Assessment of Legal and Regulatory Compliance in Blood Donation Practices in Nigeria

Assessment of Legal and Regulatory Compliance in Blood Donation Practices in Nigeria | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessment of Legal and Regulatory Compliance in Blood Donation Practices in Nigeria Oluwatosin Oni, Leroy Edozien, Jumoke Olowookere This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7597198/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 17 You are reading this latest preprint version Abstract Background In compliance with WHO standards, the Nigerian government established laws to prevent paid blood donation. However, Nigeria struggles to provide safe and adequate blood supply, negatively affecting health indicators. This study compared blood donation practices in Nigeria with existing laws using primary and secondary data. Methods A descriptive and analytical cross-sectional survey was conducted in Akure, Nigeria, involving 805 eligible donors (aged 18–65) and 102 healthcare workers. Primary data were collected via structured questionnaires assessing knowledge, practices, and perceptions. Secondary data from a hospital blood bank captured donation types. Data were analyzed using SPSS version 21, with descriptive statistics and chi-square tests for associations. Results Among eligible donors, 38.5% had donated blood previously, but only 8.0% were regular donors and 4.3% donated voluntarily. Awareness of the legal framework prohibiting paid donation was low (29.7%). Secondary data showed < 1% voluntary donations. Healthcare workers reported frequent delays (72.0%) and patient deaths (43.0%) due to blood shortages. Gender was significantly associated with willingness to donate voluntarily (p = 0.001). Conclusions Compliance with voluntary non-remunerated blood donation laws is poor in Nigeria, leading to blood shortages. Key recommendations include phased transition from paid to voluntary systems, enhanced public sensitization, establishment of donor databases, and stricter enforcement with penalties for non-compliance. Compliance legal framework Blood donation voluntary donors Figures Figure 1 Figure 2 INTRODUCTION In the realm of healthcare, there are binding regulations that prescribe the rights and responsibilities of various stakeholders, including governments, health care professionals, corporations, civil society, and the general population of a country. These regulations collectively constitute the legal framework or structure governing the domain of health delivery systems. These regulations manifest in various forms, such as statute regulatory and administrative laws, contracts, case law, and customary laws. The entities involved in creating these rules and their specific forms can vary from one country to another. 1 A legal framework is a foundational structure of rules, regulations, and principles that provides a systematic and organized approach to governing various aspects of society. It serves as a scaffolding upon which laws, policies, and regulations are constructed and applied to achieve specific goals, uphold rights, and maintain order within a jurisdiction. Legal frameworks play a crucial role in guiding individuals, organisations, and governments in their interactions and decision-making processes. These frameworks have several fundamental purposes, such as regulation, the protection of rights, accountability, consistency and enforcement. They are expected to evolve to reflect changing societal values, technological advancements, and emerging challenges. They must adapt to remain effective in addressing contemporary issues. Blood transfusion is a crucial medical intervention that saves lives and enhances health outcomes. Unfortunately, many patients in need of blood transfusions face challenges in accessing safe blood promptly. Ensuring the availability of safe and adequate blood should be an integral component of every nation’s health care policy and infrastructure. To address this issue, the African Health Organization (AHO) recommends the establishment of a well-coordinated national framework for activities related to blood collection, testing, processing, storage, and distribution. In 2018, a national blood policy was in place in 73% of the reporting countries, which translates to 125 out of 171. Moreover, specific legislation addressing the safety and quality of blood transfusion was established in 66% of the reporting countries, with 113 out of 171 having such regulations. This breakdown includes 79% of high-income countries, 63% of middle-income countries and 39% of low-income countries. These statistics highlight the importance of having robust policies and legal frameworks in place to ensure the safe and effective provision of blood transfusions worldwide. 2 In December 2006, Nigeria established a comprehensive National Blood Transfusion Policy through the publication of a set of guidelines. This National Blood Policy essentially consisted of a series of action plans, all aimed at ensuring the provision of safe, accessible, and affordable blood donor units whenever and wherever they are needed throughout the country. 3 The Nigerian National Blood Policy made the following provision in section XIV: “Blood donations shall be based on the principle of regular, voluntary and nonremunerative donations. Financial rewards for blood or blood component donation should be prohibited. Donor appreciation by giving tokens, certificates, badges, and direct transport expense refunds is acceptable. Donor motivation and mobilization should be promoted through extensive awareness programs through organized donor drives, information education and communication materials, schools and public campaigns, print and electronic media, jingles, billboards, posters, and other methods. Attention to donor safety, care, and comfort should be enforced throughout the National Blood Service. Donor selection, deferral, counselling and appropriate record-keeping should be performed as specified in the NBS guidelines. Family replacement donation systems shall be gradually phased out as voluntary donation programs become established”. 4 The World Health Organization (WHO) has consistently underscored the importance of obtaining blood from voluntary, nonremunerated donors as a strategy to significantly diminish the potential risks associated with the transmission of transfusion-transmissible infections (TTIs). This stance has been reaffirmed and substantiated by a growing body of research conducted by Nigerian scholars, and the World Health Organization (WHO) has set a target of attaining 100% voluntary nonremunerated donations globally by 2023. 5 To meet the WHO standard of blood transfusion practice, the Nigerian government made policy provisions as documented in part VI of the National Health Act (NHA) 2014. Subject to the provision of section 53, there are specific restrictions in place, such as the prohibition of removing nonreplaceable tissue from a person younger than 18 years. Additionally, the extraction of tissue, blood, or blood products for merchandise, sale, or commercial activities is strictly forbidden. In the event of a contravention or failure to comply with the provisions above, the individual responsible commits an offence. The penalties for such offences vary: in the case of tissue, a fine of N 1,000,000 or imprisonment for a minimum of two years, or both, is applicable; for blood or blood products, the penalty is a fine of N 100,000 or imprisonment for a term not exceeding one year, or both. 6 Additionally, section 53 of the NHA, 2014, states that it is considered an offense for an individual who has donated tissue, blood, or a blood product to receive any form of financial or other reward for such a donation, with the exception of the reimbursement of reasonable costs incurred in providing the donation. Additionally, selling or trading in tissue, blood, or blood products is prohibited, except for reasonable payments made in appropriate health establishments for the procurement of tissues, blood, or blood products. In the event of a contravention under this section, the individual responsible commits an offense. Upon conviction, they are subject to a fine of N 100,000 or imprisonment for a period not exceeding one year, or both. 7 Despite these legal provisions, the objective of providing safe and adequate blood units has remained elusive in Nigeria and several other African nations, leading to adverse effects on health indicators. Effective global health care delivery relies heavily on a robust and secure supply of blood units, which can serve as life-saving resources in various critical medical scenarios. According to Aneke et al., 2015, only half a million units of blood were collected from both the private and public health sectors in 2004, while the estimated blood requirement for the year was 1.5 million units. 8 However, in the public sector, the donor population comprises approximately 25% commercial donors and approximately 75% replacement donors, with minimal voluntary unpaid donors. In the private sector, approximately 75% of the donor population consists of commercial donors, while approximately 25% consists of replacement donors, and the percentage of voluntary unpaid donors is insignificant. 