Action Research to develop a model for exclusive voluntary non-remunerated blood donation in a former colony: The case of Trinidad and Tobago

ABSTRACT
Background: International transfusion bodies recommend blood collection from exclusively voluntary non-remunerated donors for safety, adequacy and equal access. This goal has been achieved in some former British colonies in the Pan American Health Organization Region of the Americas such as America and Canada. Trinidad and Tobago is one former British colony whose national blood transfusion service remains heavily reliant on family replacement (> 80%) and remunerated (18%) donors despite its high development index and social capital. An attempt to switch to voluntary non-remunerated blood donation was curtailed by an abrupt fall in donations that disrupted clinical services.
Method: Action Research was used to examine historical and social determinants, describe the current situation, implement change in a closed setting, monitor outcomes and produce a model for achieving exclusive voluntary non-remunerated blood donation in Trinidad and Tobago.
Findings: Policy determined in the colonial period and path dependency after independence prevented uptake of voluntary non-remunerated blood donation in Trinidad and Tobago. Family replacement donation with its attendant deficiencies developed insidiously and became institutionalized over decades. Failure to develop a social interface between the transfusion service and the community with its blood donors allowed fear and mistrust to undermine the introduction of voluntary non-remunerated blood donation. A university-led programme of research, education and collaboration generated a pool of mostly young (49% 18-25 years old), female (56%) and repeat (58%) voluntary non-remunerated donors who were less likely to be deferred (8%) or test positive for transfusion transmissible infections (1.1%) than the existing pool of family replacement donors (p < 0.05 for all domains). This programme has been accepted by decision-makers as the model for achieving exclusive voluntary non-remunerated blood donation nationally.
Conclusion: Action research was used to overcome historical and social barriers to voluntary non-remunerated blood donation in a former colony.