Forecasting Blood Supply and Demand under Population Aging: Implications and Challenges for Healthcare Resource Allocation

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Blood is essential in surgery, cancer therapy, and critical care, which are frequently used in older adults. However, declining birth rates and diminishing younger cohorts threaten the sustainability of the blood donor pool. Methods In this study, we integrated demographic data from the Taiwanese household registration system, annual blood supply and demand data from the Taiwan Blood Services Foundation, and national population projection data from the National Development Council of Taiwan to forecast the supply-and-demand dynamics of blood in Taiwan through 2060. Results An analysis of population pyramids revealed Taiwan’s progression toward a superaged society, with profound implications for blood supply management. It also revealed a marked reduction in the absolute number and proportion of young first-time donors. According to population projections, the number of individuals eligible to donate blood (aged 17–65 years) is expected to decrease from 16 million in 2025 to approximately 8.7 million by 2060. We identified a projected crossover point around 2027, when demand is expected to exceed supply. If current trends persist. this shortfall is forecasted to surpass 1 million units annually by 2060. Conclusions The SWOT analysis further identified internal strengths and weaknesses, alongside external opportunities and threats. Based on this, some strategic directions were proposed to enhance recruitment, optimize utilization, adopt emerging technologies, and safeguard long-term sustainability. Ensuring blood availability is essential for healthy aging, as equitable access to transfusion supports medical interventions that preserve functional ability and improve quality of life in older adults. Overall, these findings highlight the urgent need for developing proactive donor recruitment strategies, reconsidering transfusion eligibility criteria, and enhancing patient management to ensure the availability of blood as a key resource. Aging Transfusion Blood supply and demand Forecasting Demographic Young first-time donor SWOT analysis Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Blood transfusion is a key component of modern health care. It supports the management of trauma and hematologic and oncologic disorders and enables major surgery and palliative care. Ensuring a safe and sufficient blood supply requires a stable donor base, effective recruitment strategies, and efficient utilization practices. However, demographic transitions, particularly population aging and declining birth rates, pose growing challenges to the sustainability of blood supplies worldwide [ 1 ]. As populations age, the demand for blood products increases; for example, approximately 50% of individuals who require blood transfusion are those aged ≥ 60 years, indicating the disproportionate need for blood products in this demographic [ 2 ]. In addition to this unequal distribution, countries with rapidly aging populations have a shrinking pool of eligible donors alongside increasing transfusion requirements [ 3 , 4 ]. This dual pressure reflects two concurrent trends: younger cohorts make fewer blood donations, whereas older populations, who are more likely to require blood transfusion because of a chronic illness or age-related procedures, expand in size [ 5 ]. High-income countries such as Japan, South Korea, and several European nations have already documented this phenomenon, reporting both reduced donor availability and increasing transfusion requirements [ 6 – 9 ]. Taiwan is currently undergoing one of the fastest demographic transitions worldwide [ 10 ]. According to the National Development Council of Taiwan, the country is expected to become a super-aged society by 2025, with more than 20% of its population aged ≥ 65 years [ 11 ]. This transition from an aged to a superaged society in only 7 years is substantially faster than that observed in Europe and the United States, which spanned 20 to 50 years. It is also faster than that observed in all other East Asian countries. Coupled with the persistently low fertility rates in Taiwan, this demographic transition is expected to reshape the balance between blood supply and demand in the country. This delicate balance is also expected to be directly influenced by developments in medical practice. In scenarios involving rapid demographic transitions, regular monitoring of blood demand and the age distribution of both donors and recipients is essential for strategic planning to prevent shortages or unnecessary surpluses [ 6 ]. In this study, we utilized population survey data from the past decade, together with blood collection and utilization records from the Taiwan Blood Services Foundation, to forecast future changes in blood donation eligibility and demand through 2060. Methods Data sources This study used three types of data sets: (1) demographic data from the Department of Household Registration, Ministry of the Interior, Executive Yuan, (2) annual blood supply and demand data published by the Taiwan Blood Services Foundation from 2010 to 2024; and (3) national population projection data from the National Development Council of Taiwan (2024 edition). Population pyramid construction Raw data were aggregated into annual totals and organized into a time series format in Microsoft Excel (Microsoft, Redmond, WA, USA). All data were cleaned to ensure consistency in year-to-year reporting. Historical demographic data were compiled on the basis of records from the Department of Household Registration. Future population projection data were obtained from the National Development Council. These data sets were used to construct population pyramids illustrating age and sex distributions across different time points. Blood donor age distribution In Taiwan, healthy individuals aged 17–65 years are eligible to donate blood. To facilitate blood donation and enhance donation services, the Taiwan Blood Services Foundation has progressively enhanced its blood management information system. This enhancement led to a steady improvement in the volume and quality of donor data available. In this study we analyzed the annual reports published by the Taiwan Blood Services Foundation between 2011 and 2023. Using these reports, we extracted and examined the age distribution of blood donors over the 13-year period from 2011 to 2023 to assess temporal changes in the proportion of donors across different age groups. We also drew future projections of blood supply by examining the medium population growth of national projection. These forecasts account for the rates of fertility, mortality, and net migration. In this study, the projected number of eligible donors was derived from population counts of individuals aged 17–65 years. Although this age-based criterion aligns with the current donor eligibility standards, it does not account for future changes in policy, health status, or donor recruitment strategies that may influence the actual donor pool. Forecasting method To estimate future blood demand, we analyzed the demographic transitions projected in Taiwan for the period between 2025 and 2060. To validate our forecasting model, we retrospectively applied it to historical data obtained from annual reports published by the Taiwan Blood Services Foundation from 2011 to 2024. We also utilized actual blood supply records to simulate predicted demand and evaluate model performance. In addition, we used an exponential smoothing model to forecast both total blood demand and total blood donations. We then performed forecasting by using the “Forecast Sheet” feature in Microsoft Excel LTSC for Enterprise 2021, which applies a variant of the simple exponential smoothing method that accounts for both level and trend components of time series data. This tool automatically generates point forecasts accompanied by 95% confidence intervals. To project future blood donations, we assumed that the average number of units donated per eligible donor would remain constant over time. Using data obtained for the preceding 5 years, we estimated the average as 2.31 ± 0.05 units per donor. Using this assumption, we projected a gradual decline in total blood donations from 2023 to 2060. This forecasting procedure involved selecting relevant time series data (i.e., year versus number of blood units), using the feature of “Forecast Sheet” from the “Data” tab, specifying the forecast horizon (e.g., 10 to 50 years ahead), and exporting the predicted values along with their corresponding confidence intervals for further analysis and visualization. Model validation To evaluate the accuracy of the forecasting model, back-testing was conducted using historical data. Specifically, the exponential smoothing model was trained on data from 2011 to 2020 to generate forecasts for the period between 2021 and 2024. The forecasted values were then compared with the actual observed blood issue volumes reported by the Taiwan Blood Services Foundation. Finally, forecast performance was evaluated using standard error metrics, including the mean absolute error and root mean square error. Overall, the forecasting model demonstrated acceptable predictive accuracy, supporting its application in long-term trend projection. Results Population age structure by sex in 2000, 2025, and 2060 Figure 1 depicts a progressive demographic