9 Globally, an impressive 80 million units of blood are donated annually, but notably, only two million units come from sub-Saharan Africa, where the need is monumental. 10 In Nigeria, although a good percentage of the population is eligible for blood donation considering age, a mere four out of every thousand individuals are voluntary blood donors. 11 In a study by Ahmed et al. (2007), the proportion of donations designated as voluntary and family replacement significantly declined, decreasing from 31% to 5% and from 49% to 23%, respectively. These declines were countered by noteworthy increases in the proportions of donations categorized as commercial or autologous, which surged from 20% to 63% and from 1% to 9%, respectively. Many studies on blood donation and transfusion have focused on transfusion-transmissible infections and the sufficiency of the blood unit supply in Nigeria. However, to the best of our knowledge, no study in Nigeria has compared blood donation practices with the legal framework contained in the National Health Act 2014 (NHA), while various studies have shown that we are nowhere near the World Health Organization (WHO) target of having a 100% voluntary donation system. Hence, this study assessed blood donation practices in Nigeria and compared our compliance with the legal provisions of the NHA, 2014, on blood donation. Additionally, factors responsible for poor compliance or various factors that might be responsible for poor implementation of the NHA, 2014 provision on blood transfusion in Nigeria, were assessed. Furthermore, the study explored the possible need for revisions in policy provision and offered recommendations in the best interest of ensuring safe and adequate blood supply, thereby ensuring that no Nigerian has to suffer owing to the unavailability of blood units for medical intervention. This research evaluated the degree of compliance with blood donation practices and the law governing blood donation in Nigeria, the factors possibly responsible for poor compliance, as well as the ways of improving compliance with the law governing blood donation practices in Nigeria. METHODOLOGY Study area The primary focus of this study was Akure city, which is located within the Akure South Local Government Area (LGA). The Akure South LGA falls within the Ondo Central Senatorial district and is one of the eighteen LGAs within Ondo State. The LGA's administrative centre is located in Akure, which also serves as the state capital. The Akure South LGA is the most populous LGA in Ondo State. The study design was a health facility and community-based descriptive cross-sectional survey of health care workers and members of the community aged 18–65 years. Study population. In this study, the target populations were (a) potential blood donors and (b) healthcare workers working in health facilities that have a blood transfusion service. Data collection Primary Data Two structured questionnaires were used as the survey instrument for the collection of primary data. The first structured questionnaire was administered to potential blood donors to assess their knowledge of and compliance with Nigeria's legal framework for guiding voluntary blood donation. The second structured questionnaire was designed to assess healthcare workers' knowledge about the legal framework preventing commercial blood donation and to collect information about blood sufficiency from healthcare workers. Secondary Data The secondary data were obtained from the Blood Bank Unit of the Medial Laboratory Department, University of Medical Sciences Teaching Hospital, Akure Complex. The data were used to capture compliance with voluntary blood donation over paid donation and family replacement (an indirect form of paid donation). Data Management The primary data and secondary data were analysed via the Statistical Package for the Social Sciences (SPSS) version 21 program. Descriptive analysis was used to determine the frequency distribution and percentage of all sections of the questionnaire. Ethical approval: Ethical approval was obtained from the University of Medical Sciences, Ondo City, Ondo State, Nigeria, with the approval number: NHREC/TR/UNIMED-HREC-Ondo St/22/06/21. All methods were performed in accordance with the Declaration of Helsinki (2024 revision). RESULTS AND DISCUSSION From table 1, a total of 805 potential blood donors between 18 and 65 years of age completed the structured questionnaire aimed at assessing the knowledge and practice of potential blood donors with respect to voluntary blood donation. Variables Frequency (n) (%) Age 18-24 years 231 28.7 25-34 years 306 38.0 35-44 years 188 23.4 45-54 years 72 8.9 55-65 years 8 1.0 Gender Male 411 51.1 Female 394 48.9 Highest level of education Graduate 421 52.3 O' Level 35 4.3 Post Graduate 308 38.3 Secondary Education 41 5.1 Have you heard about blood donation before? Yes 785 97.5 No 20 2.5 Are you aware of Nigeria's legal framework or policy guiding voluntary blood donation? Yes 239 29.7 No 566 70.3 Is donating blood for financial remuneration legally permitted in Nigeria? No 238 29.6 Not Sure 386 48.0 Yes 181 22.5 Have you ever donated blood before? No 495 61.5 Yes 310 38.5 Will you be willing to donate blood without any financial remuneration? No 137 17.0 Not Sure 93 11.6 Yes 575 71.4 Why will you not donate blood without any financial remuneration? I need money to feed 4 3.0 My blood would be sold eventually 74 54.0 Lack of motivation 53 38.7 Poor attitude of HCWs 6 4.3 How can voluntary blood donation be encouraged in Nigeria? Introduce the use of mobile blood-donating vans 6 0.7 More sensitization on the need for voluntary blood donation practice 596 74.0 Introduce nonmonetary incentives 41 5.1 Strict punishment for healthcare workers or institutions that sell blood after voluntary donation 54 6.7 Introduce financial incentives 108 13.5 Table 1: Knowledge and practice of potential blood donors with respect to voluntary blood donation in Nigeria. Similarly, 107 health care workers completed the questionnaire aimed at assessing the experience and perceptions of health care workers about voluntary blood donation (Table 2). Would you be willing to donate blood without any financial remuneration? Total p value Yes No Not sure Gender Male 291 58 62 411 0.001 Female 284 79 31 394 Total 575 137 93 805 Table 2: Relationship between gender and willingness to donate without financial remuneration. Note: Table 1 and Table 2 were obtained from the data of the eligible Donors. The majority of the potential blood donors were in the age range of 25--34 years (306 (38.0%)), while the lowest age distribution was 55 - 65 years. Among the respondents, 411 (51.1%) were male, whereas 394 (48.9%) were female. Although almost all potential donors (785, 97.5%) claimed to have heard about blood donation previously, only approximately 30% of the participants said that they were aware of the legal framework or policy that makes commercial blood donation a punishable offense. Among the population eligible for donation, 310 (38.5%) had donated blood. This percentage was higher than the 15.3% reported in a study assessing the knowledge and behaviour of students in Nigerian tertiary institutions towards voluntary blood donation. 12 This difference might be attributed to the greater propensity to donate blood altruistically in 2023 than in 2011, when Salaudeen carried out the initial assessment. Interestingly, a good percentage of the respondents (575; 71.4%) indicated their willingness to donate blood units without any financial benefit. This percentage was higher than the percentage of participants willing to donate their blood without financial payment reported by Ugwu et al . (2018). In the same study, it was revealed that gender and level of education are strongly associated with willingness to donate blood without financial remuneration . 