Although formerly limited to whole blood only and to emergency blood transfusion, the need for human blood in medicine has grown greatly in recent decades due to specific usage of blood components. In industrialized countries where this therapy is common practice, the notion of its cost arises in a health system in which self-sufficiency is being sought in the face of commercial practices. An entire national organization must be set up to safeguard the donors and the correct preparation of blood products for patients, often acting through specific legislation.
Most developing countries simply do not have the basic infrastructure for producing and delivering blood and blood products. Motivated professionals are scarce. Political and financial backing is insufficient. International assistance is difficult to implement. Because of this mortality and morbidity are higher in these countries.
In developing countries, where the structures for collecting, testing and distributing blood and blood products exist the immediate main problem of national blood programmes is to inform their populations with a view to recruiting blood donors. The blood needed for transfusion can only be supplied by the portion of the population which is healthy, neither too old nor too young, not pregnant nor nursing a baby. Paid donors, whose ranks essentially include poor people of low socio-economical standards, greatly increase transfusion risks. Blood and plasma are liable to transmit infectious diseases: viral hepatitis, AIDS, syphilis and malaria. The clinical and biological control of the blood donor must be compulsory and there are far fewer risks in the voluntary contingent.
In developed countries the lack of recognition of transfusion medicine as a medical specialty is the most important problems facing the field.
Although shortages and crises of supply (especially of the rarer blood types) were common in the past, during holidays and on week-ends, plastic containers and new storing solutions now make it possible to prolong the life span of red blood cells and platelets. Still, there may be acute shortage during the period leading up to Christmas or during flu epidemics.
In USA, regions with surplus blood supplies have long sent blood to areas with shortages, but it is also increasingly turning to import from Europe. While demand there has increased, donors have remained steady at about 6% of the population.