Department of Public Health Sciences, School of Public Health, University of Alberta, 3-50 H University Terrace, 8303-112 Street, Edmonton, Alberta, Canada, T6G 2G3.
Health Policy Plan. 2012 Mar;27(2):147-55. doi: 10.1093/heapol/czr016. Epub 2011 Mar 3.
Contemporary public policy, supported by international arbitrators of blood policy such as the World Health Organization and the International Federation of the Red Cross, asserts that the safest blood is that donated by voluntary, non-remunerated donors from low-risk groups of the population. These policies promote anonymous donation and discourage kin-based or replacement donation. However, there is reason to question whether these policies, based largely on Western research and beliefs, are the most appropriate for ensuring an adequate safe blood supply in many other parts of the world. This research explored the various and complex meanings embedded in blood using empirical ethnographic data from Pakistan, with the intent of informing development of a national blood policy in that country. Using a focused ethnographic approach, data were collected in 26 in-depth interviews, 6 focus group discussions, 12 key informant interviews and 25 hours of observations in blood banks and maternity and surgical wards. The key finding was that notions of caste-based purity of blood, together with the belief that donors and recipients are symbolically knitted in a kin relationship, place a preference on kin-blood. The anonymity inherent in current systems of blood extraction, storage and use as embedded in contemporary policy discourse and practice was problematic as it blurred distinctions that were important within this society. The article highlights the importance-to ensuring a safe blood supply-of basing blood procurement policies on local, context-specific belief systems rather than relying on uniform, one-size-fits-all global policies. Drawing on our empirical findings and the literature, it is argued that the practice of kin-donated blood remains a feasible alternative to the global ideal of voluntary, anonymous donations. There is a need to focus on developing context-sensitive strategies for promoting blood safety, and critically revisit the assumptions underlying contemporary global blood procurement policies.
当代公共政策得到了国际血液政策仲裁者的支持，如世界卫生组织和国际红十字会，它们断言最安全的血液来自来自低风险人群的自愿、无偿的捐赠者。这些政策提倡匿名捐赠，反对亲缘或替代捐赠。然而，有理由质疑这些政策是否基于西方的研究和信仰，对于确保世界上许多其他地区有足够的安全血液供应是最合适的。本研究使用来自巴基斯坦的经验民族志数据，探讨了血液中嵌入的各种复杂含义，旨在为该国制定国家血液政策提供信息。研究采用集中的民族志方法，在血液银行和妇产科及外科病房进行了 26 次深入访谈、6 次焦点小组讨论、12 次关键知情人访谈和 25 小时的观察，收集了数据。主要发现是，基于种姓的血液纯洁观念，以及认为捐赠者和接受者在象征性的亲缘关系中联系在一起的信念，优先考虑亲缘血液。当前血液提取、储存和使用系统所固有的匿名性，如嵌入当代政策话语和实践中的那样，这是有问题的，因为它模糊了在这个社会中很重要的区别。文章强调了在制定血液采购政策时，基于当地、具体情况的信仰体系而不是依赖统一的、一刀切的全球政策的重要性，以确保安全的血液供应。本文通过我们的实证发现和文献，认为亲属捐赠的血液仍然是全球自愿、匿名捐赠理想的可行替代方案。需要关注制定敏感的促进血液安全的策略，并批判性地重新审视当代全球血液采购政策背后的假设。