shift in the age distribution of the Taiwanese population from 2000 to 2060. In 2000, the population pyramid demonstrates a broad base and a narrow apex, which are characteristic of a young population with relatively high birth rates. By 2025, the base substantially narrows, indicating declining birth rates, whereas the upper segments of the pyramid expand, consistent with population aging. Projections for 2060 suggest an inverted pyramid shape, with a high concentration of older age groups and a sharp reduction in younger cohorts, indicating both advanced population aging and overall population decline. Across all time points, women consistently outnumber men in older age brackets, a pattern likely attributable to the longer life expectancy of women. Donor population trends A major shift was observed in the age distribution of blood donors from 2011 to 2024. The proportion of donors aged 17–20 years steadily decreased from 15.7% in 2011 to 5.6% in 2024 (Fig. 2 A). A similar downward trend was observed among donors age 21–30 years. By contrast, a uniform increase was observed in the proportion of donors aged 51–65 years, rising from 13.3% to 24.8% over the same period. During this period, the proportions of donors aged 31–40 and 41–50 years remained relatively stable, with only minor fluctuations observed. By 2023, individuals aged 41–65 years had accounted for more than half of the entire donor population, indicating a clear shift toward an aging donor base. During the same period, a uniform decline was observed in the absolute number and percentage of first-time blood donors aged ≤ 24 years (Fig. 2 B). The number of young first-time donors decreased from 117,932 in 2011 to 49,172 in 2024, representing a reduction of 58.3%. Correspondingly, their proportion among all first-time donors decreased from 69.5% to 50.3%. Notably, this decline became faster after 2019, with a marked drop between 2019 and 2020 (from 83,992 to 69,098 donors). Throughout the study period, both the absolute number and proportion of young first-time donors markedly decreased. Overall, these findings underscore a significant and sustained reduction in the number of young first-time blood donors, highlighting a demographic shift that may necessitate targeted recruitment strategies to engage younger donors and ensure the long-term stability of blood supply. Long-term projections of the eligible blood donor population Figure 3 presents the projected demographic shifts of the eligible blood donor population in Taiwan between 2010 and 2060. Panel A displays absolute population counts across three age groups: 0–16 years (future potential donors), 17–24 years (emerging donors), and 25–65 years (core donors). The overall population across all age groups is expected to decline over time, with the sharpest decline observed among donors aged 25–65 years. In accordance with population projection data, a progressive drop is expected in the number of eligible blood donors aged 17–65 years from 16 million in 2025 to 7 million in 2070. This drop represents a reduction of almost 56% in the number of potential donors (Fig. 3 A). Although donors aged 17–65 years remain the primary source of blood donations, their proportion has started demonstrating a significant downward trajectory after 2020. The proportion of donors aged 17–24-years has also started demonstrating a steady decline, limiting the recruitment of new and young donors. Panel B depicts the rate of change in the proportion of eligible donors aged 17–65-years stratified by sex. In the early 2020s, the proportions of both male and female donors started exhibiting a steady and nearly identical decline. By 2040, these proportions are expected todecline by more than 20%, and by 2066, they are expected to decline by more than 50% relative to the 2011 baseline. Overall, these findings highlight a key demographic challenge for the blood services system of Taiwan: the dual impact of an aging population and shrinking donor pool across both male and female donors. To address this challenge, strategic interventions are urgently required to maintain the donor population. Estimated future blood demand and blood donations Analysis of blood demand and supply trends from 2011 to 2060 revealed a projected decline in blood donations in a medium population growth scenario. Between 2011 and 2024, both blood donations and blood issue volumes in Taiwan remained relatively stable, with annual units ranging from approximately 2.3 to 2.5 million. A slightt upward trend was observed starting around 2020, with blood donations and blood issue volumes converging at approximately 2.5 million units by 2024. Projections based on a medium population growth scenario indicate that blood donations will peak around 2027 and then gradually decline, falling below 2.5 million units by 2060. By contrast, projected blood demand is expected to steadily increase, surpassing 3 million units by 2037 and reaching more than 3.6 million units by 2060. This change represents a 40% increase relative to 2024, with an average annual growth rate of approximately 1.2%. Notably, the gap between blood supply and demand is expected to significantly increase after 2027, indicating a potential shortage in supply if these current trends continue unabated. Discussion This study presents future projections for the supply and demand of blood in Taiwan with the country transforming into a superaged society. First, the total population of Taiwan is expected to substantially decline, accompanied by accelerated population aging (Fig. 1 ). Second, because of the combined effects of population aging and the declining population of younger blood donors, the donor population itself is aging, as evidenced by the marked decline in the proportion of young blood donors over the past decade (Fig. 2 ). Third, the number of eligible blood donors is projected to significantly decrease in the upcoming decades, posing a major challenge to the maintenance of a stable blood supply (Fig. 3 ). Fourth, a critical crossover point in supply and demand is expected to occur around 2027, when the available donated units are projected to no longer meet transfusion requirements (Fig. 4 ). Taken together, these projections highlight the urgent need for strategic planning (Table 1 ) to mitigate the impact of demographic transitions on the sustainability of blood services. Table 1 SWOT matrix and corresponding strategies Strengths INTERNAL FACTORS Weaknesses INTERNAL FACTORS ž Established blood supply and safety system ž Strong voluntary donation culture ž Advanced medical technology and transfusion safety ž Blood product wastage (over-ordering, expiration) ž Low engagement of younger donors ž Lack of real-time cross-hospital inventory Opportunities EXTERNAL FACTORS S/O Strategies W/O Strategies ž AI and big data for supply-demand forecasting ž International collaboration and best practices ž Emerging technologies (synthetic blood, cell therapies) ž Integration with long-term care and public health policies ž Apply AI-driven demand forecasting in Taiwan’s blood system ž Expand voluntary donation via digital platforms, peer networks, campuses, and health education ž Leverage international collaboration for synthetic blood and advanced medical technologies ž Use intraoperative autotransfusion and minimally invasive surgery ž Enhance education/outreach to boost youth donation ž Build AI-supported, real-time cross-hospital inventory system ž Adopt international best practices to reduce inefficiencies ž Develop proactive donor recruitment, including older healthy individuals ž Reconsider transfusion eligibility criteria Threats EXTERNAL FACTORS S/T Strategies W/T Strategies ž Declining eligible donors (17–65 years) ž Rising demand from population aging ž Vulnerability to pandemics/disasters ž Changing social values affecting donation ž Use strong infrastructure to maintain supply in emergencies ž Promote donor retention to counter shrinking donor pool ž Improve preservation to extend shelf life and ease shortages ž Implement patient blood management, optimize surgical techniques, and enforce stricter transfusion guidelines ž Reduce wastage via optimized transfusion practices ž Increase donor engagement to offset population decline ž Prepare contingency plans for outbreaks/disasters ž Reevaluate transfusion eligibility criteria Blood transfusion is an essential component of medical interventions that aim to maintain the health and functional ability of older adults. These interventions include joint replacement surgery [ 12 , 13 ], cancer therapy, and palliative care [ 14 ]. If the amount of blood available fails to meet demand, the quality and accessibility of care for elderly patients may become compromised, ultimately undermining the goals of healthy aging. Therefore, ensuring a sustainable blood supply is a key prerequisite for meeting the health-care requirements of a superaged society and for protecting the health and ensuring the functional independence of aging populations. According to a review of the global aging trajectories of major countries, France is the first nation to transform into an aging society in 1864, and Japan is the first country to be classified as a superaged society in 2005 [ 15 ]. Taiwan is projected to reach a superaged status by 2025 [ 16 ]. Notably, the pace of population aging in Taiwan is among the fastest worldwide. Specifically, Taiwan will have taken only 25 years to transition from an aging society