Basic components of a national blood system.

Blood transfusions are used to treat patients with serious medical conditions that cannot be corrected by other means (1). Despite the availability of certain blood substitutes that make it possible to maintain the volume or the consistency of circulating blood (2, 3), the biological activity of cellular and plasma components makes these the most efficient treatment for a number of clinical conditions (4–6). The mission of a nation's blood services is to collect and prepare safe blood products in an efficient and timely manner and to appropriately transfuse them (7). Blood services include health facilities and centers that collect, process, store, and transfuse blood and blood components. Blood services may be run by the ministry of health, the social security system, the armed forces, the private sector, or nongovernmental organizations. For their part, transfusion services are part of health care facilities , usually hospitals. The role of blood services includes educating, recruiting, selecting, retaining, and registering blood donors; collecting blood; processing blood into its components; performing serological and hematological analyses on the blood; storing the blood, releasing it, and transfusing it to patients who need a blood component; and evaluating the impact of those transfusions on the health of the recipients (7). Multiple institutions are involved in collecting, processing, and transfusing blood as well as in the wide range and variety of functions that blood services must perform. Therefore, to accomplish their mission, a country's blood services must be struc-tured and organized in a manner—a national blood system—that assures the efficient use of donated blood and other resources and that also minimizes any potential untoward effect on the donors, the patients, and the blood services staff. Donated blood must be considered a national resource that is provided voluntarily by healthy, socially committed individuals. Therefore, a blood system must prevent commercial exploitation of blood products and profit-making by blood services. It is the responsibility of the State to guarantee the availability of and access to safe blood in sufficient quantities for those who need it. The ministers of health of the Region of the Americas endorsed these concepts and outlined the principles of a national blood program in a resolution that the Directing Council of the Pan American Health Organization (PAHO) adopted in 1999 (Appendix 1). In developing and implementing a national blood