The future of the Irish Blood Transfusion Service
The Irish Blood Transfusion Service’s (IBTS) new Chief Executive, Orla O’Brien, and Medical and Scientific Director, Professor Stephen Field, speak to eolas about how the statutory body responsible for the national blood supply has dealt with the Covid-19 crisis and their hopes for how it will evolve in 2021.
Having started her new role in June 2020, just as Ireland was emerging from the first wave of Covid-19 public health restrictions, Orla O’Brien reflects on a “baptism of fire” of sorts as the well-established modes of working in blood transfusion were forced to adapt. “I was in the unique position as I took over as we were coming out of restrictions,” she says. “As I arrived the IBTS had rapidly changed how it approached its core business. That core business for which the IBTS, as a national organisation, is responsible for is collecting, processing, testing and distributing blood and blood products in Ireland.
The IBTS operates within a highly regulated environment. Only blood, which has been donated by appropriately selected donors and has been tested for known transfusion transmissible infectious agents, can be issued for transfusion. It remains the case that the perhaps the greatest threat to the provision of safe blood is the emergence of a new virus or infectious disease and we continue to focus our efforts on minimising this risk. Ironically, what we learned this year is that a virus, even one which is not transmitted through transfusion, can pose a threat and potentially disrupt our blood supply. “Traditionally, IBTS clinics ran on a ‘walk in’ basis, this meant that regular donors, eligible to donate, would be texted and invited to attend a clinic and new donors would also be welcome. The arrival of Covid-19 meant we had to rethink how we could continue to collect blood safely for both donors and staff and implement those changes rapidly.
“When I joined the IBTS, the model had changed, almost overnight, to an appointment-based system for donors. It took an enormous effort from a number of teams to do that and I was privileged to witness staff going over and above what they were normally doing. I saw leadership, determination and a really intent focus on our mission to provide excellent blood and tissue services that improve patients’ lives. I was very inspired by that and it was great to see.”
O’Brien is aware that the need for donors to voluntarily leave their homes and donate blood was a particularly “unusual” ask given that government instructions were to stay and home and limit contacts, but she pays tribute to those who “answered that call”. “We couldn’t have maintained the blood supply without them,” she asserts.
June 2020 was an interesting time for an externally recruited individual to join the IBTS as Chief Executive, and O’Brien speaks of the admiration she felt for the staff involved as she got to grips with her new role. “I witnessed incredible agility and resilience from our frontline staff, especially those in the labs and clinics who had to come into work every day,” she says. “One of the challenges for me was how I was going to be able to provide strong leadership and support to them when they didn’t know me.
“My leadership style is very much based on empathy and authenticity, so my approach was informed by the fact that none of us had been through a crisis quite like this before and therefore could not predict the outcome. I was walking the same road with them and rolling up my sleeves to help in every way I could.”
“Despite the Covid-19 crisis I was keen that, as an organisation, we continued our work to develop a new strategic plan in 2020. I felt that was something that we needed to do because 2021 will be another disrupted year and we would need a clear strategic direction to focus on.”
Elaborating, Stephen Field, the IBTS’ Medical and Scientific Director discusses those future plans for the statutory body. His first priority is the further streamlining of the clinic setting, with health questionnaires moving to an electronic format on tablets or even to online settings in order to allow for their completion shortly before appointments. There is an imperative to facilitate specific blood types for the growing population in Ireland who suffer from sickle cell anaemia.
“Almost all of these are of Afro-Caribbean descent and their blood typing frequencies are slightly different to that of the indigenous Irish population; their Rh type is slightly differently configured and we need to give them Rh negative blood when they are anaemic,” he says. “This adds extra demand on our O Negative donors in Ireland which leads to them being called disproportionally more than other donors. However, we can get around this if we can recruit more donors from the Afro-Caribbean community.” To enable this, malaria antibody testing, a necessity given the possibility of those from endemic areas carrying low level parasites, will be rolled out in 2021.
Safety is also a concern for Field, who explains: “We have a world-class testing system, with nucleic acid testing for the RNA or DNA of viruses, a very sensitive method of screening blood. Whereas many other blood services around the world pool several samples together, we believe in testing each individual sample, which makes it extremely sensitive.
“There are areas where safety can be further enhanced and one of those is the storing of platelets, which are stored at room temperature. This means that there may be a small growth of bacteria if there has been a contamination at the time of donation. There are ways to minimise this and we screen cultures using a bacterial method, but an additional safety step would be the introduction of pathogen reduction, a process whereby we treat the product with a compound that would render any bacteria within the unit sterile. We plan to introduce a process of pathogen reduction into our platelet components within the next few years.”
Other priorities include the re-establishment of an Irish Eye Bank, as an alternative to the importation of corneas from the USA. The Service needs to develop genetic sequencing methods that allow screening of the donor population for multiple blood groups and thus allow better matching with patients. There is also a renewed focus on R&D so that the IBTS “can do its own research and development and place the Irish context on transfusion medicine”.
“We need about 3,000 donations of blood every week; one in four of us will need a transfusion at some point in our lives but we take it for granted that blood will be available for us should we need it. With the onset of the Covid-19 crisis we still needed to ensure that the blood supply met the demand irrespective of the fact that so many people were “locked down” in their homes,” O’Brien says.
“Of the population in Ireland today, roughly 2.8 million are eligible to give blood or platelets. Currently, only 3 per cent of us do. In 2019, around 1,000 people reached either a 50 or 100 donation milestone. That’s an incredible achievement and shows the loyalty of those individuals who have, for years, given their blood or platelets and their time. While some of these donors are in the older age groups, one of the challenges for us now is to attract younger people and encourage them to develop an ongoing donor relationship with us.”
Concluding on a hopeful note, the new Chief Executive issues a call to action: “Normally we would have about 17,000-18,000 first-time donors every year but because of the Covid-19 crisis that’s down 60 per cent this year. That’s not a problem right now but it might be in a few years’ time. Our ask would be that people who have not considered it previously would think about becoming a blood donor. I am very optimistic about the future; I have a high level of confidence that we can meet any challenge in front of us as we navigate our way out of the pandemic. One of our greatest assets is our people, who have shown incredible commitment during this time. We also have the unwavering support and generosity of our donors, who have continued to turn out, when we asked them to. I am filled with optimism for the future of IBTS.”
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