to an aged society and only 7 years to transform from an aged society to a superaged society [ 17 ]. Our findings are consistent with trends observed in other high-income, rapidly aging societies, where declining birth rates and increasing life expectancy have narrowed the base of eligible blood donors while driving a growing demand for transfusion services. Similar demographic trajectories and corresponding pressures on national blood systems have been reported in Japan, South Korea, and several European countries. Previous research has indicated a strong link between future blood supply and demographic characteristics [ 18 ]. In this study, we analyzed demographic data obtained from the Taiwanese household registration system for the period between 2011and 2024, and we examined donor records maintained by the Taiwan Blood Services Foundation. We observed that the blood donation patterns in Taiwan are associated with population structure, consistent with the aforementioned finding. As depicted in Fig. 2 A, the proportion of donors aged 17–20 years steadily decreased from 15.7% in 2011 to 5.6% in 2024, and the proportion of donors aged 17–30 years also uniformly decreased, accompanied by an increase in the proportion of middle-aged donors (51–65 years). Although this growing contribution of middle-aged donors provides short-term stability [ 19 ], it raises long-term concerns, particularly because this cohort is at a high deferral risk of age-related conditions or medication use and is eventually expected to become ineligible to donate [ 18 , 20 ]. Simultaneously, the number of first-time donors has markedly decreased. Specifically, the number of first-time donors aged ≤ 24 years substantially decreased from 117,932 (69.5%) in 2011 to 49,172 (50.3%) in 2024, reflecting a reduction of 58.3% (Fig. 2 B). First-time blood donors are key contributors to the blood donor base [ 21 ]. Traditionally, blood donors recruitment efforts have targeted younger populations because they are assumed to be healthier and able to donate blood for longer periods [ 22 , 23 ]. Furthermore, the decline observed in the number of first-time donors reflects multiple aspects, including academic and economic pressures, reduced school-based drive, and the impact of COVID-19, which disrupted recruitment channels and imposed additional deferrals [ 24 , 25 ]. Together, these trends make a bad situation: the declining participation of young donors, who represent the future of the donor base, and the increasing reliance on older donors, whose capacity may become limited. In recent years, the proportion of young blood donors in Taiwan has markedly declined, whereas reliance on middle aged donors has increased. Although older donors often demonstrate higher return rates and more uniform donation patterns, they are also at a greater risk of becoming ineligible due to the possibility of age-related issues [ 26 ]. In addition, an aging recipient population is projected to drive a sustained increase in blood demand [ 19 ]. This evolving landscape of blood supply and demand necessitates the development of progressive strategies to ensure blood transfusion sufficiency and safety in the upcoming decades. Figure 3 illustrates major demographic transitions that are expected to shape Taiwan’s future blood donor base. After remaining stable or even increasing before 2020, the population of both younger donor (17–24 years) and core donors (25–65 years) are projected to steadily decline after 2020, with an accelerating downward trend over time. By 2059, the population of both male and female eligible donors are projected to have decreased by approximately 50%, presenting difficulties in maintaining a stable blood supply. Similar patterns have been observed in other high-income countries, where population aging has resulted in a decrease in the number of core donors and limited the inflow of first-time younger donors [ 27 , 28 ]. The parallel decline in the number of both male and female donors suggests that this trend is not sex-specific but rather reflects broader structural demographic transitions. Similar non-sex-specific downward trends have been reported in population-based donor projections in Europe and Japan [ 8 , 29 ]. These findings underscore the need for population-wide interventions and continuous monitoring of donor demographics. Integrating donor population forecasts with blood utilization projections is essential for anticipating future challenges and shaping effective policy responses. The steady increase observed in blood demand reflects the anticipated increase in age-related medical procedures, chronic disease management requirements, and surgical interventions [ 5 ]. As shown in Fig. 4 , blood demand is projected to continue increasing, driven by population aging and the associated medical needs, further increasing the risk of an imbalance between supply and demand. Although slight recovery has been observed in both blood donations and blood issue volumes during the period from 2020 to 2023, likely because of post-pandemic normalization and targeted recruitment, blood supply is expected to start decreasing again around 2030. This inflection point corresponds to major demographic shifts, including Taiwan’s rapidly aging population and declining birth rates, which both have major implications for health-care resource planning. By 2060, the imbalance between demand and supply is projected to exceed 1 million units annually if donation levels are not maintained or improved. Therefore, the next 5 years represent a crucial period, because the supply gap is projected to become increasingly significant under all population scenarios, particularly in the low population growth scenario, in which donation decline is most pronounced. To address the aforementioned challenges, multifaceted strategies are required to both replenish the donor pool and ensure the sustainability of the blood supply. The SWOT framework, summarized in Table 1 , guided the development of four categories of strategies by linking internal strengths and weaknesses with external opportunities and threats [ 30 ]. S/O strategies build on Taiwan’s strong infrastructure, culture of voluntary donation, and advanced medical technologies by applying AI-driven forecasting, expanding recruitment through digital platforms and health education, strengthening international collaboration for synthetic blood, and promoting intraoperative autotransfusion or minimally invasive surgery. W/O strategies address internal gaps by enhancing outreach to younger donors, developing a real-time cross-hospital inventory system, adopting international best practices, and re-evaluating donor eligibility to include older but healthy individuals. Meanwhile, S/T strategies leverage existing strengths to counter demographic and systemic threats by maintaining supply during emergencies, improving preservation methods [ 31 ], and implementing patient blood management with stricter transfusion guidelines [ 32 ]. Finally, W/T strategies mitigate vulnerabilities by reducing wastage [ 33 ], improving donor engagement, strengthening contingency planning for disasters [ 34 ], and reassessing transfusion eligibility criteria [ 35 ]. Collectively, these strategies emphasize the importance of integrating technological innovation, international cooperation, and systemic reforms to enhance the resilience of Taiwan’s blood supply system. By combining proactive donor recruitment with optimized clinical practices, Taiwan can better adapt to demographic shifts and secure a sustainable blood supply for future healthcare demands. Limitations and Future Directions This study has several limitations. First, our projections are based on national demographic estimates and historical transfusion data, which may not fully capture unforeseen changes in health-care practices, donor eligibility criteria, or advancements in medical technology. Second, we did not model the potential impact of emerging alternatives, such as artificial blood products, advanced cell therapies, or expanded autologous transfusion programs, which may alter future demand. Third, although Taiwan represents a valuable case study because of its rapid population aging dynamic, direct generalization to other health-care systems should be made with caution. Future studies should incorporate more dynamic modeling approaches, evaluate policy interventions such as patient blood management, and conduct comparisons on an international level to refine predictions. Declarations Ethics approval and consent to participate This study was conducted in accordance with the principles of the Declaration of Helsinki and relevant local regulations. Ethical approval was obtained from the Research Ethics Committee of Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation (REC113-13). The study utilized three types of datasets: (1) demographic data from the Department of Household Registration, Ministry of the Interior, Executive Yuan; (2) annual blood supply and demand data published by the Taiwan Blood Services Foundation from 2010 to 2024; and (3) n national population projection data from the National Development Council of Taiwan (2024 edition). As the study did not involve any direct interventions or experimental procedures with human participants, the Ethics Committee waived the requirement for informed consent. Competing interests The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Funding This work was supported by grants from the Jen-Ai Hospital and the Central Taiwan University of Science and Technology, Taichung, Taiwan (CTU114-JAH-001). Author Contribution Lin YM contributed to study conceptualization, investigation, and formal analysis. Ma CC contributed to study supervision and writing—original draft. Chien JH contributed to data collection, investigation, and formal analysis. Ho TF contributed to project administration, supervision, funding acquisition, conceptualization, methodology, and writing—review & editing. Acknowledgement The authors sincerely thank all the participants involved in this project for their valuable contribution and dedication. This manuscript was edited by Wallace Academic Editing. Data Availability All data analyzed in this study are either publicly available from government websites (Ministry of the Interior and National Development Council of Taiwan) or available upon reasonable request with permission from the Taiwan Blood Services Foundation. References Kim KW, Kim OS. 