The United States blood system collects, tests, processes and distributes the
blood that is ultimately used in clinical practice. In 2013, more than
14 million units of blood were collected in the United States from about
15.2 million individuals, with 13.2 million units transfused.
Medical advances have reduced the demand for blood in the United
States, creating financial pressure on the nation's blood collection
centers and threatening their future survival, revealed a new RAND
‘More government oversight of the nation's blood system may be needed to safeguard the future of the blood supply and prevent blood shortages from posing a risk to the public's health.’
While the existing system continues to function well, more
government oversight of the nation's blood system may be needed to
safeguard the future of the blood supply and prevent blood shortages
from posing a risk to the public's health, according to the report.
"The U.S. blood system operates effectively, but it is in a state of
flux and uncertainty," said Andrew Mulcahy, lead author of the study
and a policy researcher at RAND, a nonprofit research organization.
"Financial pressures, changes in health care practice and technology,
and the emergence of external threats such as the Zika virus are
pressuring the system and may potentially threaten the available supply
of blood. We need a better, more-efficient and more-sustainable system."
The RAND report finds changes, such as less-invasive surgeries and
new drugs, have lowered the demand for blood over the past decade, while
the size of the blood collection and distribution system has downsized
only slightly. At the same time, consolidation of hospital ownership has
shifted negotiation power toward hospital buyers and away from blood
The result has been increased competition among blood centers that
has led to falling prices for blood, which slices into blood centers'
already thin margins and revenue.
Meanwhile, technological innovation and the emergence of pathogens,
such as the Zika virus, are adding new production and testing costs for
blood suppliers. A dwindling pool of active donors poses another
In the short term, unexpected and sudden changes, such as the
closure of multiple blood centers, could potentially affect the timely
availability of safe blood products and have other negative
consequences, according to researchers. In the long term, however,
consolidation among blood centers may be necessary and may result in a
stronger blood system.
Researchers conclude the best option for fortifying the U.S. blood
system would be for the federal government to play a targeted role in
ensuring blood system sustainability - rather than continuing the
status quo or having the government assume operation of the blood system
as is done in some nations.
Fundamental to strengthening the blood system is for federal
officials to begin collecting comprehensive data about performance of
the blood system, including details about both blood use and financial
arrangements between blood centers and hospitals.
The researchers also recommend regulators better define appropriate
levels of surge capacity to respond to public health emergencies and
subsidize the ability of blood centers to maintain that capacity. They
also urge government agencies to build relationships with other
participants in the blood system to form a blood safety net.
Additionally, they recommend the development of a value framework
for new technologies to provide information about costs and benefits,
and guide decisions about adoption. And where technologies do not
justify investments from a business perspective - yet have clear public
health and preparedness benefits - policymakers may want to require
adoption and pay directly for those investments. The researchers also
recommend the implementation of emergency use authorization and
contingency planning for key supplies and inputs.