13 Among the respondents, 137 (17.0%) indicated that they would never donate their blood without any financial reward. The reason for this seeming lack of altruism was primarily their perception of exploitation since the freely donated blood would be “sold” to the patient in need. This has been a major obstacle to achieving the legal framework for voluntary blood donation. According to Table 2, sex plays a significant role in the practice of voluntary blood donation. Regarding how to encourage voluntary blood donation in Nigeria, the majority of the respondents, 596 (74.0%), suggested the need for more sensitization. Approximately 6.7% of the respondents suggested strict punishment for healthcare workers who sell blood units after donation, claiming that if the blood units were given freely to patients, voluntary donation would not be a major issue for eligible donors. VARIABLES Frequency (n) (%) Gender Male 63 58.9 Female 44 41.1 Is blood donation for financial remuneration legally permitted in Nigeria? Yes 18 16.8 No 62 57.9 Not sure 27 25.2 Have you had a patient whose treatment or management got delayed due to the lack of blood unit? Yes 77 72.0 No 25 23.4 Not sure 5 4.7 Have you ever had a patient whose treatment outcome could have been better and different if not for the unavailability of a safe blood unit? Yes 55 51.4 No 43 40.2 Not sure 9 8.4 Have you ever lost a Patient due to the lack of blood unit? Yes 46 43.0 No 61 57.0 Not sure 0 0.0 Do you think your Health Facility can cope with the demand for blood unit by relying majorly on voluntary blood donation? Yes 7 6.5 No 83 77.6 Not sure 17 15.9 Do you think encouraging Commercial blood donation can solve the problem of inadequate blood units in Health Facilities? Yes 56 52.3 No 37 34.6 Not sure 14 13.1 Table 3: Experience and perceptions of healthcare workers regarding voluntary blood donation and blood unit sufficiency in Nigeria As shown in Table 3, 63 (58.9%) healthcare workers were male, whereas 44 (41.1%) were female. Also from table 3, a reasonable percentage of healthcare workers (62, 57.9%) were aware of the legal framework prohibiting commercial blood donation in Nigeria. As expected, the proportion of healthcare workers who were aware of this legal framework was greater than that of eligible blood donors (57.9% and 29.6%, respectively). Generally, knowledge about legal provisions prohibiting commercial blood donors is very poor. A good number of healthcare workers, 77 (72%), reported having had patients who had delayed treatments due to the lack of a blood unit. Furthermore, 55 (51.4%) of the healthcare workers reported having had patients whose treatment outcome could have been better, and different patients had a prompt supply of blood units. Similarly, since the inception of the regulation to sustain voluntary blood donation, there has been a sharp decline in the total number of blood units donated annually, especially in low-income and lower-middle-income countries. This was evident in the response of the health workers to their experience of losing patients due to the lack of blood units. Almost half of the healthcare workers, 46 (43.0%), reported having lost at least one patient solely because of the lack or delayed supply of blood units. Losing patients due to a lack of blood units is not alien to the Nigerian health system. On August 2, 2023, the Nigerian Medical Association, Lagos Branch, in a press release, mourned the death of one of its members, Dr. Diaso Vwaere. She was reportedly trapped in an elevator for more than 40 minutes before her rescue. The second paragraph of the press release reads: “We were also reliably informed that there was no blood available for resuscitation and this has become a recurring issue because of the review made by the government on the previous policy on blood donation”. The Nigerian policy on voluntary blood donation as contained in the National Health Act aimed at achieving the WHO 100% voluntary blood donation target. One hundred percent voluntary blood donation is used to reduce transfusion transmissible infections (TTIs) and blood-related mortality. However, this policy has generated another possible challenge with respect to the availability of safe blood for patients in need of a transfusion. According to the WHO, the minimum number of donations required to meet the national blood demand is 1% of the population. Hence, our target is to obtain 1% of our population as voluntary donors. It was estimated that out of 836,969,536 people in the WHO African region in 2010, over 8,000,000 units of blood were required to meet the annual target. A total of 3,486,192 blood units were collected, leaving a shortfall of over 4,500,000. Notably, a good percentage of these units were obtained from paid donors. This severe shortage of blood units has led to the death of several patients who would have survived if not because of a lack of blood units for transfusion. On a global scale, maternal mortality remains a significant concern, with more than half a million women losing their lives each year due to complications related to pregnancy and childbirth. Among these complications, severe bleeding is the leading cause of maternal mortality, contributing to up to 44% of maternal deaths in sub-Saharan Africa. 14 Preventable deaths and deteriorating medical conditions due to low blood units appear to be some visible outcomes of the voluntary blood policy document if not well implemented. The majority of healthcare workers, 83 (77.6%), opined that health facilities cannot cope with the demand for blood units by solely relying on voluntary blood donation. However, 7 (6.5%) of them were optimistic that the blood unit requirement could be actualized through voluntary blood donation, whereas 17 (15.9%) of the respondents had neither conviction. Number of Blood donations Voluntary donations Commercial or paid donations n % N % Total Male 3 0.2 1819 99.8 1822 Female 7 8.5 75 91.5 82 Total blood units donated 10 1894 1904 Table 4: Number of blood donations at the UNIMED THC Akure Complex between April 2022 and August 2023. A comparison of the practices of our health facilities with the policy document regarding voluntary blood donation (Table 4) revealed that a total of 1904 units of blood were donated between April 2022 and August 2023 at the University of Medical Sciences Teaching Hospital, Akure complex. Of these, only 10 units were donated by voluntary donors, accounting for 0.5% of the total units donated, whereas 1894 (99.5%) were from commercial or paid Donors. Seven (70.0%) of the voluntary blood donations were female, whereas 3 (30.0%) were male. The reverse was the case when commercial or paid donations were considered, with the male gender accounting for 1819 (96.0%) and the female gender accounting for the remaining 75 (4.0%). This finding corroborates the findings presented in Table 2 regarding the significance of gender for the practice of voluntary donation. In general, males have a greater propensity for paid blood donation, whereas females are more predisposed to voluntary donation. While the WHO projected that, in the year 2020, member states would have attained 100% voluntary blood donation, this study revealed that Nigeria only has less than 1% compliance in the year 2023 according to this study. This is far from the legal framework. The remaining 99.5% were donated by paid donors and family replacement. Notably, the majority of the family replacement donations were equally donated by commercial blood donors. The graph in figure 1, shows blood transfusion litigation (blue) and judicial outcomes (orange) from 1980–2020. Cases surged in the late 1980s, peaking at about 50 in 1994 amid concerns over HIV and hepatitis, then fell steadily with improved safety measures. Judicial outcomes rose only after the late 1990s, peaking at over 50 around 2015–2016 before declining as most cases were resolved and new filings decreased . In like manner, Nigeria's legal framework for voluntary blood donation is comprehensive, with well-defined punishments for defaulters, including donors who demand payments and healthcare workers who commercialise blood donation. However, there have been no documented cases of penalizing such offenders, suggesting that the legal framework exists mainly to fulfil WHO membership requirements rather than to enforce actual compliance. This poor implementation aligns with the theory of legal realism, indicating that the Nigerian government may not be fully prepared to enforce these laws. Deterrence theory posits that the threat of punishment deters crime. Individuals, acting as rational decision-makers, will avoid criminal acts if the perceived costs or risks outweigh the benefits; thus, donors would avoid accepting N 10,000 to N 15,000 for a blood unit if facing a fine of N 100,000 or up to a year in prison. This theory, which is influential in criminal justice, suggests that stricter enforcement could reduce commercial donations. The Chinese Government, in Article 59 of the Tort Law, 2005, 15 classified blood transfusion damage as no-fault liability, mandating that hospitals compensate patients for transfusion-related infections. This approach, which focused on fairness and justice, led to more rigorous blood screening in China. Nigeria could adopt a similar commitment to ensure ethical practices and thorough blood screening. Given the experience of China, in 1998, recruiting voluntary blood donors in China was a significant challenge, with only 8% of blood donations being unpaid. By 2005, this figure rose dramatically to 95.5%. 16 A significant milestone occurred in 2009 when all clinical blood supplies in China were exclusively sourced from unpaid donations. This marked a notable transformation in the country's blood donation practices, emphasizing the shift toward voluntary and altruistic contributions to ensure the safety and sustainability of the blood supply. The Chinese government achieved this through a series of laws and policies aimed at improving blood safety following an HIV outbreak among paid donors in two provinces in China. 17 From figure 2, initially, in 1998, the Chinese government allowed employer-organized blood donations as a transitional measure. By 2005, they prohibited employer-organized donations and coordinated donations by local blood stations, shifting to a partially mandatory and incentivized unpaid approach. Eventually, China moved to a mutual blood donation system (family replacement), and by 2011, mutual blood donation was cancelled, resulting in 100% voluntary nonremunerated donation. 