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Supplementary Files 5Table1SWOT.docx Cite Share Download PDF Status: Published Journal Publication published 12 Feb, 2026 Read the published version in BMC Health Services Research → Version 1 posted Editorial decision: Revision requested 08 Dec, 2025 Reviews received at journal 05 Dec, 2025 Reviews received at journal 05 Dec, 2025 Reviewers agreed at journal 04 Dec, 2025 Reviewers agreed at journal 03 Dec, 2025 Reviewers agreed at journal 03 Dec, 2025 Reviewers agreed at journal 03 Dec, 2025 Reviewers invited by journal 03 Dec, 2025 Editor invited by journal 27 Nov, 2025 Editor assigned by journal 13 Oct, 2025 Submission checks completed at journal 12 Oct, 2025 First submitted to journal 12 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7800748","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":555175428,"identity":"6c3b6e3b-8af5-4617-a448-d5a4e412e3b5","order_by":0,"name":"Yueh-Mei Lin","email":"","orcid":"","institution":"Jen-Ai Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yueh-Mei","middleName":"","lastName":"Lin","suffix":""},{"id":555175429,"identity":"9e5fbbc0-bb13-4122-ad6b-8bb82086dcad","order_by":1,"name":"Tsing-Fen Ho","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwUlEQVRIiWNgGAWjYDAC5jMMDB9gHB5idPCw5TAwzmAwYGBgg2iRIEoLMw9JWuzZeA8+tqn5kzh/fgPjg7dtDHUGBwjawpdsnHPMIHHDMQZmw7ltDBKEtcj3mEnnNgC1sDGwSfMCtZgRtoXHTNoSqGV+GwP7b+K1MAK1NBxjYGMmTssxHmPDnmPGxhuOJTZLzjknIbmfkBb2Nh7DBz9q5GTnNx8++OFNmQ2/ZAMBLUiAEaSWcLSMglEwCkbBKCACAADFWzVCVmTxPwAAAABJRU5ErkJggg==","orcid":"","institution":"Central Taiwan University of Science and Technology","correspondingAuthor":true,"prefix":"","firstName":"Tsing-Fen","middleName":"","lastName":"Ho","suffix":""},{"id":555175430,"identity":"6ebe5a40-18b3-4490-aa06-d9e73242998c","order_by":2,"name":"Chao-Chun Ma","email":"","orcid":"","institution":"Jen-Ai Hospital","correspondingAuthor":false,"prefix":"","firstName":"Chao-Chun","middleName":"","lastName":"Ma","suffix":""},{"id":555175431,"identity":"e26f4243-10d0-4657-9cf5-c286d44f8ab3","order_by":3,"name":"Ju-Huei Chien","email":"","orcid":"","institution":"Taichung Tzu-Chi Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ju-Huei","middleName":"","lastName":"Chien","suffix":""}],"badges":[],"createdAt":"2025-10-07 14:53:34","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7800748/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7800748/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12913-026-14150-9","type":"published","date":"2026-02-12T15:59:06+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":97894265,"identity":"55385874-3efa-4af0-8ea4-c021269de49e","added_by":"auto","created_at":"2025-12-10 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1","display":"","copyAsset":false,"role":"figure","size":811078,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"1Fig1Populationpyramids.png","url":"https://assets-eu.researchsquare.com/files/rs-7800748/v1/39b659c0abc3df3038b7a220.png"},{"id":97693370,"identity":"255d4b72-1074-4143-ac8f-64aee4206d42","added_by":"auto","created_at":"2025-12-08 11:16:52","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":796581,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"2Fig2Donors.png","url":"https://assets-eu.researchsquare.com/files/rs-7800748/v1/c2a2711b8e735063a487831b.png"},{"id":97693373,"identity":"6d0096a3-5727-4a01-b2a8-4407ee31a2b1","added_by":"auto","created_at":"2025-12-08 11:16:52","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":113923,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"3Fig3Projectedeligibledonors.png","url":"https://assets-eu.researchsquare.com/files/rs-7800748/v1/cdaa8fec9bc1ca2b1b74c15a.png"},{"id":97693368,"identity":"46c20c37-74b9-456c-b09b-b4166b81e53f","added_by":"auto","created_at":"2025-12-08 11:16:52","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":106227,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"4Fig4projectedsupplyanddemand.png","url":"https://assets-eu.researchsquare.com/files/rs-7800748/v1/88f2b1028aa0828e2870a9b5.png"},{"id":102785476,"identity":"bd72da0a-ae67-4792-a20f-c543f4ca530b","added_by":"auto","created_at":"2026-02-16 16:07:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2392213,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7800748/v1/a0ba06d7-f2c4-4a59-b97a-eec86af816c0.pdf"},{"id":97693366,"identity":"2bcc37e4-8887-4bcd-b51b-4a30e4d52867","added_by":"auto","created_at":"2025-12-08 11:16:51","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":20340,"visible":true,"origin":"","legend":"","description":"","filename":"5Table1SWOT.docx","url":"https://assets-eu.researchsquare.com/files/rs-7800748/v1/8cbda9a6b6bc66b02bce37ed.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Forecasting Blood Supply and Demand under Population Aging: Implications and Challenges for Healthcare Resource Allocation","fulltext":[{"header":"Background","content":"\u003cp\u003eBlood transfusion is a key component of modern health care. It supports the management of trauma and hematologic and oncologic disorders and enables major surgery and palliative care. Ensuring a safe and sufficient blood supply requires a stable donor base, effective recruitment strategies, and efficient utilization practices. However, demographic transitions, particularly population aging and declining birth rates, pose growing challenges to the sustainability of blood supplies worldwide [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. As populations age, the demand for blood products increases; for example, approximately 50% of individuals who require blood transfusion are those aged\u0026thinsp;\u0026ge;\u0026thinsp;60 years, indicating the disproportionate need for blood products in this demographic [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In addition to this unequal distribution, countries with rapidly aging populations have a shrinking pool of eligible donors alongside increasing transfusion requirements [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This dual pressure reflects two concurrent trends: younger cohorts make fewer blood donations, whereas older populations, who are more likely to require blood transfusion because of a chronic illness or age-related procedures, expand in size [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. High-income countries such as Japan, South Korea, and several European nations have already documented this phenomenon, reporting both reduced donor availability and increasing transfusion requirements [\u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTaiwan is currently undergoing one of the fastest demographic transitions worldwide [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. According to the National Development Council of Taiwan, the country is expected to become a super-aged society by 2025, with more than 20% of its population aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This transition from an aged to a superaged society in only 7 years is substantially faster than that observed in Europe and the United States, which spanned 20 to 50 years. It is also faster than that observed in all other East Asian countries. Coupled with the persistently low fertility rates in Taiwan, this demographic transition is expected to reshape the balance between blood supply and demand in the country. This delicate balance is also expected to be directly influenced by developments in medical practice. In scenarios involving rapid demographic transitions, regular monitoring of blood demand and the age distribution of both donors and recipients is essential for strategic planning to prevent shortages or unnecessary surpluses [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In this study, we utilized population survey data from the past decade, together with blood collection and utilization records from the Taiwan Blood Services Foundation, to forecast future changes in blood donation eligibility and demand through 2060.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eData sources\u003c/h2\u003e\u003cp\u003eThis study used three types of data sets: (1) demographic data from the Department of Household Registration, Ministry of the Interior, Executive Yuan, (2) annual blood supply and demand data published by the Taiwan Blood Services Foundation from 2010 to 2024; and (3) national population projection data from the National Development Council of Taiwan (2024 edition).