The Turbulent History of Blood Transfusion and Why We Should Become Regular, Voluntary Donors
For thousands of years, blood was a mystery to scientists; perhaps it still is because we haven’t unraveled it completely. Before blood transfusion became possible, we first had to answer fundamental questions about blood. Questions like what it is, what it does, how it is produced, how it flows through the body, and so on. Interestingly, it took centuries to answer some of these questions. So much has been discovered, and much more remains to be known, that an entire field – hematology – has been dedicated to the study of blood. As a result, blood transfusion, which appears to be a recent discovery, has a very long and turbulent history behind it.
If there were to be a most memorable day in the history of blood transfusion, it would be in February 1665, when Richard Lower successfully transfused blood between two dogs. On June 15, 1667, Jean-Baptiste Denis transfused a 17-year-old boy with blood from a sheep – the first animal-to-human transfusion. Lower then performed a calf-to-man transfusion without any complications on November 20, 1667. Denis followed suit, but his fourth transfusion ended in disaster; his patient, Antoine Mauroy, became insane, and it was thought that the blood of a meek and gentle calf might calm him. Denis performed two more transfusions, which unfortunately led to severe complications. Mauroy gradually recovered and was apparently well for two months before his condition deteriorated again, and Denis allegedly gave him another transfusion after which he died. Embattled Denis was charged with murder but later acquitted. In response, physicians of the Parisian Faculty of Medicine banned further transfusion experiments, and for over one and a half centuries, blood transfusion was not heard of.
In 1818, James Blundell was worried about the alarming rate of death from postpartum hemorrhage and decided to continue blood transfusion experiments. After several animal trials, he concluded that man-to-man transfusion was possible. So, on September 20, 1818, he transfused a patient who was critically ill from stomach cancer with human blood. The patient improved but died two days later. Blundell went on, transfusing six patients with severe postpartum hemorrhage, but they all died. His first success came in 1829, when he devised a syringe for collecting and transfusing blood, with a special apparatus suspended from the patient’s chair. Other obstetricians followed Blundell’s methods; however, clotting complications and adverse reactions prevented the widespread acceptance of blood transfusion, relegating it to a treatment of last resort.
In 1900, Samuel Shattock observed that human red cells could be agglutinated by serum from another human. Then Karl Landsteiner, who later won a Nobel Prize for his work, discovered the ABO blood groups among his laboratory staff at the University of Vienna. The fourth blood group, AB, was discovered by DeCastello and Sturli in 1902. Together with Philip Levine, Landsteiner discovered the M and N blood groups, and later in 1940, Alexander Wiener discovered the Rhesus antigen. These discoveries unraveled the mystery behind incompatibility reactions, and to ensure safe transfusion, the donor’s blood is cross-matched with the recipient’s blood. However, transfusions were performed directly, as clotting and storage problems persisted.
In 1914, almost simultaneously, Albert Hustin and Luis Agote discovered that adding sodium citrate to blood would prevent it from clotting. And so, during World War II, blood for transfusion was stored in a citrated flask, which lasted about five days. Richard Weil discovered that citrated blood could be refrigerated. But red blood cells need glucose to stay alive. And so, in 1943, acid-citrate-dextrose was developed, extending shelf life to about 21 days. Citrate-phosphate-dextrose, developed in 1957, had the same shelf life of about 21 days, while citrate-phosphate-dextrose-adenine, developed in 1978, extended shelf life to about 35 days.
Today, advancements in blood transfusion have enabled the separation of whole blood into specific components, and safe transfusion practices have been established. The first blood transfusion service was created by the British Red Cross in 1926, and since then, several non-profit organizations have emerged, with hospitals operating blood banks. It cannot be overestimated how many lives have been saved through blood transfusions in emergencies, childbirth, surgeries, cancer treatment, and many other medical conditions. The number runs into hundreds of millions. The real heroes? Voluntary, non-remunerated blood donors.
“Voluntary, non-remunerated blood donors are those who donate blood, plasma or cellular components on their own free will without receiving payment, either in the form of cash or in kind, which could be considered a substitute for money, including time off work other than that reasonably needed for the donation and travel. Small tokens, refreshments, and reimbursements for direct travel costs are compatible with voluntary, non-remunerated donations.”