19 In contrast, Nigeria's policy criminalized paid blood donation without penalizing offenders or providing alternative measures. This policy expected Nigerians to adapt instantly, without a plan for noncompliance or a transition period. Effective change should be a gradual process, not an immediate destination. By learning from China's phased approach, Nigeria can develop a more effective strategy for transitioning to a fully voluntary blood donation system. CONCLUSION AND RECOMMENDATION Why do we enact laws? While social contract thinkers such as Thomas Hobbles, John Locke, and Jean-Jacques Rousseau argue for social order and stability, philosophers such as Immanuel Kant argue that laws should be based on universal principles of morality, for moral justice, to protect individual rights, ensure fairness, and prevent harm. 20 Utilitarian thinkers such as Jeremy Bentham and John Stuart Mill argue that laws should maximize happiness or minimize suffering for the greatest number of people. 21 In the same vein, some legal philosophers, such as John Austin and H.L.A. Hart, advocate for a positivist view of law. They argue that the existence and validity of laws depend solely on their enactment by a recognized authority. 22 The law governing voluntary blood donation in Nigeria fulfils all the schools of thought and philosophical views mentioned above. However, legal provisions do not seem to exist in practice because of poor implementation and inadequate enforcement. Nigeria, like many African countries, has struggled to implement the legal provision guiding voluntary blood donation. Nigeria has less than 1% compliance with the law governing voluntary blood donation. Attempts to implement voluntary nonremunerated blood donation have generated another loop of blood shortages. While the aim of the WHO in advocating voluntary nonremunerated blood donation is to ensure safe blood units, this aim would never be achieved should patients die because of the lack or inadequate supply of blood units or should their conditions worsen because of the lack of a timely supply of blood units. This is referred to as second-order effects, which is also antithetical to the original intent of the blood donation policy. China has demonstrated the potential to achieve 100% voluntary blood donation while nearing blood unit adequacy through the effective implementation of laws and regulations. Nigeria has the necessary policy framework to achieve similar success, but poor implementation hinders progress. To address this, the National Blood Service Commission should collaborate with other ministries to combat commercial blood donation and address blood shortages. The National Orientation Agency should lead proper orientation efforts, and the Ministry of Information should use mass media, including telemedicine, to raise awareness. The Ministry of Education should integrate blood donation into the secondary school curriculum and establish blood donor clubs. Engagement with religious and civil society organizations, as well as student bodies, is crucial for effective sensitization. The National Assembly should amend the National Health Act of 2014 to impose strict penalties on healthcare workers who facilitate paid blood donations. The Federal Ministries of Finance and Budget and Economic Planning should prioritize voluntary blood donation by allocating a minimum of 10% PAYE tax to sustain the system, with similar commitments from state ministries. The National Blood Service Commission should create a donor database and an electronic tracking system to retain voluntary donors. Policies should be developed to gradually transition from paid to voluntary donations. Equally, a voluntary donor club should be established, with experienced donors serving as ambassadors and decentralized at the state level for better coordination. A national hemovigilance system should be implemented, including hospital transfusion committees, to monitor and improve transfusion safety. The Commission should approve licenced private blood collection sites under strict regulations and create a task force to oversee licence validity and audit practices. Every state should establish a State Blood Service Commission to regulate blood donation practices and set up mobile blood collection points to make donations more accessible. Non-financial incentives for voluntary donors, such as a day off work, customized items, and an electronic card for appointment scheduling, should be provided. Donors should also have access to free blood units and prioritized consideration when needed. The primary healthcare system should develop a community-directed initiative for regular engagement, with Community Blood Donor champions providing feedback and recruiting new members. Nigeria should study and adapt China's blood donation policies. A blood policy amendment committee, including the Director General of the National Blood Service Commission, the Minister of Health, and the Chairperson of the House Committee on Health, should be established. This committee should engage experienced consultants to develop amendments to the existing law, incorporating these recommendations. LIST OF ABBREVIATIONS Voluntary, Non-remunerated Blood Donation - VNRBD African Health Organization - AHO World Health Organization - WHO Transfusion-Transmissible Infections - TTIs National Health Act - NHA Health Care Workers – HCWs Declarations Ethics approval: Ethical approval was obtained from the University of Medical Sciences, Ondo City, Ondo State, Nigeria, with the approval number: NHREC/TR/UNIMED-HREC-Ondo St/22/06/21. All methods were performed in accordance with the Declaration of Helsinki (2024 revision). Consent to participate: An informed consent to be a part of the study was obtained from every Participant. Clinical Trial Number: Not Applicable Consent for publication: Not Applicable Availability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests Funding : The Authors did not receive any funding for this research Authors’ Contributions: OO: Conceived and designed the research, wrote the article performed data analysis. LE: Supervised the research process and corrected the article OJ: Collected the data, contributed to data analysis and article writing. Acknowledgements: None Corresponding Author: Oni Oluwatosin Email: [email protected] References World Health Organization. Law for Universal Health Coverage (September 2022) accessed 31 August 2023. World Health Organization. Blood safety and availability (2023) accessed 2 June 2023 National Blood Transfusion Service, Federal Ministry of Health Nigeria, the National Blood Policy. Abuja: National Blood Transfusion Service, Federal Ministry of Health (2016). Nigerian National Blood Policy Revised November 2005 s xiv accessed 2 June 2023. Awan, S. A., Junaid, A., & Sheikh, S. Transfusion Transmissible Infections: Maximizing Donor Surveillance. Cureus, 10(12), e3787 (2021). National Health Act 2014 (NHA 2014), ss 47 and 48. National Health Act (2014, see note 6) Okocha EC, Aneke JC, Ezeh TU and others, ‘The epidemiology of transfusion-transmissible infections among blood donors in Nnewi, South‒East Nigeria’. African Journal of Medical and Health Science 125: 14 (2015). ibid. World Health Organization. Global database on blood safety report 2001 – 2002. accessed 31 August 2023. Salaudeen A and Odeh E, ‘Knowledge and behavior towards voluntary blood donation among students of a tertiary institution in Nigeria. ’Nigerian Journal of Clinical Practice, 303 (2023). ibid. Ugwu AO, Madu AJ, Efobi CC and other ‘Pattern of blood donation and characteristics of blood donors in Enugu, Southeast Nigeria’. Niger J Clin Pract 21:1438-43 (2018). WHO, ‘The World Health Report, 2005. Make every mother and child count. Geneva’ accessed on 7 September 2023. Tort Law of the People's Republic of China 2005, article 59. Gao D, Li H and Wang K. ‘The development of a legal framework for blood donation and blood safety in China over 24 years’ [2020] 20. BMC Health Serv Res 1099-1100 . Ibid. Ibid. Ibid. Johnson, Robert and Adam Cureton, "Kant’s Moral Philosophy", The Stanford Encyclopedia of Philosophy [Fall 2022 Edition ], https://plato.stanford.edu/archives/fall2022/entries/kant-moral/ accessed on 2 November 2023. Driver, Julia, "The History of Utilitarianism", The Stanford Encyclopedia of Philosophy [Winter 2022 Edition], Edward N. Zalta & Uri Nodelman (eds.), https://plato.stanford.edu/archives/win2022/entries/utilitarianism-history/ accessed on 1 November 2023. Green, Leslie and Thomas Adams, "Legal Positivism", The Stanford Encyclopedia of Philosophy [Winter 2019 Edition], Edward N. Zalta (ed.), accessed on 31 October 2023. