Not long ago, a relative of Beijing resident Li Zhao (pseudonym) rushed from out of town to a Grade 3A hospital in Beijing for surgery. The surgery required blood, and the doctor asked the family member to donate 400 milliliters at a blood collection point. If the relative could not donate blood, they could also "find a way"—pay 2,000 yuan to have someone donate 400 milliliters on their behalf.

So-called proxy blood donation means that someone at this Grade 3A hospital hands out small cards claiming they can arrange "mutual blood donation": if a patient needs blood but family members cannot donate, the card distributor can find someone to donate on their behalf, but charges a certain fee.

A recent investigation by reporters from Legal Daily found that the above phenomenon exists at multiple hospitals in Beijing and Tianjin.

The experts interviewed believe that according to legal provisions, China implements a voluntary blood donation system. This kind of transaction conducted in the name of "mutual blood donation" is illegal. Intermediary services for the purpose of profit should be investigated and dealt with according to law to safeguard the seriousness and fairness of the voluntary blood donation system. Solving the problem of blood for patient surgery requires efforts on multiple fronts: increasing blood supply, strengthening management and supervision, and ensuring blood safety.

　　Patient needs blood for surgery

Relatives and friends pay someone to donate blood

In March this year, a relative far away in their hometown contacted Li Zhao, saying they felt unwell and wanted to go to a hospital in Beijing for an examination.

Li Zhao registered this relative, who was already over 70 years old, for an expert consultation at a Grade 3A hospital in Beijing, and the relative came to Beijing for treatment. After examination, the attending doctor told them that hospitalization and surgery were needed, but because hospital beds were in short supply at the time, the relative could only go home and wait.

A month later, the hospital notified them that hospitalization was possible. Li Zhao quickly contacted the relative to go to the Beijing hospital to complete admission procedures and also prepared a full set of daily necessities for hospitalization.

After all this, Li Zhao sat down to rest in the small garden outside the hospital's surgery building. A woman walked up to her and handed her a small card printed with the red characters "mutual blood donation" and a phone number. The woman said she could solve the problem of blood donation by the relatives and friends of surgical patients, with payment made after approval by the hospital doctor.

"Keep it, just in case it's useful." Li Zhao thought to herself and took the small card.

Not long afterward, the attending doctor's assistant called Li Zhao, saying that the elderly person needed a blood transfusion for surgery, and relatives and friends needed to voluntarily donate an equal amount of blood free of charge before the surgery could be scheduled. Li Zhao asked whether the relative's out-of-town blood donation certificate could be used instead of donating again. The other party replied that out-of-town blood donation certificates were not acceptable and that donation had to be made at a blood collection point in Beijing. They also said relatives and friends could donate themselves or find someone else to donate on their behalf, and the hospital did not care about this.

Considering that she was over 50 and in poor health, and that there were no other suitable relatives or friends to donate blood, Li Zhao found the "mutual blood donation" card and called the person. After asking for the patient's relevant hospitalization information, the other party said the surgery required 400 milliliters of blood, and they could find someone to donate on her behalf for 2,000 yuan.

Li Zhao then contacted the attending doctor's assistant again and said the blood donation had been prepared. The other party gave her a group voluntary blood donor commitment form, which stated: I voluntarily become a group voluntary blood donor at XX Hospital; the blood products donated are only for comprehensive allocation by XX Hospital to treat patients, and not for designated patients; and I solemnly promise that any information provided is legal, objective, true, and valid; I solemnly promise to strictly abide by national laws and regulations and never participate in or organize any form of blood product trading. If I violate the above commitments, I am willing to bear all legal responsibilities.

The commitment form contained the patient's name and medical record number and required the signer's signature and relevant identity information. Li Zhao filled it out according to the information provided by the proxy donor and submitted it to the relevant hospital office for registration.

In mid-April, the other party brought Li Zhao a blood donation certificate showing the donor's name, donation amount of "400CC," and the blood donation certificate number. Li Zhao handed the certificate to the hospital's nurses' station, and after confirmation by the attending doctor's assistant, she paid the woman 2,000 yuan through a social account.

　　Imbalance between blood supply and demand

Leads to distortion of mutual blood donation

A few days later, the doctor performed surgery on Li Zhao's relative. A week later, the elderly person was discharged, and the discharge bill showed a charge of more than 400 yuan for blood use. According to the Blood Donation Law, this is the cost incurred during blood collection, storage, separation, testing, and other processes when a patient uses blood in the hospital.