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePopulation pyramid construction\u003c/h3\u003e\n\u003cp\u003eRaw data were aggregated into annual totals and organized into a time series format in Microsoft Excel (Microsoft, Redmond, WA, USA). All data were cleaned to ensure consistency in year-to-year reporting. Historical demographic data were compiled on the basis of records from the Department of Household Registration. Future population projection data were obtained from the National Development Council. These data sets were used to construct population pyramids illustrating age and sex distributions across different time points.\u003c/p\u003e\n\u003ch3\u003eBlood donor age distribution\u003c/h3\u003e\n\u003cp\u003eIn Taiwan, healthy individuals aged 17\u0026ndash;65 years are eligible to donate blood. To facilitate blood donation and enhance donation services, the Taiwan Blood Services Foundation has progressively enhanced its blood management information system. This enhancement led to a steady improvement in the volume and quality of donor data available. In this study we analyzed the annual reports published by the Taiwan Blood Services Foundation between 2011 and 2023. Using these reports, we extracted and examined the age distribution of blood donors over the 13-year period from 2011 to 2023 to assess temporal changes in the proportion of donors across different age groups. We also drew future projections of blood supply by examining the medium population growth of national projection. These forecasts account for the rates of fertility, mortality, and net migration. In this study, the projected number of eligible donors was derived from population counts of individuals aged 17\u0026ndash;65 years. Although this age-based criterion aligns with the current donor eligibility standards, it does not account for future changes in policy, health status, or donor recruitment strategies that may influence the actual donor pool.\u003c/p\u003e\n\u003ch3\u003eForecasting method\u003c/h3\u003e\n\u003cp\u003eTo estimate future blood demand, we analyzed the demographic transitions projected in Taiwan for the period between 2025 and 2060. To validate our forecasting model, we retrospectively applied it to historical data obtained from annual reports published by the Taiwan Blood Services Foundation from 2011 to 2024. We also utilized actual blood supply records to simulate predicted demand and evaluate model performance. In addition, we used an exponential smoothing model to forecast both total blood demand and total blood donations. We then performed forecasting by using the \u0026ldquo;Forecast Sheet\u0026rdquo; feature in Microsoft Excel LTSC for Enterprise 2021, which applies a variant of the simple exponential smoothing method that accounts for both level and trend components of time series data. This tool automatically generates point forecasts accompanied by 95% confidence intervals. To project future blood donations, we assumed that the average number of units donated per eligible donor would remain constant over time. Using data obtained for the preceding 5 years, we estimated the average as 2.31 \u0026plusmn; 0.05 units per donor. Using this assumption, we projected a gradual decline in total blood donations from 2023 to 2060. This forecasting procedure involved selecting relevant time series data (i.e., year versus number of blood units), using the feature of \u0026ldquo;Forecast Sheet\u0026rdquo; from the \u0026ldquo;Data\u0026rdquo; tab, specifying the forecast horizon (e.g., 10 to 50 years ahead), and exporting the predicted values along with their corresponding confidence intervals for further analysis and visualization.\u003c/p\u003e\n\u003ch3\u003eModel validation\u003c/h3\u003e\n\u003cp\u003eTo evaluate the accuracy of the forecasting model, back-testing was conducted using historical data. Specifically, the exponential smoothing model was trained on data from 2011 to 2020 to generate forecasts for the period between 2021 and 2024. The forecasted values were then compared with the actual observed blood issue volumes reported by the Taiwan Blood Services Foundation. Finally, forecast performance was evaluated using standard error metrics, including the mean absolute error and root mean square error. Overall, the forecasting model demonstrated acceptable predictive accuracy, supporting its application in long-term trend projection.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003ePopulation age structure by sex in 2000, 2025, and 2060\u003c/h2\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e depicts a progressive demographic shift in the age distribution of the Taiwanese population from 2000 to 2060. In 2000, the population pyramid demonstrates a broad base and a narrow apex, which are characteristic of a young population with relatively high birth rates. By 2025, the base substantially narrows, indicating declining birth rates, whereas the upper segments of the pyramid expand, consistent with population aging. Projections for 2060 suggest an inverted pyramid shape, with a high concentration of older age groups and a sharp reduction in younger cohorts, indicating both advanced population aging and overall population decline. Across all time points, women consistently outnumber men in older age brackets, a pattern likely attributable to the longer life expectancy of women.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eDonor population trends\u003c/h3\u003e\n\u003cp\u003eA major shift was observed in the age distribution of blood donors from 2011 to 2024. The proportion of donors aged 17\u0026ndash;20 years steadily decreased from 15.7% in 2011 to 5.6% in 2024 (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003eA). A similar downward trend was observed among donors age 21\u0026ndash;30 years. By contrast, a uniform increase was observed in the proportion of donors aged 51\u0026ndash;65 years, rising from 13.3% to 24.8% over the same period. During this period, the proportions of donors aged 31\u0026ndash;40 and 41\u0026ndash;50 years remained relatively stable, with only minor fluctuations observed. By 2023, individuals aged 41\u0026ndash;65 years had accounted for more than half of the entire donor population, indicating a clear shift toward an aging donor base. During the same period, a uniform decline was observed in the absolute number and percentage of first-time blood donors aged\u0026thinsp;\u0026le;\u0026thinsp;24 years (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003eB). The number of young first-time donors decreased from 117,932 in 2011 to 49,172 in 2024, representing a reduction of 58.3%. Correspondingly, their proportion among all first-time donors decreased from 69.5% to 50.3%. Notably, this decline became faster after 2019, with a marked drop between 2019 and 2020 (from 83,992 to 69,098 donors). Throughout the study period, both the absolute number and proportion of young first-time donors markedly decreased. Overall, these findings underscore a significant and sustained reduction in the number of young first-time blood donors, highlighting a demographic shift that may necessitate targeted recruitment strategies to engage younger donors and ensure the long-term stability of blood supply.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eLong-term projections of the eligible blood donor population\u003c/h2\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the projected demographic shifts of the eligible blood donor population in Taiwan between 2010 and 2060. Panel A displays absolute population counts across three age groups: 0\u0026ndash;16 years (future potential donors), 17\u0026ndash;24 years (emerging donors), and 25\u0026ndash;65 years (core donors). The overall population across all age groups is expected to decline over time, with the sharpest decline observed among donors aged 25\u0026ndash;65 years. In accordance with population projection data, a progressive drop is expected in the number of eligible blood donors aged 17\u0026ndash;65 years from 16\u0026nbsp;million in 2025 to 7\u0026nbsp;million in 2070. This drop represents a reduction of almost 56% in the number of potential donors (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003eA). Although donors aged 17\u0026ndash;65 years remain the primary source of blood donations, their proportion has started demonstrating a significant downward trajectory after 2020. The proportion of donors aged 17\u0026ndash;24-years has also started demonstrating a steady decline, limiting the recruitment of new and young donors. Panel B depicts the rate of change in the proportion of eligible donors aged 17\u0026ndash;65-years stratified by sex. In the early 2020s, the proportions of both male and female donors started exhibiting a steady and nearly identical decline. By 2040, these proportions are expected todecline by more than 20%, and by 2066, they are expected to decline by more than 50% relative to the 2011 baseline. Overall, these findings highlight a key demographic challenge for the blood services system of Taiwan: the dual impact of an aging population and shrinking donor pool across both male and female donors. To address this challenge, strategic interventions are urgently required to maintain the donor population.