In Focus
Unmet needs for blood transfusion in India
A systemic public health challenge
Amita Radhakrishnan Nair
Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram Kerala, India
Blood transfusion is a cornerstone of modern clinical care, critical across specialties including obstetrics, oncology, trauma, and chronic haematological conditions like thalassemia1.
In India, the scale of transfusion need is vast due to a high population burden, elevated maternal mortality risks, and increasing surgical and accident-related demand. Despite infrastructure gains, the country continues to face an unmet need for safe and timely blood with estimated shortfall to be nearly 26,2 million units of blood and components which roughly translates to 23% of worldwide deficit.2 The shortfall is not merely a logistical inconvenience - it results in delayed treatments, compromised outcomes, and, in some cases, preventable deaths. Rural and public health systems are particularly affected, with seasonal shortages and uneven distribution exacerbating the problem. In this context, accurately understanding and quantifying India’s blood requirements becomes crucial for policy, logistics, and ethics. Addressing the transfusion gap is not only a matter of healthcare delivery but also of equity, trust in public systems, and national health security.
Estimating Transfusion Need
Estimating transfusion demand at a national level requires a robust, standardized methodology that accounts for clinical usage patterns, hospital capacity, and component utilization. One widely used proxy is the annual blood requirement per hospital bed. Among the most comprehensive national estimates, a 2022 PLOS One study led by Mammen et al.1, presumed 9.6 units per bed per year, with calculations depending on specialty mix and case load with bed occupancy being factored in the calculations. Demand may also be modelled based on disease-specific needs, such as average units per thalassemia patient annually or transfusion frequency in postpartum haemorrhage. These facility-level estimates are then extrapolated across India’s total hospital bed capacity, both public and private. Component usage - packed red cells, platelets, FFP - is also factored in where data are available.
This quantitative modelling approach, while inherently approximate, offers a structured method to forecast clinical demand and informs supply planning, donor mobilization strategies, and blood bank resource allocation. It has been projected that India’s annual whole-blood requirement is approximately 14,6 million units, translating to 36,3 units per 1000 eligible population, yet only ~33,8 units per 1000 are supplied, creating a gap of around 2,5 units per 1000 (~1 million units), which underscores a significant supply-demand mismatch1.
Figure 1.
Donation Landscape
The Blood Transfusion Services (BTS) in India comprises of an expansive network of approximately 4263 blood centres across the country3. Predominantly, these are hospital-affiliated blood centres (66,94%) in government (29%) and private (37,15%) sectors; the remaining 33% are charitable establishments or stand-alone blood centres3. Three-fourths of the blood collection is from voluntary donors, and the remaining comes from family and friends (replacement donation). But there is regional and state-wise disparity, with western India having 82.5% voluntary donations, followed by south (77,3%), east (68,9%), northeast (55,5%), and lowest in northern India (52.5%). Kerala and Tamil Nadu exceed 90% voluntary rates, while states like Bihar and Jharkhand lag below 50%4.
There are 2,2 blood banks per one million people, collecting around one unit per 100 persons annually with wide variation between states. Bihar, Jharkhand, Uttar Pradesh, West Bengal, Rajasthan, Madhya Pradesh, Manipur, and Odisha reported less than two blood banks per million people, whereas states, such as Kerala (5,0), Tamil Nadu (3,7), Karnataka (3,0), and Maharashtra (2,7) reported a very high density of blood banks per million people5.
Around 38% of blood centres have annual collection less than 2000 units. This was more marked in the blood centres of Northeast region (49%) followed by South (46,4%), North (37,8%), 37% in East and 26,6% in Western region5,6. Of the approximately 8,7 million blood units collected from blood centres with component separation units, 71% of blood units are separated into components, corresponding to 53% of the total collection in the country.
Current Deficit
A national-level study published in 2022, on the clinical demand for blood in India, estimated the annual requirement at 14,6 million whole blood units. Our collection was 12,6 million units per annum. There is still a shortfall of approximately 2 million units6. Our annual collections are equivalent to 31 donations per 1000 eligible persons. A modelling study done by Roberts et al in 2019 estimated a need of 52,5 million blood units with an unmet need of 40,9 million in India, which means India requires 34,3 million donations, equivalent to 85 donations per 1000 eligible persons (around 0,4 billion)2. This gap is exacerbated during summer months and festivals, when donation rates plummet by up to 50%. Seasonal imbalances - such as surges during political events or awareness drives - contrast with critical shortages during emergencies. Compounding the issue, nearly 6,5 lakh units are wasted annually due to improper cold chain and lack of coordination between healthcare facilities. Digital platforms like e-Raktkosh, which allow real-time inventory management is a step in the right direction.
