March 14, 2022
Only by having a diverse blood donor pool can United States blood centers effectively serve the needs of the patients in their communities. For this reason, building a diverse blood donor pool remains a priority, and there is much work to be done.
As it exists today, the blood donor pool remains overwhelmingly White/Caucasian. Recent data from The Biomedical Excellence for Safer Transfusion (BEST) Collaborative found that among donors at eight U.S blood collectors, Whites made up the majority of first-time (66.7%) and regular (82.7%) red blood cell donors. However, from 2006 to 2015, the percentage of White donors decreased over time for both first-time and regular donors.1
These data would indicate a trend toward more unique donors coming from race/ethnic categories other than White. During the same time period, there was an almost 50% increase in the proportion of unique donors who were Hispanic or Latino (5.98% in 2006 to 8.94% in 2015). However, there was a slight decrease in the proportion of blood from Black/African American donors from 18.8% in 2006 to 18.1% in 2015.2
“In the ‘post-COVID’ environment we have seen even more of a drop in the diversity of the blood supply,” said Jenni Gasbarro, product development and implementation director at the American Red Cross Biomedical Services. “Our Hispanic and African American segments have dropped to almost half of the levels they were pre-COVID.”
A Diverse Blood Supply
So why does diversity in the blood supply matter? One reason is that group O donors can donate red blood cells to anybody and in the in the U.S., the Latino population has the highest percentage of people that are group O. It is estimated that almost 60% of the Hispanic population has group O blood3 and about 50% of African-Americans are group O.4
“Just to meet transfusion needs of the general population we need donors from these diverse groups,” said Yvette D. Miller, MD, executive medical officer for the American Red Cross Donor and Client Support Center. “We need it for the general blood supply and for emergency use blood.”
A diverse group of donors also matters because blood is so much more than ABO group and Rh type, according to Margaret A. Keller, PhD, executive of National Laboratories at the Red Cross and senior director of the American Rare Donor Program. The commonly discussed blood types are A+, A-, B+, B-, AB+, AB-, O+ and O-, but there are many variations that are less discussed.
“There are more than 60 blood group systems and 600 molecules that can be on the surface of the red blood cell,” Keller said.
All of these blood group antigens are encoded by inherited genes. Because they are inherited, the likelihood of finding a particular phenotype is different in different populations.
“For the average recipient we need blood that will match based on ABO/Rh but there are other cases where we need to match for more,” Keller said. “To find a match or compatible unit it is often easier to look in a population of donors that are similar in racial/ethnic background to the patient.”
This need is particularly great for people who have sickle cell disease (SCD). People with sickle cell disease have red blood cells that form a sickle-like shape. One of the most critical treatments for SCD is blood transfusions.
“In this country, the majority of individuals who have SCD are African American or of African descent,” said Miller.
“When we are looking to identify units for transfusion for patients with SCD, in many cases the units that most closely match would be from a donor that is African American or of African descent.”
The more closely matched a unit of blood is the less likely that an individual will have an adverse reaction, Miller explained. Recipient-donor mismatch of Rh and K antigens can result in alloimmunization, an immune response to foreign antigens from another person’s blood antigens.
“Even when we have the most compatible blood, the patient may still develop an antibody because the diversity of Rh antigens in the Black population is so incredibly large,” Miller said. If a patient with SCD develops a new antigen, finding a match in the future becomes even more challenging.
Donor Hesitancy
There are many possible reasons that underserved or underrepresented communities do not donate blood in higher percentages. One reason is a lack of trust in the larger medical community and blood collection organizers are seen as a part of that community, Miller said.
“Because of some historical abuses in relation to communities of color being used as research subjects without permission, there is still mistrust,” Miller said. “People want to know, ‘What are you going to do with my blood?’”
To begin to encourage more trust, it is important to hire individuals that reflect the communities that blood centers are trying to serve and encourage to donate. Representation matters, Miller said.
“That means diversity in staff, recruitment staff, leadership teams and collections staff,” she said.
Another thing affecting diversity of blood donors is that the blood collection marketing and communications materials — in many cases — do not reflect those communities.
“When you look at commercials aimed at a particular racial or ethnic group or age group, the outreach materials have to visually reflect that community,” Miller said.
Gasbarro added that the COVID-19 pandemic has not helped the situation. The American Red Cross recently conducted surveys after an external marketing campaign detailing the importance of a diverse blood supply and encouraging donations from the Black community.
“The survey showed high awareness and 20% retention of the ads we had shown,” Gasbarro said. “It also showed that the number one reason members of the African American community were not coming out to donate was COVID.”
Katherine J. Kaherl, executive director, Immunohematology Reference Laboratories at American Red Cross, said that COVID has highlighted the need for increased convenience and opportunities to donate in underserved communities.
