Blood: the ultimate donation in emergencies.

The images of suffering in the aftermath of disasters, particularly earthquakes, never fail to stimulate the greatest generosity among people. If cash is the donation preferred by a humanitarian organization, generally, a more person-alized contribution is favored by the public; be it food supplies, clothing, or the ultimate social gift—blood. Appeals for blood donations in the aftermath of a disaster generate the same overwhelming solidarity, no matter where the disaster occurs. 1,2 When misguided or mismanaged, generosity also is a source of considerable logistical and operational problems. Managers during earthquakes, Bam included, experienced the counterproductive and sometimes unmanageable flow of inappropriate initiatives and donations. As noted by the Pan-American Organization (PAHO) in its Guide for Effective Aid, " there are some supplies and forms of assistance that should never be the subject of an open, massive appeal ". Local donations of blood and blood derivatives usually are enough to satisfy local needs. 3 Decades old PAHO recommendations that " international donors of blood should verify that a need exists, that it cannot be met locally, that the blood can be properly handled, and that its safety can be ensured " remain in effect. Proper handling and safety often are issues in remote provinces as was the case in the 2005 earthquake in Pakistan where storage conditions " posed a serious threat to safety of the blood ". 4 Discouraging unnecessary international donations is one step; organizing the local supply chain rationally and safely is another. Preparedness of the blood banks is essential. While the PAHO/World Health Organization (WHO) guidelines outline the principles of preparedness and response for blood banks, 5 the paper by Hassan Abolghasemi and colleagues offer a practical , real life illustration of how national authorities can and should assess the needs rationally, and best match the needs while ensuring the safety of the blood supplies. Assessing the needs is a prerequisite. Initial estimates of blood requirements often are exaggerated after earthquakes 4 or mass-casualty incidents resulting from bombing. 6 The authors of this review credited the early establishment of a Disaster Response Committee specifically for blood transfusion as an important measure to improve the flow of information in spite of the disruption of telecommunication. Indeed, centralization of information and management of appeals for blood is perceived as necessary to match supplies. 7 Meeting those needs is a logistical and managerial challenge. The authors correctly identified that " …