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eEstimated future blood demand and blood donations\u003c/h2\u003e\u003cp\u003eAnalysis of blood demand and supply trends from 2011 to 2060 revealed a projected decline in blood donations in a medium population growth scenario. Between 2011 and 2024, both blood donations and blood issue volumes in Taiwan remained relatively stable, with annual units ranging from approximately 2.3 to 2.5\u0026nbsp;million. A slightt upward trend was observed starting around 2020, with blood donations and blood issue volumes converging at approximately 2.5\u0026nbsp;million units by 2024. Projections based on a medium population growth scenario indicate that blood donations will peak around 2027 and then gradually decline, falling below 2.5\u0026nbsp;million units by 2060. By contrast, projected blood demand is expected to steadily increase, surpassing 3\u0026nbsp;million units by 2037 and reaching more than 3.6\u0026nbsp;million units by 2060. This change represents a 40% increase relative to 2024, with an average annual growth rate of approximately 1.2%. Notably, the gap between blood supply and demand is expected to significantly increase after 2027, indicating a potential shortage in supply if these current trends continue unabated.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study presents future projections for the supply and demand of blood in Taiwan with the country transforming into a superaged society. First, the total population of Taiwan is expected to substantially decline, accompanied by accelerated population aging (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Second, because of the combined effects of population aging and the declining population of younger blood donors, the donor population itself is aging, as evidenced by the marked decline in the proportion of young blood donors over the past decade (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Third, the number of eligible blood donors is projected to significantly decrease in the upcoming decades, posing a major challenge to the maintenance of a stable blood supply (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Fourth, a critical crossover point in supply and demand is expected to occur around 2027, when the available donated units are projected to no longer meet transfusion requirements (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Taken together, these projections highlight the urgent need for strategic planning (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) to mitigate the impact of demographic transitions on the sustainability of blood services.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSWOT matrix and corresponding strategies\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStrengths\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eINTERNAL FACTORS\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eWeaknesses\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eINTERNAL FACTORS\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e\u0026#158; Established blood supply and safety system\u003c/p\u003e\u003cp\u003e\u0026#158; Strong voluntary donation culture\u003c/p\u003e\u003cp\u003e\u0026#158; Advanced medical technology and transfusion safety\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e\u0026#158; Blood product wastage (over-ordering, expiration)\u003c/p\u003e\u003cp\u003e\u0026#158; Low engagement of younger donors\u003c/p\u003e\u003cp\u003e\u0026#158; Lack of real-time cross-hospital inventory\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOpportunities\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEXTERNAL FACTORS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e\u003cb\u003eS/O Strategies\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e\u003cb\u003eW/O Strategies\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u0026#158; AI and big data for supply-demand forecasting\u003c/p\u003e\u003cp\u003e\u0026#158; International collaboration and best practices\u003c/p\u003e\u003cp\u003e\u0026#158; Emerging technologies (synthetic blood, cell therapies)\u003c/p\u003e\u003cp\u003e\u0026#158; Integration with long-term care and public health policies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e\u0026#158; Apply AI-driven demand forecasting in Taiwan\u0026rsquo;s blood system\u003c/p\u003e\u003cp\u003e\u0026#158; Expand voluntary donation via digital platforms, peer networks, campuses, and health education\u003c/p\u003e\u003cp\u003e\u0026#158; Leverage international collaboration for synthetic blood and advanced medical technologies\u003c/p\u003e\u003cp\u003e\u0026#158; Use intraoperative autotransfusion and minimally invasive surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e\u0026#158; Enhance education/outreach to boost youth donation\u003c/p\u003e\u003cp\u003e\u0026#158; Build AI-supported, real-time cross-hospital inventory system\u003c/p\u003e\u003cp\u003e\u0026#158; Adopt international best practices to reduce inefficiencies\u003c/p\u003e\u003cp\u003e\u0026#158; Develop proactive donor recruitment, including older healthy individuals\u003c/p\u003e\u003cp\u003e\u0026#158; Reconsider transfusion eligibility criteria\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eThreats\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEXTERNAL FACTORS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e\u003cb\u003eS/T Strategies\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e\u003cb\u003eW/T Strategies\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u0026#158; Declining eligible donors (17\u0026ndash;65 years)\u003c/p\u003e\u003cp\u003e\u0026#158; Rising demand from population aging\u003c/p\u003e\u003cp\u003e\u0026#158; Vulnerability to pandemics/disasters\u003c/p\u003e\u003cp\u003e\u0026#158; Changing social values affecting donation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e\u0026#158; Use strong infrastructure to maintain supply in emergencies\u003c/p\u003e\u003cp\u003e\u0026#158; Promote donor retention to counter shrinking donor pool\u003c/p\u003e\u003cp\u003e\u0026#158; Improve preservation to extend shelf life and ease shortages\u003c/p\u003e\u003cp\u003e\u0026#158; Implement patient blood management, optimize surgical techniques, and enforce stricter transfusion guidelines\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e\u0026#158; Reduce wastage via optimized transfusion practices\u003c/p\u003e\u003cp\u003e\u0026#158; Increase donor engagement to offset population decline\u003c/p\u003e\u003cp\u003e\u0026#158; Prepare contingency plans for outbreaks/disasters\u003c/p\u003e\u003cp\u003e\u0026#158; Reevaluate transfusion eligibility criteria\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eBlood transfusion is an essential component of medical interventions that aim to maintain the health and functional ability of older adults. These interventions include joint replacement surgery [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], cancer therapy, and palliative care [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. If the amount of blood available fails to meet demand, the quality and accessibility of care for elderly patients may become compromised, ultimately undermining the goals of healthy aging. Therefore, ensuring a sustainable blood supply is a key prerequisite for meeting the health-care requirements of a superaged society and for protecting the health and ensuring the functional independence of aging populations. According to a review of the global aging trajectories of major countries, France is the first nation to transform into an aging society in 1864, and Japan is the first country to be classified as a superaged society in 2005 [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Taiwan is projected to reach a superaged status by 2025 [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Notably, the pace of population aging in Taiwan is among the fastest worldwide. Specifically, Taiwan will have taken only 25 years to transition from an aging society to an aged society and only 7 years to transform from an aged society to a superaged society [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Our findings are consistent with trends observed in other high-income, rapidly aging societies, where declining birth rates and increasing life expectancy have narrowed the base of eligible blood donors while driving a growing demand for transfusion services. Similar demographic trajectories and corresponding pressures on national blood systems have been reported in Japan, South Korea, and several European countries.