Frequently Asked Questions
Blood Safety & the Security of Canada’s Blood System
- Who is responsible for blood safety in Canada?
- How safe is the blood system in Canada?
- Who is responsible for the monitoring and surveillance of the blood system?
- If Canadian Blood Services becomes aware of a new blood screening process/technique, what does it do?
- How is Canadian Blood Services reconciling the paramountcy of safety principle with the comprehensive risk management framework within which it is to operate?
- Can I get AIDS by donating blood?
- Is the blood supply transferred from province to province, from hospital to hospital?
- Are there any alternatives to receiving blood from an anonymous donor?
- Are there no alternatives to human blood?
- What is a directed donation?
- What about bloodless surgery?
- Given the risks, why do doctors prescribe blood transfusions?
- Is the Unrelated Bone Marrow Donor Registry (UBMDR) part of Canadian Blood Services?
1. Who is responsible for blood safety in Canada?
The Chief Executive Officer of Canadian Blood Services is the ultimate focal point of accountability for decisions affecting safety for blood operations in all provinces except Quebec. However, there are a number of entities across jurisdictions that also have responsibility for blood safety in Canada. Each plays an important role in ensuring the safety and security of Canada's blood system:
The federal government is the regulator of blood safety. The National Blood Safety Council, appointed by the Minister, advises the federal government on blood safety issues.
The federal government provides an annual budget for research and development on matters related to Canada's blood supply system.
The federal government, through the federal Minister of Health, plays two major roles in the Canadian blood supply system. First, the Minister of Health Canada is responsible for the administration of the Food and Drugs Act, which includes the regulations relevant to the blood supply system. Secondly, the Minister of Health Canada has the responsibility to maintain an effective system for the surveillance of blood-borne pathogens.
Canada's Provincial and Territorial Health Ministers are responsible and accountable for the national blood supply program, including ensuring the overall integrity of the blood supply system.
Canadian Blood Services' Role
The mandate of Canadian Blood Services is "to be responsible for a national blood supply system which assures access to a safe, secure, cost effective, affordable and accessible supply of quality blood, blood products and their alternatives, and supports their appropriate use." Specifically, Canadian Blood Services is responsible for:
- the development, implementation and audit/verification of standards and policies related to all aspects of safety within the regulatory framework that are related to the donors, the blood supply, and the recipients of blood and blood products; and
- the maintenance of surveillance, monitoring and timely response capability to deal with the sudden appearance of safety problems and emerging threats at any point in the blood supply.
2. How safe is the blood system in Canada?
The World Health Organization has said that Canada's blood system is among the safest in the world. We have the strictest criteria in terms of vCJD, and are one of the only systems in the world with universal leukoreduction. Despite this, blood will never be completely without risk. As a form of human tissue, blood is the potential carrier of both viral and bacterial infections. However, Canadian Blood Services takes great measures to reduce that risk as much as possible. If you require blood or blood products, the risks of not getting a transfusion are far greater than the extremely remote chance of being transfused with infected blood.
3. Who is responsible for the monitoring and surveillance of the blood system?
Health Canada is responsible for disease surveillance in Canada. As part of this mandate, Health Canada monitors the emergence of new pathogens that could potentially pose a threat to the safety of the blood system. In addition, through its role as the regulatory authority for the blood system in Canada, Health Canada monitors national and international trends that affect blood management and safety.
In addition, their efforts are supplemented via the establishment of the National Blood Safety Council, which advises the federal government on blood safety matters that fall within its jurisdictional responsibilities.
Canadian Blood Services is also involved in monitoring and surveillance and has an epidemiology department responsible for trending diseases in various populations, including our donor population. In addition, Canadian Blood Services is involved in studies that examine the impact of some policies on the security of the blood supply. As such, Canadian Blood Services assesses trends to ensure a balance between the safety of the blood system and the availability of blood products for Canadians.
4. If Canadian Blood Services becomes aware of a new blood screening process/technique, what does it do?
When Canadian Blood Services is apprised of a new blood screening process or technique, through the Laboratory Centre for Disease Control, its Advisory Committees, interested stakeholders or network of contacts, the Chief Executive Officer or the relevant executive team member immediately ensures that due diligence evaluations of its effectiveness and safety are conducted. This includes the assessments of alternative systems and approaches, and their relative costs. Once the Chief Executive Officer and the Board of Directors agree that the process or technique is absolutely required for safety purposes, the Board approves, through the contingency fund if necessary, its purchase and/or implementation. The Board then advises provinces and territories through its regular reporting mechanisms.