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 30 Jan, 2026 Reviews received at journal 27 Nov, 2025 Reviewers agreed at journal 23 Nov, 2025 Reviews received at journal 19 Nov, 2025 Reviewers agreed at journal 17 Nov, 2025 Reviewers agreed at journal 16 Nov, 2025 Reviewers agreed at journal 14 Nov, 2025 Reviews received at journal 13 Nov, 2025 Reviews received at journal 05 Nov, 2025 Reviewers agreed at journal 04 Nov, 2025 Reviewers agreed at journal 03 Nov, 2025 Reviewers agreed at journal 30 Oct, 2025 Reviewers invited by journal 28 Oct, 2025 Editor invited by journal 13 Oct, 2025 Editor assigned by journal 06 Oct, 2025 Submission checks completed at journal 04 Oct, 2025 First submitted to journal 04 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-7597198","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":540403906,"identity":"1d87383c-88bd-41c6-a77c-4d346edcb18c","order_by":0,"name":"Oluwatosin Oni","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDElEQVRIiWNgGAWjYBACfnYogw1EJFRI1PODGQW4tUg2g1XAtJyxSZBsADEMcGsxOAzVAgaMbWkJBgfA4vi08JhJ/PxhY88n3XzswYMzh/OMz69O/PDAgEGeX+wATi2SPQlpiW0yx9INEioOF5vdeLtZAugww5mzE3BqucGTcDiBTSLHTCLhzGHGbTfObgBpSTC4jVvLzT8Jh+3BWhLbDjNunnF28w9CWm4DbWFsg2hJS9zA37sNry2SzWzlv2XSgH6RSEsDOszGWOIG7zaLBAMJnH7hZ2/ebPjGxsZefkbyMckfFRJy/P1nN9/8UWEjzy+NXQsWIAFWKUGscrDFB0hRPQpGwSgYBSMAAAAi8mAnyg4wNwAAAABJRU5ErkJggg==","orcid":"","institution":"Ondo State Primary Health Care Development Agency","correspondingAuthor":true,"prefix":"","firstName":"Oluwatosin","middleName":"","lastName":"Oni","suffix":""},{"id":540403907,"identity":"06d3395f-5f85-47a5-9699-7d6847c4f959","order_by":1,"name":"Leroy Edozien","email":"","orcid":"","institution":"University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Leroy","middleName":"","lastName":"Edozien","suffix":""},{"id":540403908,"identity":"7c468611-8f5d-41f2-9c4c-2a658f60ae93","order_by":2,"name":"Jumoke Olowookere","email":"","orcid":"","institution":"University Clinic, Federal University Lokoja","correspondingAuthor":false,"prefix":"","firstName":"Jumoke","middleName":"","lastName":"Olowookere","suffix":""}],"badges":[],"createdAt":"2025-09-12 06:38:31","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7597198/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7597198/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":95500960,"identity":"ffe6b446-be29-46e4-8d2b-372663b5d5e4","added_by":"auto","created_at":"2025-11-10 05:23:56","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":498010,"visible":true,"origin":"","legend":"","description":"","filename":"Blloddonationpolicyevaluationtcomplete.docx","url":"https://assets-eu.researchsquare.com/files/rs-7597198/v1/ede2d258045b5d8bcc03c97b.docx"},{"id":95500955,"identity":"e1cfe181-bde4-44c5-8b0d-21bccda1b3a4","added_by":"auto","created_at":"2025-11-10 05:23:55","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":5113,"visible":true,"origin":"","legend":"","description":"","filename":"ad7469e17acc4baca089afa4c518b9b1.json","url":"https://assets-eu.researchsquare.com/files/rs-7597198/v1/a7a6dafdf76fb3157ee239b6.json"},{"id":95500957,"identity":"229d0fcf-46ad-45c2-a170-d0da8fe19280","added_by":"auto","created_at":"2025-11-10 05:23:56","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":70725,"visible":true,"origin":"","legend":"","description":"","filename":"ad7469e17acc4baca089afa4c518b9b11enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7597198/v1/0f7f3ce8b184a5c77021a5f0.xml"},{"id":95500964,"identity":"a050b26d-6cb3-4f75-af22-45427b234c51","added_by":"auto","created_at":"2025-11-10 05:23:56","extension":"jpeg","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":615160,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7597198/v1/62de54f40ed4becf43f28f2a.jpeg"},{"id":95528257,"identity":"435a0d1d-08ba-4d8e-884c-476cdf849414","added_by":"auto","created_at":"2025-11-10 10:15:47","extension":"png","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":289401,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage10.png","url":"https://assets-eu.researchsquare.com/files/rs-7597198/v1/0747f032c4820ecf322f3871.png"},{"id":95500967,"identity":"450155cf-4fba-4edd-a951-a726eb4dd42d","added_by":"auto","created_at":"2025-11-10 05:23:56","extension":"jpeg","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":724061,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage11.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7597198/v1/204255af936ba661e6b2e967.jpeg"},{"id":95529407,"identity":"2cad6bc0-6379-4dea-846d-8dc2d8acfdea","added_by":"auto","created_at":"2025-11-10 10:17:05","extension":"jpeg","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1520415,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7597198/v1/9b2ff0c38b420c6eb4cddae4.jpeg"},{"id":95528441,"identity":"f37f280b-fb83-42c5-8f09-4c0014957f78","added_by":"auto","created_at":"2025-11-10 10:16:06","extension":"jpeg","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":86257,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7597198/v1/cfbf97036baa81d0825926a3.jpeg"},{"id":95500971,"identity":"ae638438-7e51-4983-86df-9eb64c9cf5ef","added_by":"auto","created_at":"2025-11-10 05:23:56","extension":"jpeg","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":156692,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7597198/v1/5c4fcd0df7ceb29a747f0c3f.jpeg"},{"id":95528625,"identity":"8b3afba9-feb7-49aa-8074-8add746b9df9","added_by":"auto","created_at":"2025-11-10 10:16:21","extension":"jpeg","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":240734,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7597198/v1/4d9c869a3441114858a57e1c.jpeg"},{"id":95528559,"identity":"89bec78d-00d4-4e21-a7ce-c947e1ea9323","added_by":"auto","created_at":"2025-11-10 10:16:16","extension":"jpeg","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":19956,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage6.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7597198/v1/6f836d4e930b2fd9e6ca3fef.jpeg"},{"id":95529126,"identity":"bc7812b8-de15-4d4e-8007-e0ecc235f98f","added_by":"auto","created_at":"2025-11-10 10:16:49","extension":"jpeg","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1566887,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage7.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7597198/v1/128595b48726770457595356.jpeg"},{"id":95500979,"identity":"8264e0ab-65cd-4103-8ace-0245caa993ce","added_by":"auto","created_at":"2025-11-10 05:23:56","extension":"jpeg","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1514535,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage8.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7597198/v1/b0d91b19cb55dc1d1b57771b.jpeg"},{"id":95529351,"identity":"f703afc4-197b-4538-b677-aad9ab45fbf2","added_by":"auto","created_at":"2025-11-10 10:17:01","extension":"jpeg","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":264803,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage9.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7597198/v1/c5045938fbb99bb1cef0f609.jpeg"},{"id":95500972,"identity":"f3ecaabd-be4c-4650-8d6e-7aca1e6f4f82","added_by":"auto","created_at":"2025-11-10 05:23:56","extension":"png","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":110080,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7597198/v1/e9522254ffe3b324df95a7ce.png"},{"id":95500962,"identity":"56bb33d2-6622-403e-9dd0-593a3604ffdf","added_by":"auto","created_at":"2025-11-10 05:23:56","extension":"png","order_by":15,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":35139,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage10.png","url":"https://assets-eu.researchsquare.com/files/rs-7597198/v1/449c900a5aa7b10889bb4668.png"},{"id":95500968,"identity":"b6f924ed-b82f-49bc-aa21-a9607045cbf1","added_by":"auto","created_at":"2025-11-10 05:23:56","extension":"png","order_by":16,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":563173,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage11.png","url":"https://assets-eu.researchsquare.com/files/rs-7597198/v1/11ae1f1dc3c8f01823a85298.png"},{"id":95529359,"identity":"ddc55c65-e3af-46f8-b608-72e942820ea2","added_by":"auto","created_at":"2025-11-10 10:17:01","extension":"png","order_by":17,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":274294,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7597198/v1/f059b5356b0b4b23fab9b4cb.png"},{"id":95500977,"identity":"f6d85998-2367-454b-9089-91ba32fae558","added_by":"auto","created_at":"2025-11-10 05:23:56","extension":"png","order_by":18,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":15699,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7597198/v1/671f4ee41d44374b4d795352.png"},{"id":95500980,"identity":"bd763089-a127-4f5f-a43f-2cdf642c7c16","added_by":"auto","created_at":"2025-11-10 05:23:56","extension":"png","order_by":19,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":30508,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7597198/v1/5b475e42dfddfea2c0bc7919.png"},{"id":95500969,"identity":"dc97362c-a220-4823-b986-4da7f21b2c5a","added_by":"auto","created_at":"2025-11-10 05:23:56","extension":"png","order_by":20,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":43239,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-7597198/v1/5225a606c5f50664736afb19.png"},{"id":95528749,"identity":"d8cc2825-043f-46e4-85c7-81c0d4a1193d","added_by":"auto","created_at":"2025-11-10 10:16:27","extension":"png","order_by":21,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":4763,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-7597198/v1/15d685b9aef7086afe45e64a.png"},{"id":95500974,"identity":"d8bbd74f-f0ee-425c-be81-2efb11336ab8","added_by":"auto","created_at":"2025-11-10 