\u003c/p\u003e\u003cp\u003ePrevious research has indicated a strong link between future blood supply and demographic characteristics [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In this study, we analyzed demographic data obtained from the Taiwanese household registration system for the period between 2011and 2024, and we examined donor records maintained by the Taiwan Blood Services Foundation. We observed that the blood donation patterns in Taiwan are associated with population structure, consistent with the aforementioned finding. As depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003eA, the proportion of donors aged 17\u0026ndash;20 years steadily decreased from 15.7% in 2011 to 5.6% in 2024, and the proportion of donors aged 17\u0026ndash;30 years also uniformly decreased, accompanied by an increase in the proportion of middle-aged donors (51\u0026ndash;65 years). Although this growing contribution of middle-aged donors provides short-term stability [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], it raises long-term concerns, particularly because this cohort is at a high deferral risk of age-related conditions or medication use and is eventually expected to become ineligible to donate [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Simultaneously, the number of first-time donors has markedly decreased. Specifically, the number of first-time donors aged\u0026thinsp;\u0026le;\u0026thinsp;24 years substantially decreased from 117,932 (69.5%) in 2011 to 49,172 (50.3%) in 2024, reflecting a reduction of 58.3% (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003eB). First-time blood donors are key contributors to the blood donor base [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Traditionally, blood donors recruitment efforts have targeted younger populations because they are assumed to be healthier and able to donate blood for longer periods [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Furthermore, the decline observed in the number of first-time donors reflects multiple aspects, including academic and economic pressures, reduced school-based drive, and the impact of COVID-19, which disrupted recruitment channels and imposed additional deferrals [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Together, these trends make a bad situation: the declining participation of young donors, who represent the future of the donor base, and the increasing reliance on older donors, whose capacity may become limited. In recent years, the proportion of young blood donors in Taiwan has markedly declined, whereas reliance on middle aged donors has increased. Although older donors often demonstrate higher return rates and more uniform donation patterns, they are also at a greater risk of becoming ineligible due to the possibility of age-related issues [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In addition, an aging recipient population is projected to drive a sustained increase in blood demand [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This evolving landscape of blood supply and demand necessitates the development of progressive strategies to ensure blood transfusion sufficiency and safety in the upcoming decades.\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003e illustrates major demographic transitions that are expected to shape Taiwan\u0026rsquo;s future blood donor base. After remaining stable or even increasing before 2020, the population of both younger donor (17\u0026ndash;24 years) and core donors (25\u0026ndash;65 years) are projected to steadily decline after 2020, with an accelerating downward trend over time. By 2059, the population of both male and female eligible donors are projected to have decreased by approximately 50%, presenting difficulties in maintaining a stable blood supply. Similar patterns have been observed in other high-income countries, where population aging has resulted in a decrease in the number of core donors and limited the inflow of first-time younger donors [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The parallel decline in the number of both male and female donors suggests that this trend is not sex-specific but rather reflects broader structural demographic transitions. Similar non-sex-specific downward trends have been reported in population-based donor projections in Europe and Japan [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. These findings underscore the need for population-wide interventions and continuous monitoring of donor demographics.\u003c/p\u003e\u003cp\u003eIntegrating donor population forecasts with blood utilization projections is essential for anticipating future challenges and shaping effective policy responses. The steady increase observed in blood demand reflects the anticipated increase in age-related medical procedures, chronic disease management requirements, and surgical interventions [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. As shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e4\u003c/span\u003e, blood demand is projected to continue increasing, driven by population aging and the associated medical needs, further increasing the risk of an imbalance between supply and demand. Although slight recovery has been observed in both blood donations and blood issue volumes during the period from 2020 to 2023, likely because of post-pandemic normalization and targeted recruitment, blood supply is expected to start decreasing again around 2030. This inflection point corresponds to major demographic shifts, including Taiwan\u0026rsquo;s rapidly aging population and declining birth rates, which both have major implications for health-care resource planning. By 2060, the imbalance between demand and supply is projected to exceed 1\u0026nbsp;million units annually if donation levels are not maintained or improved. Therefore, the next 5 years represent a crucial period, because the supply gap is projected to become increasingly significant under all population scenarios, particularly in the low population growth scenario, in which donation decline is most pronounced.\u003c/p\u003e\u003cp\u003eTo address the aforementioned challenges, multifaceted strategies are required to both replenish the donor pool and ensure the sustainability of the blood supply. The SWOT framework, summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, guided the development of four categories of strategies by linking internal strengths and weaknesses with external opportunities and threats [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. S/O strategies build on Taiwan\u0026rsquo;s strong infrastructure, culture of voluntary donation, and advanced medical technologies by applying AI-driven forecasting, expanding recruitment through digital platforms and health education, strengthening international collaboration for synthetic blood, and promoting intraoperative autotransfusion or minimally invasive surgery. W/O strategies address internal gaps by enhancing outreach to younger donors, developing a real-time cross-hospital inventory system, adopting international best practices, and re-evaluating donor eligibility to include older but healthy individuals. Meanwhile, S/T strategies leverage existing strengths to counter demographic and systemic threats by maintaining supply during emergencies, improving preservation methods [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], and implementing patient blood management with stricter transfusion guidelines [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Finally, W/T strategies mitigate vulnerabilities by reducing wastage [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], improving donor engagement, strengthening contingency planning for disasters [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], and reassessing transfusion eligibility criteria [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Collectively, these strategies emphasize the importance of integrating technological innovation, international cooperation, and systemic reforms to enhance the resilience of Taiwan\u0026rsquo;s blood supply system. By combining proactive donor recruitment with optimized clinical practices, Taiwan can better adapt to demographic shifts and secure a sustainable blood supply for future healthcare demands.\u003c/p\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eLimitations and Future Directions\u003c/h2\u003e\u003cp\u003eThis study has several limitations. First, our projections are based on national demographic estimates and historical transfusion data, which may not fully capture unforeseen changes in health-care practices, donor eligibility criteria, or advancements in medical technology. Second, we did not model the potential impact of emerging alternatives, such as artificial blood products, advanced cell therapies, or expanded autologous transfusion programs, which may alter future demand. Third, although Taiwan represents a valuable case study because of its rapid population aging dynamic, direct generalization to other health-care systems should be made with caution. Future studies should incorporate more dynamic modeling approaches, evaluate policy interventions such as patient blood management, and conduct comparisons on an international level to refine predictions.\u003c/p\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003e This study was conducted in accordance with the principles of the Declaration of Helsinki and relevant local regulations. Ethical approval was obtained from the Research Ethics Committee of Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation (REC113-13). The study utilized three types of datasets: (1) demographic data from the Department of Household Registration, Ministry of the Interior, Executive Yuan; (2) annual blood supply and demand data published by the Taiwan Blood Services Foundation from 2010 to 2024; and (3) n national population projection data from the National Development Council of Taiwan (2024 edition). As the study did not involve any direct interventions or experimental procedures with human participants, the Ethics Committee waived the requirement for informed consent.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis work was supported by grants from the Jen-Ai Hospital and the Central Taiwan University of Science and Technology, Taichung, Taiwan (CTU114-JAH-001).