“In COVID times we realized we had an inability for blood drives to occur in these communities without the use of high school or college drives,” Kaherl said. “We needed to provide access for different ethnicities to get to a blood drive within their community.”
Outreach
To start to address some of these issues, the American Red Cross recently approached Burrell Communications, a multicultural agency specializing in the African-American market, to help support efforts to attract more diverse blood donors.
When the American Red Cross first approached the agency, the pandemic had caused the cancellation of thousands of blood drives at schools and businesses, resulting in a significant decline in all blood donations, but specifically those from the Black community.
By partnering with Burrell, the American Red Cross hoped to raise awareness of the role that blood transfusions play in the treatment of SCD and increase donations from the Black community.
“The Red Cross obviously recognizes the impact that the Black community could have,” said Keisha Boyd, public relations director at Burrell Communications. “They came to us to help raise awareness among the Black community and to share ways that they can help.”
One of the resulting events was a series of virtual, live chats called Coffee & Conversation. One, hosted on Facebook, was a partnership between the American Red Cross and BlackDoctor.org. The event was hosted by Rashan Ali and included speakers from the American Red Cross and the NAACP. Another event was an Instagram Live event hosted again by Rashan Ali and featured singer Tionne “T-Boz” Watkins, NFL coach Bobby Engram and his wife Deanna and Miller.
“Sickle cell warriors who come to share their story are super impactful,” Boyd said. “People connect with those human stories.”
Susan Forbes, senior vice president of corporate communications and public relations for OneBlood, agreed. Forbes said that using authentic voices is key to elevating the message.
Forbes said that last year she reached out to Super Bowl 43 MVP Santonio Holmes with information about the need for diverse blood donors. Holmes’ son has SCD and he has been a vocal advocate for creating awareness about the disease. However, Forbes said Holmes, like so many others, was unaware of the need for a diverse blood supply to help patients with SCD.
“Santonio was eager to help. We created a campaign called be the MVP of Your Community,” Forbes said. “His voice is resonating. We have seen an increase in African American donors coming forward to donate since we started the campaign.”
The American Red Cross also begun to offer sickle cell trait screening to any donor who self-identifies as African American.
“Sickle cell trait status is an important piece of health information that many African Americans or people of African-descent still don’t know,” Miller said. “It is only since 2006 that it has been mandatory that every newborn be screened for SCD. There is a generation of individuals that do not know if they have sickle cell trait.”
The Red Cross has also recognized the importance of partnering with diverse organizations to help build trust.
“The way the blood collection community can begin to build trust in blood collection organizations is by partnering with trusted organizations in their community,” Miller said.
Organizations like the National Pan-Hellenic Council, the NAACP or the National Council of Negro Women have been working in the space of health disparities for decades.
“When we partner with those organizations, the community will trust us because they trust those organizations,” Miller said. “This cannot be underestimated.”
Ongoing Effort
Forbes stressed that recent efforts to attract a more diverse group of blood donors have been tremendous, but that the blood center community needs to always be looking for creative ways to bring this issue to the forefront and engage the community.
Throughout the OneBlood service area, Forbes said she often shares videos of patients with SCD or the physicians who treat them. OneBlood tries to use the voices of doctors who treat these patients to be the messenger of the important need for a diverse blood supply. Other video content takes people into OneBlood’s labs to show the massive effort of people working around the clock to find compatible blood for patients in need. OneBlood also shares the videos on social media and with the news media.
“It is one thing to talk about the need for a diverse blood supply, but when people can see it firsthand, it puts a whole different perspective on it,” Forbes said.
By showing these videos at events and on various media platforms, Forbes said OneBlood is not only creating awareness but also empowering people to carry forth that message. The right messaging can bring more people into the fold who can help communicate the need for a diverse blood donor pool.
“Keeping the important topic of diversity of the blood supply at the forefront is a relentless effort,” Forbes said. “We need to move the numbers in the right direction and to do that, the topic has to remain front and center. It has to be part of our everyday efforts to help ensure that we have a ready and diverse blood supply.”
Endnotes
1 Yazer MH, Vassallo R, Delaney M, et al. Trends in age and red blood cell donation habits among several racial/ethnic minority groups in the United States. Transfusion.2017;57(7):1644-1655.
2 Yazer MH, Delaney M, Germain M, et al. Trends in US minority red blood cell unit donations. Transfusion. 2017;57(5):1226-1234.
3 Oneblood.org. Hispanic Blood Donors. https://www.oneblood.org/about-donating/blood-donor-basics/hispanic-blood-donors.stml. Accessed February 22, 2022.
4 American Red Cross. Facts About Blood and Blood Types. https://www.redcrossblood.org/donate-blood/blood-types.html. Accessed February 22, 2022.
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