05:23:56","extension":"png","order_by":22,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":286158,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage7.png","url":"https://assets-eu.researchsquare.com/files/rs-7597198/v1/af4f1a585c8db796dcdcfb68.png"},{"id":95500983,"identity":"dc2cd916-fe18-4ce2-b6d4-1ac9ff124e13","added_by":"auto","created_at":"2025-11-10 05:23:56","extension":"png","order_by":23,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":274210,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage8.png","url":"https://assets-eu.researchsquare.com/files/rs-7597198/v1/21d70a60d4b4cf1edfb291fd.png"},{"id":95500981,"identity":"c60d369a-d0c7-4777-84d1-863d81e4217f","added_by":"auto","created_at":"2025-11-10 05:23:56","extension":"png","order_by":24,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":50180,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage9.png","url":"https://assets-eu.researchsquare.com/files/rs-7597198/v1/e2138f637d5a6e564310d257.png"},{"id":95528592,"identity":"40271a19-dad3-4797-9102-b7ef8db628bf","added_by":"auto","created_at":"2025-11-10 10:16:18","extension":"xml","order_by":25,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":68034,"visible":true,"origin":"","legend":"","description":"","filename":"ad7469e17acc4baca089afa4c518b9b11structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7597198/v1/e2ba29eba66895e1e7203b6a.xml"},{"id":95500982,"identity":"23522678-2d01-4e4d-8aea-bed8f091d0a7","added_by":"auto","created_at":"2025-11-10 05:23:56","extension":"html","order_by":26,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":79056,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7597198/v1/db73425fc8a3d039ad71189d.html"},{"id":95500959,"identity":"e6ed3654-22a6-4d42-afe0-bd7a46d70907","added_by":"auto","created_at":"2025-11-10 05:23:56","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":74168,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eNumber of litigation cases due to blood transfusion in China between 1980 and 2020.\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7597198/v1/9b190b08f4eee4408bf5c179.jpg"},{"id":95500956,"identity":"42906f56-8640-4d09-a64c-abb5b2dcffaf","added_by":"auto","created_at":"2025-11-10 05:23:55","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":141197,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eImportant policies in the development of China’s blood donation modes.\u003c/strong\u003e\u003c/em\u003e\u003csup\u003e\u003cem\u003e\u003cstrong\u003e18\u003c/strong\u003e\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7597198/v1/e008a4a9b03ebf480fb9b9dc.jpg"},{"id":95531710,"identity":"b59d6f2a-2e2e-4a37-8fbe-478c1b531cff","added_by":"auto","created_at":"2025-11-10 10:24:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1211526,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7597198/v1/04a41e22-285c-4359-acb7-9a9a1246f1ee.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessment of Legal and Regulatory Compliance in Blood Donation Practices in Nigeria","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eIn the realm of healthcare, there are binding regulations that prescribe the rights and responsibilities of various stakeholders, including governments, health care professionals, corporations, civil society, and the general population of a country. These regulations collectively constitute the legal framework or structure governing the domain of health delivery systems. These regulations manifest in various forms, such as statute regulatory and administrative laws, contracts, case law, and customary laws. The entities involved in creating these rules and their specific forms can vary from one country to another.\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eA legal framework is a foundational structure of rules, regulations, and principles that provides a systematic and organized approach to governing various aspects of society. It serves as a scaffolding upon which laws, policies, and regulations are constructed and applied to achieve specific goals, uphold rights, and maintain order within a jurisdiction. Legal frameworks play a crucial role in guiding individuals, organisations, and governments in their interactions and decision-making processes. These frameworks have several fundamental purposes, such as regulation, the protection of rights, accountability, consistency and enforcement.\u003c/p\u003e\n\u003cp\u003eThey are expected to evolve to reflect changing societal values, technological advancements, and emerging challenges. They must adapt to remain effective in addressing contemporary issues.\u003c/p\u003e\n\u003cp\u003eBlood transfusion is a crucial medical intervention that saves lives and enhances health outcomes. Unfortunately, many patients in need of blood transfusions face challenges in accessing safe blood promptly. Ensuring the availability of safe and adequate blood should be an integral component of every nation’s health care policy and infrastructure.\u003c/p\u003e\n\u003cp\u003eTo address this issue, the African Health Organization (AHO) recommends the establishment of a well-coordinated national framework for activities related to blood collection, testing, processing, storage, and distribution. In 2018, a national blood policy was in place in 73% of the reporting countries, which translates to 125 out of 171. Moreover, specific legislation addressing the safety and quality of blood transfusion was established in 66% of the reporting countries, with 113 out of 171 having such regulations. This breakdown includes 79% of high-income countries, 63% of middle-income countries and 39% of low-income countries. These statistics highlight the importance of having robust policies and legal frameworks in place to ensure the safe and effective provision of blood transfusions worldwide.\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eIn December 2006, Nigeria established a comprehensive National Blood Transfusion Policy through the publication of a set of guidelines.\u0026nbsp;This National Blood Policy essentially consisted of a series of action plans, all aimed at ensuring the provision of safe, accessible, and affordable blood donor units whenever and wherever they are needed throughout the country.\u003csup\u003e3\u003c/sup\u003e The Nigerian National Blood Policy made the following provision in section XIV: “Blood donations shall be based on the principle of regular, voluntary and nonremunerative donations. Financial rewards for blood or blood component donation should be prohibited. Donor appreciation by giving tokens, certificates, badges, and direct transport expense refunds is acceptable. Donor motivation and mobilization should be promoted through extensive awareness programs through organized donor drives, information education and communication materials, schools and public campaigns, print and electronic media, jingles, billboards, posters, and other methods. Attention to donor safety, care, and comfort should be enforced throughout the National Blood Service. Donor selection, deferral, counselling and appropriate record-keeping should be performed as specified in the NBS guidelines. Family replacement donation systems shall be gradually phased out as voluntary donation programs become established”.\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eThe World Health Organization (WHO) has consistently underscored the importance of obtaining blood from voluntary, nonremunerated donors as a strategy to significantly diminish the potential risks associated with the transmission of transfusion-transmissible infections (TTIs). This stance has been reaffirmed and substantiated by a growing body of research conducted by Nigerian scholars, and the World Health Organization (WHO) has set a target of attaining 100% voluntary nonremunerated donations globally by 2023.\u003csup\u003e5\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eTo meet the WHO standard of blood transfusion practice, the Nigerian government made policy provisions as documented in part VI of the National Health Act (NHA) 2014.\u003c/p\u003e\n\u003cp\u003eSubject to the provision of section 53, there are specific restrictions in place, such as the prohibition of removing nonreplaceable tissue from a person younger than 18 years. Additionally, the extraction of tissue, blood, or blood products for merchandise, sale, or commercial activities is strictly forbidden.\u003c/p\u003e\n\u003cp\u003eIn the event of a contravention or failure to comply with the provisions above, the individual responsible commits an offence. The penalties for such offences vary: in the case of tissue, a fine of \u003cs\u003eN\u003c/s\u003e1,000,000 or imprisonment for a minimum of two years, or both, is applicable; for blood or blood products, the penalty is a fine of \u003cs\u003eN\u003c/s\u003e100,000 or imprisonment for a term not exceeding one year, or both.\u003csup\u003e6\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eAdditionally, section 53 of the NHA, 2014, states that it is considered an offense for an individual who has donated tissue, blood, or a blood product to receive any form of financial or other reward for such a donation, with the exception of the reimbursement of reasonable costs incurred in providing the donation. Additionally, selling or trading in tissue, blood, or blood products is prohibited, except for reasonable payments made in appropriate health establishments for the procurement of tissues, blood, or blood products.