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eLin YM contributed to study conceptualization, investigation, and formal analysis. Ma CC contributed to study supervision and writing\u0026mdash;original draft. Chien JH contributed to data collection, investigation, and formal analysis. Ho TF contributed to project administration, supervision, funding acquisition, conceptualization, methodology, and writing\u0026mdash;review \u0026amp; editing.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors sincerely thank all the participants involved in this project for their valuable contribution and dedication. This manuscript was edited by Wallace Academic Editing.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAll data analyzed in this study are either publicly available from government websites (Ministry of the Interior and National Development Council of Taiwan) or available upon reasonable request with permission from the Taiwan Blood Services Foundation.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKim KW, Kim OS. Super Aging in South Korea Unstoppable but Mitigatable: A Sub-National Scale Population Projection for Best Policy Planning. 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BMC Geriatr 24, (2024).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHsu Y-T, et al. Social participation trajectories in late life and cognitive functioning \u0026ndash; A sequence analysis based on Taiwan Longitudinal Study on aging. SSM - Popul Health. 2025;31:101821.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGreinacher A, et al. A population-based longitudinal study on the implication of demographic changes on blood donation and transfusion demand. Blood Adv. 2017;1:867\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHyde MK, et al. Rethinking the role of older donors in a sustainable blood supply. Transfusion. 2025;65:758\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRoh J, Choi SJ, Kim S, Min H, Kim HO. Blood Supply and Demand in Korea: What is in Store for the Future? Yonsei Med J. 2020;61:400\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGillet P, et al. First-time whole blood donation: A critical step for donor safety and retention on first three donations. Transfus clinique et biologique: J de la Societe francaise de Transfus sanguine. 2015;22:312\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGreinacher A, Fendrich K, Hoffmann W. Demographic Changes: The Impact for Safe Blood Supply. Transfus Med hemotherapy: offizielles Organ der Deutschen Gesellschaft fur Transfusionsmedizin und Immunhamatologie. 2010;37:141\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOdajima T, et al. Analysis of factors affecting return of first-time blood donors in Japan: The role of small volume whole blood collection. ISBT Sci Ser. 2021;16:168\u0026ndash;77.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNgo A, Masel D, Cahill C, Blumberg N, Refaai MA. Blood Banking and Transfusion Medicine Challenges During the COVID-19 Pandemic. 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Transfus Med. 2022;32:71\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. \u003cem\u003eAgeing and Health.\u003c/em\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/ fact-sheets/detail/ageing-and-health\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/ fact-sheets/detail/ageing-and-health\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2024).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eM\u0026uuml;ller-Steinhardt M, Weidmann C, Kl\u0026uuml;ter H. Changes in the Whole Blood Donor Population in South-West Germany: 2010 versus 2016. Transfus Med Hemother. 2017;44:217\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSch\u0026ouml;nborn L, et al. Longitudinal Changes in the Blood Supply and Demand in North-East-Germany 2005\u0026ndash;2015. Transfus Med Hemother. 2017;44:224\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePuyt RW, Lie FB, Wilderom C. P. M. The origins of SWOT analysis. Long Range Plann. 2023;56:102304.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWilliam N, Acker JP. Innovations in red blood cell preservation. Blood Rev. 2025;72:101283.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiu WJ, et al. An imbalance in blood collection and demand is anticipated to occur in the near future in Taiwan. J Formos Med Association = Taiwan yi zhi. 2022;121:1610\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChien J, Yao C, Chen H, Ho T-F. Trends in blood transfusion and causes of blood wastage: a retrospective analysis in a teaching hospital. BMC Health Serv Res. 2025;25:67.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStanworth SJ, et al. Effects of the COVID-19 pandemic on supply and use of blood for transfusion. Lancet Haematol. 2020;7:e756\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGoldman M. How do I think about blood donor eligibility criteria for medical conditions? \u003cem\u003eTransfusion\u003c/em\u003e 61, 2530\u0026ndash;2537 (2021).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Aging, Transfusion, Blood supply and demand, Forecasting, Demographic, Young first-time donor, SWOT analysis","lastPublishedDoi":"10.21203/rs.3.rs-7800748/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7800748/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePopulation aging poses major challenges to health-care systems by increasing the prevalence of chronic diseases and raising the demand for blood transfusion. Blood is essential in surgery, cancer therapy, and critical care, which are frequently used in older adults. However, declining birth rates and diminishing younger cohorts threaten the sustainability of the blood donor pool.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eIn this study, we integrated demographic data from the Taiwanese household registration system, annual blood supply and demand data from the Taiwan Blood Services Foundation, and national population projection data from the National Development Council of Taiwan to forecast the supply-and-demand dynamics of blood in Taiwan through 2060.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAn analysis of population pyramids revealed Taiwan\u0026rsquo;s progression toward a superaged society, with profound implications for blood supply management. It also revealed a marked reduction in the absolute number and proportion of young first-time donors. According to population projections, the number of individuals eligible to donate blood (aged 17\u0026ndash;65 years) is expected to decrease from 16\u0026nbsp;million in 2025 to approximately 8.7\u0026nbsp;million by 2060. We identified a projected crossover point around 2027, when demand is expected to exceed supply. If current trends persist. this shortfall is forecasted to surpass 1\u0026nbsp;million units annually by 2060.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThe SWOT analysis further identified internal strengths and weaknesses, alongside external opportunities and threats. Based on this, some strategic directions were proposed to enhance recruitment, optimize utilization, adopt emerging technologies, and safeguard long-term sustainability. Ensuring blood availability is essential for healthy aging, as equitable access to transfusion supports medical interventions that preserve functional ability and improve quality of life in older adults. Overall, these findings highlight the urgent need for developing proactive donor recruitment strategies, reconsidering transfusion eligibility criteria, and enhancing patient management to ensure the availability of blood as a key resource.\u003c/p\u003e","manuscriptTitle":"Forecasting Blood Supply and Demand under Population Aging: Implications and Challenges for Healthcare Resource Allocation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-08 11:16:47","doi":"10.21203/rs.3.rs-7800748/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-08T05:37:53+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-05T09:14:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-05T09:01:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"202226028632144289653663649238973002958","date":"2025-12-04T09:21:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"245901774060407540704071184661223532828","date":"2025-12-04T03:51:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"164310469566307472618137571427257761956","date":"2025-12-04T03:05:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"229965406092739293487139188068871068016","date":"2025-12-04T03:02:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-04T02:56:37+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-27T15:15:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-13T13:44:26+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-12T05:08:43+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-10-12T05:05:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e5412738-ca45-4638-8d0c-b9d28df66f1e","owner":[],"postedDate":"December 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-16T16:03:37+00:00","versionOfRecord":{"articleIdentity":"rs-7800748","link":"https://doi.org/10.1186/s12913-026-14150-9","journal":{"identity":"bmc-health-services-research","isVorOnly":false,"title":"BMC Health Services Research"},"publishedOn":"2026-02-12 15:59:06","publishedOnDateReadable":"February 12th, 2026"},"versionCreatedAt":"2025-12-08 11:16:47","video":"","vorDoi":"10.1186/s12913-026-14150-9","vorDoiUrl":"https://doi.org/10.1186/s12913-026-14150-9","workflowStages":[]},"version":"v1","identity":"rs-7800748","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7800748","identity":"rs-7800748","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}