1. National Centralized Blood System
By:
Ahmad Gharehbaghian MTD, PhD
(Faculty member of Iranian Blood Transfusion Organization)
مركز تحقيقات
First Meeting of Blood Services Directors of ECO Member States, June 2008, Tehran-Iran

2. Basic Concept
Have one organization provide the blood transfusion services for multiple hospitals
Iranian blood transfusion organization-Research centre

3. Basic functions of a blood transfusion centre
Management of services
Recruitment of donors
Collection, processing, storage and distribution of blood and blood components
Laboratory investigations
Participation in clinical use of blood and blood components
Teaching and training
Research and development
Iranian blood transfusion organization-Research centre

4. The Need

5. The Need for blood supplies
Transfusion of blood and blood products: an integral and essential part of patient management
Timely and equitable access to safe blood & blood components for all patients whose lives depend on this treatment modality
Iranian blood transfusion organization-Research centre

6. What is big challenge in blood adequacy and safety?
Lack of national or organized blood transfusion service program
Lack of safe voluntary unpaid blood donors or small size of donors pool
Insufficient blood supply
Unscreened blood
Inappropriate use of blood products
Lack of or inadequate basic QC plan
Inadequate support by stockholders
Iranian blood transfusion organization-Research centre

7. WHO report in developing countries about blood transfusion
81 million blood units collected globally every year at a cost of at least 7.5 billion USD
80% of the world has access to 20% of safe global blood supply
139 countries do not have 100% voluntary donation
6 million tests are not done on donated blood
>50% countries lack quality systems and reliable supply of reagents
Up to 50% transfusions are unnecessary
Iranian blood transfusion organization-Research centre

8. Important roles of the national blood program
Advocacy and resource mobilization
Collaboration with state, regional centers and NGOs
Development of technical guidelines and SOPs
Institution of a monitoring and evaluation mechanism for quality management
Iranian blood transfusion organization-Research centre

9. Important roles (continued)
Identification of referral centers
Promotion of research and development
Development of a plan for disaster management
Establishment of fractionation policies
Iranian blood transfusion organization-Research centre

10. Advantages of Centralized Blood Systems
Cost reductions
- High-volume testing
- High-volume purchasing leading to cost savings
- Centralized delivery of transfusion services leading to financial savings
Appropriate use of transfusion experts and senior staff
Improved quality by nation-wide standardization
Improved resource management
Increased efficiency
Development of a core of transfusion medicine specialists
Iranian blood transfusion organization-Research centre

11. Advantages (continued)
Encouragement of the exchange, standardization, and optimization of transfusion practice
Establishment of a centralized database of patient transfusion history and specialized blood component requirements
Centralized nation-wide database of patient transfusion history
Establishment of transfusion medicine specialists as a community resource
Staff efficiency
Implementation of appropriate strategy in disasters
Iranian blood transfusion organization-Research centre

12. Advantages (continued)
Delivery of specialized transfusion medicine services to any size hospital
- Coagulation factor concentrates, albumin, IVIG and related plasma derivatives
- Specialized component processing or testing: leukoreduced products, CMV and other virus-safe products, irradiated components, washed and volume-reduced components
Centralized management of blood resources across the whole nation
Report of adverse reactions and errors
Use of automate and computerized system
Active involvement of blood centers in clinics and hospitals
Exact centralized oversight (error management)
Encouragement of end-users to cooperate with blood centers
Reduction of inappropriate blood prescriptions & blood orders review
Iranian blood transfusion organization-Research centre

13. Centralization of blood donor programs
Uniform policies and functions for:
- Recruitment of donors
- Motivation of donors
- Education of donors
- Maintains of donors
Iranian blood transfusion organization-Research centre

14. Disadvantage of Centralized Blood Systems:
It may require a large inventory and face transport problems.
Decentralized Systems:
It may be more practical
but
problems related to uniformity of services, cost-efficiency and quality management.
Iranian blood transfusion organization-Research centre

15. Which model? There is not one model that suits all countries
Each country needs to study its healthcare organization, its infrastructure, resources as well as its size, geography, and the population it serves.
Iranian blood transfusion organization-Research centre