\u003c/p\u003e\n\u003cp\u003eIn the event of a contravention under this section, the individual responsible commits an offense. Upon conviction, they are subject to a fine of \u003cs\u003eN\u003c/s\u003e100,000 or imprisonment for a period not exceeding one year, or both.\u003csup\u003e7\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eDespite these legal provisions, the objective of providing safe and adequate blood units has remained elusive in Nigeria and several other African nations, leading to adverse effects on health indicators. Effective global health care delivery relies heavily on a robust and secure supply of blood units, which can serve as life-saving resources in various critical medical scenarios. According to Aneke et al., 2015, only half a million units of blood were collected from both the private and public health sectors in 2004, while the estimated blood requirement for the year was 1.5 million units.\u003csup\u003e8\u003c/sup\u003e However, in the public sector, the donor population comprises approximately 25% commercial donors and approximately 75% replacement donors, with minimal voluntary unpaid donors. In the private sector, approximately 75% of the donor population consists of commercial donors, while approximately 25% consists of replacement donors, and the percentage of voluntary unpaid donors is insignificant.\u003csup\u003e9\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eGlobally, an impressive 80 million units of blood are donated annually, but notably, only two million units come from sub-Saharan Africa, where the need is monumental.\u003csup\u003e10\u003c/sup\u003e In Nigeria, although a good percentage of the population is eligible for blood donation considering age, a mere four out of every thousand individuals are voluntary blood donors.\u003csup\u003e11\u003c/sup\u003e In a study by Ahmed et al. (2007), the proportion of donations designated as voluntary and family replacement significantly declined, decreasing from 31% to 5% and from 49% to 23%, respectively. These declines were countered by noteworthy increases in the proportions of donations categorized as commercial or autologous, which surged from 20% to 63% and from 1% to 9%, respectively.\u003c/p\u003e\n\u003cp\u003eMany studies on blood donation and transfusion have focused on transfusion-transmissible infections and the sufficiency of the blood unit supply in Nigeria. However, to the best of our knowledge, no study in Nigeria has compared blood donation practices with the legal framework contained in the National Health Act 2014 (NHA), while various studies have shown that we are nowhere near the World Health Organization (WHO) target of having a 100% voluntary donation system. Hence, this study assessed blood donation practices in Nigeria and compared our compliance with the legal provisions of the NHA, 2014, on blood donation. Additionally, factors responsible for poor compliance or various factors that might be responsible for poor implementation of the NHA, 2014 provision on blood transfusion in Nigeria, were assessed. Furthermore, the study explored the possible need for revisions in policy provision and offered recommendations in the best interest of ensuring safe and adequate blood supply, thereby ensuring that no Nigerian has to suffer owing to the unavailability of blood units for medical intervention.\u003c/p\u003e\n\u003cp\u003eThis research evaluated the degree of compliance with blood donation practices and the law governing blood donation in Nigeria, the factors possibly responsible for poor compliance, as well as the ways of improving compliance with the law governing blood donation practices in Nigeria.\u003c/p\u003e"},{"header":"METHODOLOGY","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy area\u003c/h2\u003e\u003cp\u003eThe primary focus of this study was Akure city, which is located within the Akure South Local Government Area (LGA). The Akure South LGA falls within the Ondo Central Senatorial district and is one of the eighteen LGAs within Ondo State. The LGA's administrative centre is located in Akure, which also serves as the state capital. The Akure South LGA is the most populous LGA in Ondo State.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e The study design was a health facility and community-based descriptive cross-sectional survey of health care workers and members of the community aged 18\u0026ndash;65 years.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy population.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn this study, the target populations were (a) potential blood donors and (b) healthcare workers working in health facilities that have a blood transfusion service.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003ePrimary Data\u003c/h2\u003e\u003cp\u003eTwo structured questionnaires were used as the survey instrument for the collection of primary data. The first structured questionnaire was administered to potential blood donors to assess their knowledge of and compliance with Nigeria's legal framework for guiding voluntary blood donation.\u003c/p\u003e\u003cp\u003eThe second structured questionnaire was designed to assess healthcare workers' knowledge about the legal framework preventing commercial blood donation and to collect information about blood sufficiency from healthcare workers.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSecondary Data\u003c/h3\u003e\n\u003cp\u003eThe secondary data were obtained from the Blood Bank Unit of the Medial Laboratory Department, University of Medical Sciences Teaching Hospital, Akure Complex. The data were used to capture compliance with voluntary blood donation over paid donation and family replacement (an indirect form of paid donation).\u003c/p\u003e\n\u003ch3\u003eData Management\u003c/h3\u003e\n\u003cp\u003eThe primary data and secondary data were analysed via the Statistical Package for the Social Sciences (SPSS) version 21 program. Descriptive analysis was used to determine the frequency distribution and percentage of all sections of the questionnaire.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthical approval:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the University of Medical Sciences, Ondo City, Ondo State, Nigeria, with the approval number: NHREC/TR/UNIMED-HREC-Ondo St/22/06/21. All methods were performed in accordance with the Declaration of Helsinki (2024 revision).\u003c/p\u003e"},{"header":"RESULTS AND DISCUSSION","content":"\u003cp\u003eFrom table 1, a total of 805 potential blood donors between 18 and 65 years of age completed the structured questionnaire aimed at assessing the knowledge and practice of potential blood donors with respect to voluntary blood donation.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"678\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18-24 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e231\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e25-34 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e306\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e35-44 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e188\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e45-54 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e55-65 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e411\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e394\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eHighest level of education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e421\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e52.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eO' Level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePost Graduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSecondary Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eHave you heard about blood donation before?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e785\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e97.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eAre you aware of Nigeria's legal framework or policy guiding voluntary blood donation?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e566\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e70.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eIs donating blood for financial remuneration legally permitted in Nigeria?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e238\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot Sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e386\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eHave you ever donated blood before?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e495\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e61.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e310\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eWill you be willing to donate blood without any financial remuneration?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot Sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e575\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e71.