Implications
The WHO lists blood and blood products as vital medicines and emphasises that well-organised blood transfusion services are required to ensure the timely access to safe blood and blood products. This still is a challenge in many parts of the country due to overlapping issues of demand supply mismatch and inequitable availability. According to the National Blood Transfusion Council, every district in India needs to have a blood centre; however, approximately 63 of 766 districts do not have one blood centre. Most blood centres are concentrated in urban centres leading significant rural–urban disparity in the distribution of blood supply. While urban centres may have surplus stocks, remote districts remain “blood deserts,” with only 61% of the population able to access a blood-equipped facility within an hour6. The supply against demand of blood units was estimated at 92,6% for whole blood, 91,7% for red cells, 86% for plasma, 77,5% for platelets, and 92,1% for cryoprecipitate. Similarly, the utilisation against supply was reported at 98,7% for whole blood, 99,2%, 96,8%, 97,6% and 94,6% for red cells, plasma, platelets and cryoprecipitate, respectively.
For patients with transfusion-dependent thalassemia, inconsistent access leads to under-transfusion, iron overload, and increased mortality risk. Obstetric haemorrhage - one of the leading causes of maternal mortality - often turns fatal in rural areas due to delayed or unavailable transfusions. Trauma victims, cancer patients, and those undergoing major surgeries face life-threatening delays. The reliance on replacement donors’ compromises patient safety, as seroprevalence of transfusion-transmitted infections (TTIs) is higher in this group.
Ultimately, the blood deficit is not just a logistical issue - it is a silent determinant of survival, dignity, and justice in clinical care7.
Conclusions
India’s blood transfusion system continues to face a persistent and complex shortfall, shaped by uneven infrastructure, seasonal collection gaps, and regional disparities. Despite advances like e-Raktkosh and growing voluntary donation rates in some states, the national landscape remains fractured - particularly for rural, underserved populations. Critical groups such as thalassemia patients, postpartum mothers, and trauma victims suffer disproportionately due to inadequate or delayed access to safe blood. The existing network of blood centres, while vast, is misaligned with population needs, with many districts lacking even a single functional facility. To bridge the gap between clinical demand and supply, India must invest in data-driven planning, strengthen voluntary donor retention, expand component separation capabilities, and build decentralized, accountable transfusion systems. The unmet need for blood is not simply a numerical deficit - it is a systemic public health challenge that demands policy urgency, sustained funding, and ethical accountability to ensure equitable access to this life-saving resource.
References
- Kralievits KE, Raykar NP, Greenberg SL, Meara JG. The global blood supply: a literature review. The Lancet. 2015 Apr 27;385:S28.
- Roberts N, James S, Delaney M, Fitzmaurice C. The global need and availability of blood products: a modelling study. The Lancet Haematology. 2019 Dec 1;6(12):e606-15.
- Blood transfusion services /national blood transfusion council technical divisions of dte.GHS [Internet]. [cited 2025 Jul 7].
- Asirvatham ES, Mammen JJ, Lakshman J, Sarman CJ, Charles B, Upadhyaya S, Rajan S. Assessment of Performance of Blood Banks in India: A National Level Cross Sectional Study. Indian J Hematol Blood Transfus. 2021 Oct;37(4):640-647. doi: 10.1007/s12288-021-01399-9. Epub 2021 Jan 24. PMID: 34744346; PMCID: PMC8523628.
- Mammen JJ, Asirvatham ES, Lakshmanan J, Sarman CJ, Pandey A, Ranjan V, Charles B, Mani T, Khaparde SD, Upadhyaya S, Rajan S. The clinical demand and supply of blood in India: A National level estimation study. PLoS One. 2022 Apr 6;17(4):e0265951. doi: 10.1371/journal.pone.0265951. PMID: 35385543; PMCID: PMC8986005
- Shreenik Kundu, Alejandro Munoz Valencia, Sargun Kaur Virk, Nikathan Kumar, Anita Gadgil, Joy John Mammen, Nobhojit Roy, Nakul Raykar - Defining blood deserts and access to blood products for 660 million people: a geospatial analysis of eight states in Northern India: BMJ Global Health 2024;9:e015637.
- Patidar GK, Chaurasia R, Pandey HC. Blood banking: The situation in India. Transfus Apher Sci. 2023 Oct;62(5):103802. doi: 10.1016/j.transci.2023.103802. Epub 2023 Aug 23. PMID: 37690860.
