At one of Delhi's biggest government hospitals, Shalini (name changed) is losing hope. Staring at her son covered in bandages, lying on a gurney, the middle-aged woman from Uttar Pradesh's Ghaziabad is in tears as she tells FIT, "They have asked us to arrange for a blood donor."
"He needs two units of blood. They won't do the surgery without it. We have no one (to give blood), beta," she says.
A few minutes later, we see three boys approach and start negotiating with Shalini and her daughter. We later learn that the boys are 'professional blood donors', and one of them has agreed to be their donor for Rs 3,500.
Donating blood in exchange for money was banned in India in 1996. However, paying 'professional blood donors' to meet this requirement is still fairly common.
"We come across one or two such cases daily," says Dr Devesh Dubey, MD Transfusion Medicine, who works at one of the biggest blood banks in India's capital.
Meet Ashok – the Man Who 'Supplies Blood'
To see how easy it would be to 'arrange' a paid blood donor, FIT went to one of the busiest government hospitals in Delhi.
This is where we met Shalini. As we strike up a conversation and tell her we're looking for a blood donor too, her daughter tells us that they had spoken to a person who said he would 'arrange' a donor for them. She tells us we would find him at a tea stall near the closest metro station, and that he could help us too.
All leads – from vendors to patient families and bootleg pharmacists – point us to Ashok (name changed). He sits, surrounded by 4-5 men, and is guarded when we make inquiries.
He begins with the following line of questioning:
Where is our patient admitted?
What surgery do they need?
Why couldn't we just get friends and relatives to donate?
Posing as a patient's friend, the FIT reporter gives him preplanned answers.
In the emergency ward.
He had an accident and needs surgery on his leg.
I donated blood a month ago. He has no family here, and everyone else we reached out to has refused.
Only when he's satisfied with the answers, he says he would be able to 'arrange boys' by the next day, and that it would cost between Rs 3,500 to Rs 4,000.
Why are families of patients forced to seek help from someone like Ashok? Why do so many resort to paying a random person a lump sum to donate blood at such personal risk?
'Is the Cost of Poor Person's Life Any Lesser?'
In most cases, if the patient is from out of town, they do not have friends and family in the city, and it's very difficult for them to find donors.
Speaking to FIT, Neeta Kohli, a 76-year-old cancer survivor living in Delhi, says that when their 30-year-old domestic worker, Sumit, met with an accident, "we were told there is internal bleeding, and that he needed at least 4 units of blood."
"Sumit came from a village in Balia in Uttar Pradesh, and has been working with us since he was about 20 years old. He is like family to us. He had his wife, who was pregnant, and two little children. We did not know what to do," she says.
Neeta goes on to explain that they couldn't donate it themselves because she was a cancer survivor, her husband was over 80 years old, and their kids lived overseas.
"We sent messages on at least a hundred groups, but no one responded. No one came forward to donate. His wife, who was also employed with us, was heartbroken and anxious."Neeta Kohli
She says, that's when a friend suggested that his driver knew someone who can arrange it immediately. "We ultimately paid more than Rs 5,000 for a unit."
"It really made me wonder, if I needed blood, would it be the same? Is the cost of a poor person's life any lesser? Would the groups have ignored me if I needed blood?"Neeta Kohli
'Relatives Refuse to Donate'
Sometimes, even when the patient has family and friends around, they refuse to donate.
"When you ask for donations, relatives also turn them down. It's the bitter truth," says Dr Dubey. He says this is primarily because of a lack of awareness around blood donation safety. People fear they'll get weak, have some health issues, or contract infections if they donate blood, he explains.
He goes on to talk about a case he encountered a few months ago. "I had a woman come in with her seven-year-old son. He had a brain tumor and needed surgery. She offered to donate, but her haemoglobin levels were too low, so she didn't qualify."
"She said she didn't have anyone else who would donate. When I enquired about the boy's father, she said, 'I spoke to him and he's refused to donate.'"Dr Devesh Dubey
"The father said he'll have weakness if he donates blood. I was stunned. The woman started sobbing, and I felt helpless," he says.
"The boy only needed three units of blood. I spoke to the social worker attached to the hospital to see if we could sign off on it without replacement, and we gave it to them."
"The problem", Dr Dubey says, "is that we can't do this for every patient. The blood bank only has so much blood. We have to take the call on a case-to-case basis."
'You Can't Manufacture Blood'
According to the Ministry of Health and Family Welfare, India's annual requirement for blood is around 1.5 crore units per year, while in reality, only around 1 crore units are available.
This gap in supply and demand of blood poses a major public health crisis in the country. For example, around 70 percent of postpartum hemorrhage (PPH)-related deaths in India are due to lack of immediate availability of blood.
This gap only widened during the COVID pandemic, with lockdowns putting a pause on blood donation camps, and the general air of health anxiety.
While donation rates have gone back to pre-pandemic levels, explains Jayadeep Gupta founder of Friends2Support, a portal for voluntary blood donation, it is not uncommon for families to struggle to find blood.
"You can't manufacture blood. The only way to close this gap is through voluntary donations."
So essentially, what the booming business of paid blood donation is doing is just filling a chasm that's begging to be filled.
Needless to Say, Unregulated, Paid Blood Donation Is Dangerous
Paid blood donation is not the best of practices, for both recipients as well as the donors, say experts. Unregulated buying and selling of blood ups the risk of contamination and deadly infections slipping through.
Moreover, in extreme cases, there have been reports of people, particularly migrant workers, being exploited and forced to give blood multiple times a week at the cost of their own health and wellbeing.
"The paid donors are generally young boys, between the ages of 20 and 25, from very poor backgrounds," says Dr Dubey.
"Sometimes, people have come in with multiple pricks on their arms, that's another giveaway. One time, someone I had screened before came back again for donation just a week later."
"This will no doubt be detrimental to their health," he adds. Moreover, if caught, they face the risk of jail time.
The protocol is to ask every donor a set of questions before we take their blood.
"If they seem suspicious, we ask them questions like, 'how are you related to the patient?', 'what is the patient's name?', and 'what surgery are they having?', to sus them out. If we get enough proof, we either defer them, or hand them over to the cops," Dr Priyansha Gupta, PG resident, Public Health, who has worked in Delhi's AIIMS blood bank in the past.
What, then, happens to the families who desperately need blood when their donors are deferred?
Dr Dubey says they are referred to the social workers attached to the hospital to get them help.
"In cases of emergency, at government hospitals, the patient is given blood no-questions-asked. All the blood that is given from our blood bank is given free of charge, no matter how many units the patient needs," says a senior official at one of India's leading government hospitals who didn't want to be named.
"But you have to understand, blood is a scarce commodity, and there's only so much we have."Senior Official
But the Final Solution Is Not Regulation
It all essentially boils down to the gap in supply and demand. The solution, according to experts is to encourage voluntary donations, along with promoting better supply chain management.
"Like we pay tax, everyone who qualifies to should donate blood regularly. Only then can we stop these kinds of practices," says Dr Dubey.
"What we want from the government, and blood banks is that replacement blood donation should not be a requirement for patients whose lives are dependent on blood transfusion, like thalassaemics."Shobha Tuli, founder member of Thalassaemics India
According to Tuli, to get people to donate blood voluntarily, it is important to inform people about the scarcity, and the requirements of patients whose lives are dependent on their donations.
To make this happen, "More mobile blood donation vans, camps, and most importantly, increasing public trust in the safety of blood donation, can all help," she adds.
In fact, it might be the only way people like Shalini's son, Sumit, and others like them can have a fighting chance at life without having to shell out a hefty sum, while also putting someone else's wellbeing at risk.