Sandhani have been playing a leading role in the voluntary blood donation movement since 1973 and 1978 respectively.

Jolly Biswas, head of the Transfusion Medicine Department at the BMU, says that many countries have voluntary blood donors' organizations that are part of all development programs. Some countries mandate that one has to donate a bag of blood to get a driving license or to take up a job. Even festivals become blood collection occasions.

Says Dr Musharraf Hussain, "About 2.5 crore people in the country are capable of donating blood. If only two per cent of them donate blood voluntarily, the demand for blood [in this country] will be met. In this situation, the government has to take initiatives to motivate the people and provide direct and indirect assistance to voluntary organizations."