17. Experiences on Centralization
Some blood services in
Latin American countries and European, UK, France
Canada, Australia
New Zealand, Albania,
Bhutan, Cambodia,
Malaysia, the Philippines,
Vietnam and Iran
Iranian blood transfusion organization-Research centre

18. Iranian Blood Transfusion Organization
The only nationally accredited organization in Iran that performs blood transfusion procedures ranging from blood donor recruitment to blood distribution
Iranian blood transfusion organization-Research centre

19. Iranian Blood Transfusion Organization
IBTO is a single nonprofit organization (Iranian Blood Transfusion Organization) which is responsible for the nation’s blood supply and was established in 1974.
IBTO is a national and centralized organization with blood centers across Iran in all provinces and main cities.
There are roughly 200 fixed blood collection centres out of which 65 embark both on blood components preparation, testing, and release; the other 17 out of the total number embark just on collection and preparation with no testing.
Iranian blood transfusion organization-Research centre

20. IBTO's High Council Managing Director
Department of Legal Affairs
Department of Public Relation & International Affairs
Security Office
Office of Activity Evaluation & Complaints
Managing Director Office
Deputy of Management Expansion & Improvement
Deputy of Technical & Quality Assurance
Deputy of Research & Development
Technical Department
Quality Assurance Department
Blood Donors Education & Recruitment Department
Occupational Safety & Health Department
Director of Renovation & Administrative Improvement
Department of Administrative Affairs
Department of Financial Affairs
Department of Supply, Maintenance & Services for Medical Equipments
Department of Research
Department of Education
Research Center
Regional blood transfusion
centers
IBTO organizational chart
Iranian blood transfusion organization-Research centre

21. Population: 68,920,000, Total area: 1,648,000 sq. km
Iranian blood transfusion organization-Research centre

22. All deferral criteria are observed All screening tests are conducted
Screening process ranging from proper donor selection to consultation session is precisely followed
All deferral criteria are observed
All screening tests are conducted
No blood banks in hospitals collect blood
Blood products are provided to hospitals free of charge
- No charges or fees are requested for the cost of collecting, testing, processing, storing and shipping the blood.
Iranian blood transfusion organization-Research centre
Iranian blood transfusion organization-Research centre

23. IBTO: National/Centralized & Regional/Decentralized?!
SOPs and guidelines,
evaluation policies,
external QC,
purchasing of screening kits, blood bags, major equipment and devices including refrigerated centrifuges, blast freezers, automated instruments or group typing tools
Blood donor recruitment policies except for some deviations cause of regional and provisional cultural and social status
Research and teaching
Iranian blood transfusion organization-Research centre

24. IBTO: National/Centralized & Regional/Decentralized?!
Need assessment meeting community blood demands
Screening tests
Preparation of blood components
Blood components dispatching
Budgeting and finance
Iranian blood transfusion organization-Research centre

25. IBTO: Regional/Decentralized?!
Testing and distribution of blood components
Why?
Transport problems
Largeness of the country
Extensive scope of universities of medical sciences
Availability of specialized wards in regional
hospitals e.g. transplantation or heart surgery, ...
Immediate need for blood transfusion
The vital need of special patients such as thalassemics in different provinces
Iranian blood transfusion organization-Research centre

26. Thanks, wish you all a happy stay in Iran

27. Iranian blood transfusion organization-Research centre

28. Iranian blood transfusion organization-Research centre

29. IBTO Research Center 2003
IBTO-Research Centre has published more than 70 specialized educational pamphlets and 20 books about blood transfusion, blood safety, and transfusion sciences in Farsi language in last 4 years.
IBTO-Research Centre embarked on publishing its specialized quarterly entitled “Khoon” (Blood) that is indexed by IMEMR and Index Copernicus.
We forward copies of all our pamphlets, books, and journals to WHO and EMRO so as to be used in Farsi-speaking communities (such as Afghanistan). IBTO hopefully won the status of being a WHO Collaborating Center.
Iranian blood transfusion organization-Research centre
Iranian blood transfusion organization-Research centre

30. Hospital based centers and regional centers
Mixed System
Hospital based centers and regional centers
Iranian blood transfusion organization-Research centre