Donating blood, organs or bone marrow stem cells is active citizenship
- William Gumede
It shows care, responsibility and looking out for fellow citizens in need. It is also a unique way of sharing compassion across race, colour and class.
Doing so can prolong, improve the quality and save the lives of fellow citizens. Donating is also a form of altruism, it makes one happy. But it also gives the donor a great sense of belonging, of being part of a community of donors, connected through saving lives.
Active citizenship is critical to make democracy work. It takes many forms. The most basic aspects are for citizens to vote for responsible candidates and parties, speak out against injustice, attend, engage and sit on public governance structures such as school boards, municipal ward committees and protest harmful political, business and community practices.
However, active citizenship also includes citizens helping each other and neighbours, volunteering in community organisations, donating money to social causes - doing good.
There is nothing as compassionate as donating blood, organs and tissues to others who desperately need it.
I have been involved since 1989 in grassroots campaigns to persuade specifically black South Africans to donate blood and bone marrow, through the South African National Blood Service, a non-profit, with thousands of donors and volunteers.
I myself battled a life-threatening early life illness, and a blood cancer, in which I was very close to needing to get a bone marrow transfusion. Gratefully, in the end I did not require it.
South Africa regularly faces blood supply shortages. Blood transfusions are needed during childbirth, accidents and patients undergoing surgery.
Sadly, less than 1% of South Africans are active blood donors. Of these, black donors makes up only 30%. In 2005 blacks only made up 6% of South Africa’s blood donors.
South Africa has bone marrow stem cell registry of only just under 80 000 in a population of 60m. Yet, 15% of South Africans are likely to suffer a blood disorder, whether lymphoma or leukaemia in their lives.
There is a shortage of black bone marrow stem cell donors worldwide. Shortage of finding a bone marrow donation is highest among black patients needing bone marrow. In South Africa, the black bone marrow donor pool makes up only 10%.
Only 0.2% of South Africans are registered as organ donors. At around 1.4 donors per million South Africans, this is one of the lowest organ donor rates in the world. Around 5000 people are waiting for a life-saving organ or cornea transplant in South Africa.
South Africans generally are unaware of the importance of blood, bone marrow stem cells and organs. Many others also do not know how few people donate – and why it is essential they do. Many also do not know how easy it is to donate. Many do think that donating is complicated, cumbersome and time consuming.
Many black South Africans are reluctant, whether for cultural or religious reasons or just fear of needles, to donate life-saving blood, organs and bone marrow stem cells, depriving someone who may desperately need it from a life-saving opportunity. Sadly, misplaced superstition is also a factor in some cases, making some people uneasy to donate.
Organ trafficking is at frightening levels in South Africa. Many potential organ donors worry about whether their organs would be trafficked. Restoring the rule of law in South Africa, getting the police to be more effective and less corrupt, and government and non-governmental organisations must continue to transparently tell the public about the integrity of the donation process, is critical to foster to help convince those worrying that their donated organs will be ethically used.
Clearly, there is a lack of accessible information, awareness of the blood, bone marrow stem cell and organ donation processes, importance and facts – which perpetuate ignorance, distrust and fear about donating and contribute to some people not donating.
There has to be mass education program demystifying donation of blood, organs and bone marrow stem cells, emphasising the importance of donating to save lives, and to dispel misplaced cultural, religious, cultural and superstitious beliefs that hinder donating. Such societal education must take place in schools, communities, as part of government service delivery programs, in workplaces, and by sports, cultural and traditional institutions.
The big question is whether upon death, if someone had not specifically indicated they do not want to donate because of religious, cultural or personal reasons, to go ahead and use their organs and tissue for medical reasons.
Some countries, such as Spain, follow what is called an “opt-out” system, whereby when an adult dies, if he or she did not register as a donor, unless they had recorded a decision not to donate for cultural, religious or other reasons, or belong to a community which officially is opposed to organ donation, they would be deemed as organ donors.
Currently, South Africa has an “opt-in” system, whereby if a person had not register as a donor prior to the death, it is assumed that they are not a donor. It is very likely to be against the South African Constitution to upon death, automatically bracket individuals who did not indicate prior to death that they do not want to donate their organs, as agreeing to have the organs donated.
Another tricky question is whether donors should be paid. In 25 countries, including the Germany, China and the US, individuals are paid for donating plasma. In the US, many poor citizens donate plasma as a source of money. In other countries they are paid time off work to donate blood.
There is a difference between a blood and a plasma donation. A blood donation is a whole blood donation, which includes all four components of blood, white blood cells, red blood cells, platelets and plasma. It is used to treat blood loss. A plasma donation is collecting one component of the four components of whole blood, returning the rest to the donor. Plasma is used to replace proteins in patients with life-threatening disorders as immunodeficiencies.
Nevertheless, South Africa urgently needs active citizens who care for others across race, colour, political and class divides. Donating blood, organs, and bone marrow stem cells is one form of caring for others across race, colour, political and class divides, desperately needed.
William Gumede is Associate Professor, School of Governance, University of the Witwatersrand, and a long-time blood, organ and bone marrow donor and campaigner. He was former Lead Independent Director (Alternate Chairperson) of the South African National Blood Services (SANBS).