Indeed, blood saves as many lives as drugs do. The only difference is that, unlike drugs, blood cannot be manufactured; therefore, it is not a commodity, and transfusion largely depends on voluntary donors. Voluntary donors are a more efficient, reliable, and sustainable method than paid donors. For if blood donations were paid, rising costs would create a wide inequality gap, while unsafe practices would proliferate, threatening lives. This is why the World Health Organization (WHO) and the International Federation of the Red Cross and Red Crescent Societies (IFRC) jointly developed the global framework for action to achieve 100% voluntary blood donation in 2010. The framework serves to guide and support countries seeking to establish effective voluntary blood donor programs, mitigate family/replacement donation, and eliminate paid donation. Every country in the world is strongly encouraged to adopt the framework. Other hallmarks of the holistic framework include creating public awareness and advocacy, making blood donation a pleasant experience, and ensuring quality and safety standards.
The WHO estimates that voluntary blood donation by 1% of the population is the threshold needed to meet a nation’s critical blood demand; the requirement is higher in countries with more advanced healthcare systems. Today, over 120.4 million blood donations occur each year, and based on samples of 1000 people, 28.9 donations occur in high-income countries, 18.2 in upper-middle-income countries, 8.5 in lower-middle-income countries (such as Nigeria), and 4.5 in low-income countries. Globally, an increase of 10.7 million blood donations from voluntary, non-remunerated donors has been reported from 2013 to 2023. In total, 80 countries collect over 90% of their blood supply from voluntary, non-remunerated donors, while 59 countries collect more than 50% of their blood supply from family/replacement or paid donors. Demographically, women account for about 29% of blood donations, and more young people donate blood in low- and middle-income countries than in high-income countries. If 1% of the total population is considered the threshold for meeting critical blood demand, then, based on samples of 1000 people, low- and middle-income countries face a severe blood supply deficit. The need to close this gap becomes evident. The pertinent question is: how?
It is important to understand that healthcare systems worldwide face blood shortages, with the root causes being that there are too few donors and many of the few donors available are not donating regularly. Since this problem is attributed to a lack of awareness about the importance of blood donation, the WHO, in partnership with the IFRC, the International Federation of Blood Donor Organizations, and the International Society of Blood Transfusion, created “World Blood Donor Day” in 2004 to be marked every June 14, coinciding with Karl Landsteiner’s birthday — this year’s theme – One Drop of Humanity. Give Blood. Save Lives is a stark reminder that every drop of donated blood combined helps save millions of lives every year. Regular voluntary blood donation remains the most efficient way to meet the critical demand for blood.
In Nigeria, an estimated 1.8-2 million units of blood are needed each year, yet only about 500,000 pints are obtained from voluntary donors, according to the National Blood Service Commission (NBSC). In fact, official data from the NBSC indicates that 371,827 units of blood (including voluntary, family/replacement, and paid) were collected in 2024, leaving a significant gap between demand and supply. Recognizing the need to close this gap, Nigeria established a network of 17 coordinated blood service centers across its six geopolitical zones, with improved blood donation reporting to the National Blood Service Agency (NBSA) and to the private sector. The NBSA reports an increase in voluntary donations from 12,568 in 2024 to 16,344 in 2025, a growth of over 30%. Still, supply remains far below demand and sustaining this momentum is imperative.
Massive awareness campaigns, better coordination and stronger partnerships (among the government, hospitals, NGOs, educational institutions and the private sector), adequate funding for blood services (comprising collection, processing, storage, and distribution), improved donor recruitment and retention strategies, and the adoption of policies that promote 100% voluntary non-remunerated blood donation. This is the pathway to closing Nigeria’s blood demand-supply gap.
Using the University of Ibadan (UI) and its University College Hospital (UCH) as a case study, students who meet the eligibility criteria for donation could become regular, voluntary donors to the UCH blood bank, helping save many lives. Measures such as raising awareness and educating students about the importance of blood donation; building trust by highlighting that the donation process is safe; ensuring a pleasant donation experience by covering transportation costs or using mobile blood donation services; and collecting data for follow-ups and retention will help achieve this goal. The rate-limiting step is a deliberate action and a commitment by all stakeholders involved to building an efficient system.
One thing remains clear; you and I can make a difference. At one point or another, we might have seen urgent calls for blood donations on statuses, in groups, and even in hospitals. Some of us may have witnessed the desperate search for blood for a relative, friend, or even for ourselves. Even if we haven’t experienced it, we never can tell when such a situation may arise. This is why we should become regular, voluntary donors.
