I am an Rh Negative blood donor.   Tourists and expatriates are in danger if they are Rh Negative in Thailand.    It's an extremely rare blood type.   We need more donors. 

PURPOSE 

This petition will be submitted to the Kingdom of Thailand Red Cross. It is one part of an overall strategy to save lives by increasing both the awareness of Rh-Negative rarity in the Thai Population and increasing the availability of Rh-Negative blood and associated blood products through removing restrictions on donors who have lived in the United Kingdom. . , Ireland, and France from 1980 to 1996.   

 

EXECUTIVE SUMMARY

The signatories to this petition respectfully request the Kingdom of Thailand Red Cross remove the geographic restrictions on donor eligibility based on the updated Variant Creutzfeldt-Jacob Disease (vCJD) risk analysis. VCJD is commonly referred to as "Mad Cow Disease". The geographic restriction is from people who resided in or visited the United Kingdom, Ireland, or France during the period of 1980 to 1996.

 

The risk is very low and acceptable, nearly zero, and in the context of risk-benefit analysis taking into consideration the low prevalence of Rh-Negative blood in the Thai Population. The risk of contamination from donors who resided in the United Kingdom during the period of 1980 to 1996 is approximately 1 in 30 million and the risk of infection through blood transfusion is 1 in 1.4 billion. This change will result in an increase in the number of Rh-Negative donors where the prevalence of Rh Negative in the Thai Population is extremely low at 0.3%. 

The expanded donor eligibility criteria can be expected to reduce the risk of death and complications for Rh-Negative patients. It is important to note the benefit is for both Thai and Foreigners. Foreigners with a relatively common prevalence of Rh-Negative can assist Thailand. Risk analysis principles have been applied. 

 

RH NEGATIVE RARITY IN THE KINGDOM OF THAILAND

Thailand has one of the lowest prevalences of Rh-Negative in the World at 0.3% of the Thai population. The low prevalence presents an increased risk for both Rh-Negative Thai people and foreigners who reside or travel to Thailand. The presence of Rh-Negative foreigners simultaneously creates additional requirements, and consequently risk, to the limited Rh-Negative Thai Population. It is the Thai population that donates the preponderance of blood in Thailand.  

 

For Western Foreigners, Rh Negative blood is available in our home countries when needed. Approximately 15% of the Western Population is Rh-Negative, with the highest prevalence found in the British Population at 24%. (1) The rarity in the Thai population means it is in very short supply, difficult to source, not always available in many parts of the country, and almost never in sufficient quantity for trauma or long-term requirements. Many blood banks have zero Rh-Negative on hand. In trauma cases, it is life-threatening. Even routine emergencies can quickly become life-threatening without an available unit.Bumrungrad International Hospital in Bangkok states directly on its Emergency page, "One of the biggest problems that face foreigners in an emergency situation is the issue of blood transfusions. It is recommended that you and an emergency contact know your blood type in the event of an emergency. If you end up needing an emergency blood transfer, and your type is Rh Negative, please note that this blood type is not common among Thai people and therefore in very short supply."(2)

 

The American Red Cross states that a Rare Blood Donor is present in less than 1 out of 1000 people. The Rare Blood Donor is "The Needle in their Haystack of Survival" and "That's a big deal and we want to be sure you know it".(3) Thai Rh-Negative donors can be classified as Rare Blood Donors and the Needle in the Haystack. O Rh-Negative people are at exceptionally high risk in a population with only 0.3% Rh-Negative as they cannot accept any other blood type than O Negative.    

 

The Thai Red Cross maintains a network of Rh-Negative donors who respond to emergencies. They have responded generously to Foreigner emergencies whilst having a rare blood type. The National Blood Center and Regional Blood Centers do keep a small supply. As of 4 January 2023, there was a shortfall of 360 units of Rh-Negative. (4) The requirement exceeds the supply.  

 

Foreigners can better contribute to the emergency response and maintain higher blood bank stock levels through awareness and by expanding donor eligibility criteria. The data on Rh Negative foreigners residing and traveling to Thailand is unavailable, we do know the United Kingdom, Ireland, and France constitute a statistically significant number of foreigners in the Kingdom creating both a risk to the extant supply and also a potential opportunity to increase. . the supply.  