Li Zhao had mixed feelings about this medical experience. On the one hand, the "mutual blood donation" people helped them solve the blood donation problem and ensured that the elderly person's surgery was timely and smoothly carried out; on the other hand, she did not understand why, when the elderly person was hospitalized for elective surgery, she still had to spend 2,000 yuan to find someone to donate blood on their behalf.

On an afternoon in early May, the reporter went to the hospital mentioned by Li Zhao for an on-site visit. Outside the hospital's surgery building, a woman with a shoulder bag was handing out small cards to passersby. When she saw the reporter, she also handed a small card to the reporter.

The reporter asked whose phone number was on the small card. She said it was her boss's, and that if blood donation was needed, people should contact them by phone or by adding them as a friend.

The woman explained that according to the doctor's requirements, the patient's relatives and friends could donate blood themselves. If relatives or friends had chronic diseases such as diabetes or hypertension, or infectious diseases, and did not meet the conditions for blood donation, they could come to them, and they would find someone to donate on their behalf. When donating, the donor's relevant information first had to be registered with the relevant hospital department to ensure the blood was used for this hospital, then the person would go to a blood collection point to donate, and after donation the voluntary blood donation certificate would be handed over to the hospital.

She also said that if people wanted them to arrange proxy donation, they should contact them one day in advance, and 400 milliliters of blood cost 2,000 yuan.

The reporter stood nearby and observed. The woman handed small cards to passersby and told them it was "mutual blood donation." Some people did not take them, while others accepted them.

The reporter then contacted the other party on the pretext of needing blood. The other party said they could provide someone to donate blood and that the person should call one day in advance when blood was needed. "However much the doctor tells you to donate, we will be responsible for donating that amount," the person said, and once again confirmed that 400 milliliters of blood required payment of 2,000 yuan.

The reporter's recent investigation in Beijing, Tianjin, and other places found that at the entrances or restrooms of many hospitals, small advertisements such as "mutual blood donation + WeChat: XX" were posted, and social groups for "mutual blood donation" and "charity subsidies" existed in large numbers for a long time.

"In Tianjin, voluntary blood donation is 400 yuan; whole blood 400cc has a nutrition fee of 400 yuan; after donating whole blood there must be an interval of six months. Requirements: 18 to 53 years old; those who have registered recently should not come; bring ID card; weight above 115 jin; no blood type restriction; go by yourself; all day without stopping. Those who have recently donated platelets or have high transaminase should not contact me. Those who go, or whose friends want to go, can private message me; find a few people and there is a rebate." In a "charity subsidy group" based in Tianjin, the reporter found that someone sent this kind of "paid blood donation" information every day. After the reporter contacted the group owner and said, "I am type O and can donate at any time," the group owner said to go directly to the designated blood donation station to donate and contact him after the donation.

On May 4, the reporter went near a blood collection vehicle donation point in Tanggu, Tianjin, and saw the group owner waiting to make a transaction. He said that as long as the reporter gave him the blood donation card, the reporter could receive 400 yuan in cash. "Don't worry about personal privacy information such as the name and ID number on the blood donation card being leaked. We do this often, and there will be no problem." While speaking, he opened the bag he was carrying, and the reporter saw dozens of blood donation cards inside.

"We collect blood donation cards at 400 yuan each and sell them to people who need them for more. If there are other people around you who want to donate blood, they can come to me, and both you and they can make some money," the group owner said.

A doctor at a Grade 3A hospital in Beijing explained that if a patient is hospitalized and urgently needs elective surgery but the hospital blood bank does not have enough blood, the doctor will suggest that the patient's relatives and friends go to a blood station for mutual blood donation. If the patient's relatives and friends are willing, they can fill out a blood donation commitment form stating which patient the mutual donation is for, and after donation an equal amount of blood for surgery can be applied for from the hospital blood bank. However, some patients' relatives and friends are unwilling to donate blood or do not meet the conditions for donation and are also unwilling to wait for surgery scheduling, so they pay someone to donate on their behalf.

According to the Blood Donation Law, to ensure the need for clinical emergency blood use by citizens, the state advocates and guides patients undergoing elective surgery to store their own blood and mobilizes families, relatives and friends, work units, and society for mutual blood donation.

It is worth noting that the essence of mutual blood donation as stipulated by law is voluntary blood donation.

