World Blood Donor Day is celebrated every year on 24 June. This year's theme is "20 years of celebrating donation: thank you, blood donors!". The 20th anniversary of World Blood Donor Day is an excellent occasion to thank blood donors worldwide for their life-saving donations over the years and to review the situation of transfusions and access to them worldwide, taking into account the reality of countries and their populations.

Blood transfusions are essential, helping to reduce infant and maternal mortality, drastically improving the life expectancy and quality of life of patients suffering from life-threatening hereditary diseases such as haemophilia and thalassaemia and acquired diseases such as cancer and traumatic haemorrhage, as well as supporting complex medical and surgical procedures, including transplants.

In high-income countries, transfusion is a commonly performed intervention in cardiovascular surgery, transplant surgery, major trauma and the treatment of solid malignant tumours and blood neoplasms. In low- and middle-income countries, it is more often used in cases of pregnancy complications and severe childhood anaemia. Therefore, in countries where there is a shortage of blood, children and pregnant women are the most affected, as they need it the most.

WHO figures show that 118.5 million blood donations are made worldwide annually, 40 per cent of which are made in high-income countries, home to 16 per cent of the world's population. In low-income countries, the number of donations is less than 5 per 1,000 inhabitants; in middle- and lower-middle-income countries, it is 16.4 and 6.6, respectively, per 1,000 inhabitants, while in high-income countries, it is 31.5 per 1,000 inhabitants. These figures reveal a significant difference in access to blood and blood derivatives, which means that many patients who need transfusions do not have access to this product.

World Health Assembly Resolution WHA63.12 calls on Member States to establish, implement, and support sustainable blood and plasma programmes that are efficiently managed and coordinated at the national level by the availability of resources to achieve self-sufficiency. It is the responsibility of each government to ensure an adequate and equitable supply of plasma derivatives, such as immunoglobulins and clotting factors, which are necessary to prevent and treat various severe conditions that occur in all regions of the world.

To guarantee the blood supply, countries rely on three types of blood donors: (i) voluntary and non-remunerated, (ii) family members, and (iii) remunerated. Adequate and safe blood supplies are ensured by voluntary and non-renumerated donors because, in this group, the prevalence of blood-borne infections is lower. Therefore, on World Donor Day, it is important to emphasise the essential role of voluntary and non-renumerated blood donors who guarantee universal access to this product and its derivatives for all populations.

The provision of safe and adequate blood should be an integral part of each country's national healthcare policy. As the WHO recommends, this should ensure blood's safe and rational use to reduce unnecessary and unsafe transfusions. Thus, patient outcomes and safety will improve, and the risk of adverse events, including errors, transfusion reactions, and transmission of infections, will be minimised. 

The risk of transmitting serious infections due to unsafe blood and the chronic blood shortage has made the world realise the importance of blood availability and safety. Blood management is crucial to optimising outcomes and ensuring safety and appropriate transfusions. The WHO supports countries in setting up national transfusion systems to provide rapid access to safe blood and blood derivatives in sufficient quantities and establish good blood transfusion practices to meet patients' needs.

The WHO therefore urges Member States to adopt integrated strategies that include: a) Establishment of a national blood system with well-organised and coordinated transfusion services; b) Collection of blood, plasma and other blood products from donors in low-risk, regular, voluntary and unpaid populations; c) Screening of all donated blood for transfusion-transmissible infections such as HIV, hepatitis B and C and syphilis; d) Rational use of blood and blood products to reduce the number of unnecessary transfusions and minimise transfusion-related risks; and e) Gradual implementation of effective quality systems.

It is important here to highlight the need to ensure that health professionals routinely diagnose and correct iron deficiency and anaemia, consider alternatives to transfusion, use medicines and devices to reduce the need for blood, use blood appropriately clinically and manage patients who need transfusion effectively.

Life-saving blood and donors as a whole and individually provide an excellent service of solidarity to communities by donating blood. Saving lives should be everyone's mission and everyone's support. Let's all donate blood so that access to it is universal.

Dr Fernanda Alves, Head of the WHO Non-Communicable Diseases Programme in Angola