 

RISK ANALYSIS ON VARIANT CREUTZFELDT-JACOB DISEASE

Maintaining blood supply is a public health decision balancing donations from healthy donors and the need for blood transfusion. The vCJD concern was introduced in 2000 to prevent, what was at the time, a theoretical risk of transmitting vCJD that had an incubation of several decades, between infection to disease, where the donor could potentially unknowingly infect others. Without the ability to test for vCJD and without historical data, restricting donors from geographic regions was a decision made by many countries. The concern of a second wave of vCJD was the reason to maintain this restriction even as cases have declined to less than ten over the past decade.    

Over twenty years have passed since the peak of vCJD. Between 1995 and as of 30 July 2021, 233 vCJD confirmed and probable cases have been reported in the EU/EEA and the UK, and only three since 2014.(5) Evaluating the risk of transmission through transfusion has been shown to be very close. . to zero. In the United Kingdom, there have been five cases where vCJD was potentially transmitted through blood transfusion. Approximately 2.5 million units are transfused in the UK each year, for an estimated total of over 50 million since 2000. (5). The overall (prior UK residency and travel to the United Kingdom from 1980-1996) mean risk of contamination per unit is 1 in 29,900,000 with a clinical risk o 1 in 1.4 billion. (6).  

t is this data, and the risk-benefit analysis, that is the foundation for our request to remove the restrictions on donors from the United Kingdom, Ireland, and France.

 

WESTERN COUNTRY RESPONSE TO VARIANT CREUTZFELDT-JACOB DISEASE (vCJD) DATA

The United Kingdom lifted its ban on the use of UK-sourced plasma in 2021. The UK previously sourced certain blood products from other countries. The UK assessed the vCJD risk from the UK as very low and acceptable in the context of risk-benefit analysis and chose to rescind restrictions. (7)

 

Australia and the United States removed the restrictions in April and October 2022, respectively, with the stated goal to increase blood supply. It was based on vCJD risk analysis.

 

In these countries where Rh-Negative is common, they have adjudicated the benefit outweighs the remote risk and rescinded the restrictions on vCJD concerns. It is important to note that these countries do not have issues with sourcing Rh-Negative. In consideration of the rarity of Rh-Negative in the Thai Population, we respectfully urge The Kingdom of Thailand to reevaluate geographic donor restrictions to expand the Rh-Negative supply. Unlike Western countries, it is life-threatening in Thailand.   

 

SUMMARY

The signatories to this petition desire to save lives by promoting Rh-Negative awareness through expanding donor eligibility. We respect that it is every country's responsibility and right to protect its population and to evaluate the risk-benefit of accepting donors whilst maintaining public confidence in the blood supply.      

 

The author of this petition is grateful to everyone who read this petition. The author recognizes that eliminating the vCJD restrictions is just one measure to increase Rh-Negative blood availability; education on the importance of donating blood is foremost. The removal of the vCJD is estimated to double the number of foreign donors with a secondary effect of promoting Rh-Negative awareness.  

 

REFERENCES   

(1) Wikipedia Contributors. "Blood type distribution by country", Wikipedia, The Free Encyclopedia, retrieved on 01 January 2023 from https://en.m.wikipedia.org/wiki/Blood_type_distribution_by_country

(2) Bumrungrad International Hospital. retrieved on 25 December 2022, https://www.bumrundrad.com/welcome-to-bangkok-thailand/emergency

(3) The American Red Cross. retrieved on 01 December 2022, https://www.redcrossblood.org/donate-blood/dlp/rare-donors.html

(4) The National Blood Center, Thai Red Cross Society. retrieved on 1 January 2023, https://blooddonationthai.com/en/

(5) United Kingdom National Health Services, "Prevention, Creutzfeldt-Jakob Disease", 07 September 2021, retrieved on 9 January 2023 from www.nhs.uk/conditions/creutzfeldt-jojakob-disease-cjd/prevention

(6) McManus, Hamish, et, al (24 May 2022), "Risk of variant Creutzfeldt-Jacob disease transmission by blood transfusion in Australia" Vox Sanguinus, Volume 117, Issue 8, p.1016-1026 https://doi.org/10.1111/vox.13290

(7) The European Center for Disease Prevention and Control, (3 August 2021) "Risk assessment: The risk of variant Creutzfeldt-Jakob disease transmission via blood and plasma-derived medicinal products manufactured from donations obtained in the United Kingdom" https:/ /www.ecdc.europa.eu/en/publications-data/risk-assessment-risk-variant-creutzfeldt-jakob-disease-transmission-blood