5. How is Canadian Blood Services reconciling the paramountcy of safety principle with the comprehensive risk management framework within which it operates?
Making Canada's blood supply system as safe as possible is the first priority for Canadian Blood Services; Canadians will not and should not expect anything less.
The mission of Canadian Blood Services is to ensure a safe, secure, cost effective, affordable and accessible supply of quality blood, blood products and their alternatives. Safety is the primary driver of the system. Operating within a comprehensive risk management framework means Canadian Blood Services must allocate its resources to where they have the greatest positive impact. That assessment makes safety the lens through which it must consider any decision.
In addition, the pace of technological advances in the field of medical sciences, including medical technologies and bio-pharmaceuticals, is breathtaking. As innovations that aim to improve the safety or efficiency of the blood system are brought to the attention of Canadian Blood Services, it has in place a clear process for evaluating their potential benefits and risks, including what they cost relative to other alternatives or technologies.
6. Can I get AIDS by donating blood?
Donating blood in Canada is completely safe. You cannot get AIDS or any other transmissible disease by donating blood in Canada. At Canadian Blood Services, trained personnel use only new, sterile needles for each donation.
7. Is the blood supply transferred from province to province, from hospital to hospital?
Yes, Canadian Blood Services operates a national blood system and in order to assure that all provinces have adequate inventory, Canadian Blood Services transfers blood from province to province. At different points in time, some provinces are importers of blood, while others are exporters—this is the benefit of a national system. Under certain circumstances, blood is transferred between hospitals. Regulatory standards must be adhered to, to ensure safe handling and tracking of the blood.
8. Are there any alternatives to receiving blood from an anonymous donor?
Canada's health care system relies on the generosity of Canadians who voluntarily donate their blood to help someone they will probably never meet. This is called homologous donation. Canadian Blood Services also provides a service to Canadians wishing to donate blood for their own use. This is called autologous donation. However, this service is only an option for people who have scheduled surgery and are healthy enough to bank their own blood a few weeks ahead of time. The availability of an autologous program is determined by each province and territory.
9. Are there no alternatives to human blood?
There is no substitute for human blood. News reports about blood substitutes or 'artificial blood' refer to clinical trials of products that mimic specific properties of some blood components, mainly red cells. When these products do become available, they will have only specific and limited uses. These products will help, but will not replace the need for human blood.
In addition to blood substitutes, there are medical approaches to minimizing the use of human blood. These include techniques and devices used during surgery to reduce the need for transfusion as well as drugs that can reduce surgical bleeding or stimulate a patient's own blood cell production. These alternatives have their own set of safety risks and side effects.
10. What is a directed donation?
Directed donation is sometimes confused with autologous donation. A directed donation is one given by one donor specifically and exclusively for one recipient, such as a family member. The belief that whether directed donations are more or less safe than homologous donations is controversial. Directed donations cost significantly more than homologous donations and each province and territory sets its own policy on the availability of this service. The Canadian Blood Services directed donation policy is restricted to donations made by a parent to a minor child.
11. What about bloodless surgery?
In recent years, great advances have been made in limiting the need for donated blood. The term "bloodless surgery" is a bit of a misnomer, however, it refers to a combination of measures that reduces or eliminates the need for homologous blood. These include surgical techniques that reduce blood loss, machines that recycle the patient's own blood during surgery, drugs that reduce the need for transfusions, and the use of autologous donations.
12. Given the risks, why do doctors prescribe blood transfusions?
Blood saves lives, however, like all drugs, it has risks. The latest guidelines from the Canadian Medical Association state that avoidance of transfusion is ideal to the extent that avoidance is not likely to be a more serious risk than the transfusion.
13. Is the Unrelated Bone Marrow Donor Registry (UBMDR) part of Canadian Blood Services?
Yes, the Unrelated Bone Marrow Donor Registry (UBMDR) is a core program at Canadian Blood Services. The Registry's mission is to secure compatible, committed and healthy unrelated bone marrow donors for patients in Canada and around the world. Canadian Blood Services has undertaken a review of how the program is structured and managed to ensure that it is effectively equipped to fulfill this mission.