Public information shows that in Beijing, because "blood brokers" had used mutual blood donation as a cover to organize illegal blood trading, the former Beijing Municipal Health and Family Planning Commission issued a document deciding to stop carrying out mutual blood donation starting February 10, 2018. However, in actual operation, where it truly is needed for the condition and there is genuine willingness on the part of family members, individual handling may be allowed.

Regarding the phenomenon of some people helping patients find proxy donors and charging fees in the name of "mutual blood donation," Deng Yong, a professor of health law at Beijing University of Chinese Medicine, believes that this actually reflects the contradiction between supply and demand in China's medical blood use sector.

"China implements a voluntary blood donation system and encourages citizens to donate blood voluntarily to ensure clinical blood demand. However, for various reasons, enthusiasm for voluntary blood donation is not high in some places, leading to tight blood supply, especially in certain areas and during specific periods. In this situation, when patients need blood for surgery, the hospital blood bank may not be able to provide enough blood, thus producing the distorted phenomenon of 'mutual blood donation,'" Deng Yong said.

　　Crack down on illegal blood trading

Increase supply and strengthen supervision

In Deng Yong's view, although mutual blood donation has alleviated clinical blood demand to some extent, it also has drawbacks. For example, it easily leads to blood waste and cross-infection and can also breed illegal blood trading. On the one hand, illegal mutual blood donation behavior must be cracked down on, and intermediary services for profit should be investigated and dealt with according to law to safeguard the seriousness and fairness of the voluntary blood donation system; on the other hand, publicity and promotion of voluntary blood donation should be strengthened through various channels such as media, communities, and schools to raise citizens' awareness of and participation in voluntary blood donation, so that more people understand and support the cause of voluntary blood donation, thereby increasing blood supply.

He proposed improving relevant laws and regulations to regulate mutual blood donation behavior. For example, clarifying the conditions, procedures, and responsibilities of mutual blood donation, strengthening supervision and management of mutual blood donation behavior, and preventing illegal acts such as illegal blood trading.

Deng Yong suggested establishing a blood demand forecasting and early warning mechanism, predicting blood demand for a future period through analysis of historical data, and making advance preparations for blood reserves and allocation; strengthening blood sharing among hospitals so that when blood is tight, blood sharing among different hospitals is enhanced to ensure patients can receive timely treatment; and improving blood management and allocation mechanisms by establishing a more scientific and efficient blood management and allocation system to ensure rational use of blood resources and reduce waste.

Wang Yue, a professor at the School of Medical Humanities at Peking University, called on Party members and civil servants to play an exemplary and leading role in driving the public to participate in voluntary blood donation, and said that honorary awards should also be used to encourage more people to participate in voluntary blood donation.

The reporter noted that during this year's National People's Congress and National Committee of the Chinese People's Political Consultative Conference sessions, several NPC deputies put forward suggestions on improving the voluntary blood donation system.

NPC deputy Chang Juping suggested amending certain provisions of the Blood Donation Law to further improve China's voluntary blood donation system—blood from voluntary donations must not be traded, and qualified blood must be used clinically; blood not for clinical use must not be sold by relevant blood stations or medical institutions to apheresis plasma stations or blood product manufacturers, and should be effectively utilized in accordance with relevant regulations.

NPC deputy Li Xia suggested strengthening government leadership and departmental coordination. Publicity departments can require the media to publish public service advertisements for voluntary blood donation, promote the concept of voluntary blood donation, and popularize knowledge about voluntary blood donation to improve citizens' conscientiousness in voluntary blood donation; civilization offices can incorporate voluntary blood donation work into the overall plan for spiritual civilization construction and use it as an important condition for selecting civilized units; planning departments can incorporate the construction and management of blood donation houses into urban planning, and public security traffic management, urban management, and other departments can provide support for the construction of blood donation houses and the parking of mobile blood collection vehicles.

Li Xia also called for further strengthening the public welfare nature of central blood stations and other institutions. Local governments should give policy support to central blood stations in fiscal and human resources and social security areas, gradually increase fiscal input, and enable central blood stations to contribute more to the high-quality development of the voluntary blood donation cause.

NPC deputy Liu Zhongjun said that the tight supply-demand relationship for clinical blood in China has existed for many years, and the phenomenon that some surgical operations cannot be carried out normally occurs from time to time, causing many patients to delay surgical treatment or fall into hardship. He suggested amending the provisions of the Blood Donation Law on the age for voluntary blood donation and raising the upper age limit for voluntary blood donation to 65 to ease the contradiction between clinical blood supply and demand.