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eWhy will you not donate blood without any financial remuneration?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI need money to feed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMy blood would be sold eventually\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e54.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLack of motivation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePoor attitude of HCWs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eHow can voluntary blood donation be encouraged in Nigeria?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIntroduce the use of mobile blood-donating vans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMore sensitization on the need for voluntary blood donation practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e596\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e74.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIntroduce nonmonetary incentives\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStrict punishment for healthcare workers or institutions that sell blood after voluntary donation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIntroduce financial incentives\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTable 1: Knowledge and practice of potential blood donors with respect to voluntary blood donation in Nigeria.\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSimilarly, 107 health care workers completed the questionnaire aimed at assessing the experience and perceptions of health care workers about voluntary blood donation (Table 2).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"557\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWould you be willing to donate blood without any financial remuneration?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot sure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Gender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e291\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e411\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e284\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e394\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e575\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e805\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTable 2: Relationship between gender and willingness to donate without financial remuneration.\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNote: Table 1 and Table 2 were obtained from the data of the eligible Donors.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe majority of the potential blood donors were in the age range of 25--34 years (306 (38.0%)), while the lowest age distribution was 55 - 65 years. Among the respondents, 411 (51.1%) were male, whereas 394 (48.9%) were female. Although almost all potential donors (785, 97.5%) claimed to have heard about blood donation previously, only approximately 30% of the participants said that they were aware of the legal framework or policy that makes commercial blood donation a punishable offense.\u003c/p\u003e\n\u003cp\u003eAmong the population eligible for donation, 310 (38.5%) had donated blood. This percentage was higher than the 15.3% reported in a study assessing the knowledge and behaviour of students in Nigerian tertiary institutions towards voluntary blood donation.\u003csup\u003e12\u003c/sup\u003e This difference might be attributed to the greater propensity to donate blood altruistically in 2023 than in 2011, when Salaudeen carried out the initial assessment. Interestingly, a good percentage of the respondents (575; 71.4%) indicated their willingness to donate blood units without any financial benefit. This percentage was higher than the percentage of participants willing to donate their blood without financial payment reported by Ugwu et al\u003cem\u003e. (2018).\u0026nbsp;\u003c/em\u003eIn the same study, it was revealed that gender and level of education are strongly associated with willingness to donate blood without financial remuneration\u003cem\u003e.\u003csup\u003e13\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAmong the respondents, 137 (17.0%) indicated that they would never donate their blood without any financial reward. The reason for this seeming lack of altruism was primarily their perception of exploitation since the freely donated blood would be “sold” to the patient in need.\u0026nbsp;This has been a major obstacle to achieving the legal framework for voluntary blood donation.\u003c/p\u003e\n\u003cp\u003eAccording to Table 2, sex plays a significant role in the practice of voluntary blood donation. Regarding how to encourage voluntary blood donation in Nigeria, the majority of the respondents, 596 (74.0%), suggested the need for more sensitization. Approximately 6.7% of the respondents suggested strict punishment for healthcare workers who sell blood units after donation, claiming that if the blood units were given freely to patients, voluntary donation would not be a major issue for eligible donors.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"654\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVARIABLES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e58.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e41.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eIs blood donation for financial remuneration legally permitted in Nigeria?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e16.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e57.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e25.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eHave you had a patient whose treatment or management got delayed due to the lack of blood unit?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e72.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e23.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eHave you ever had a patient whose treatment outcome could have been better and different if not for the unavailability of a safe blood unit?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e51.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e40.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e8.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eHave you ever lost a Patient due to the lack of blood unit?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e43.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e57.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eDo you think your Health Facility can cope with the demand for blood unit by relying majorly on voluntary blood donation?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e77.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e15.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eDo you think encouraging Commercial blood donation can solve the problem of inadequate blood units in Health Facilities?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e52.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e34.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e13.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTable 3: Experience and perceptions of healthcare workers regarding voluntary blood donation and blood unit sufficiency in Nigeria\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs shown in Table 3, 63 (58.9%) healthcare workers were male, whereas 44 (41.1%) were female. Also from table 3, a reasonable percentage of healthcare workers (62, 57.9%) were aware of the legal framework prohibiting commercial blood donation in Nigeria. As expected, the proportion of healthcare workers who were aware of this legal framework was greater than that of eligible blood donors (57.9% and 29.6%, respectively). Generally, knowledge about legal provisions prohibiting commercial blood donors is very poor. A good number of healthcare workers, 77 (72%), reported having had patients who had delayed treatments due to the lack of a blood unit. Furthermore, 55 (51.4%) of the healthcare workers reported having had patients whose treatment outcome could have been better, and different patients had a prompt supply of blood units. Similarly, since the inception of the regulation to sustain voluntary blood donation, there has been a sharp decline in the total number of blood units donated annually, especially in low-income and lower-middle-income countries. This was evident in the response of the health workers to their experience of losing patients due to the lack of blood units. Almost half of the healthcare workers, 46 (43.0%), reported having lost at least one patient solely because of the lack or delayed supply of blood units. Losing patients due to a lack of blood units is not alien to the Nigerian health system. On August 2, 2023, the Nigerian Medical Association, Lagos Branch, in a press release, mourned the death of one of its members, Dr. Diaso Vwaere. She was reportedly trapped in an elevator for more than 40 minutes before her rescue. The second paragraph of the press release reads: “We were also reliably informed that there was no blood available for resuscitation and this has become a recurring issue because of the review made by the government on the previous policy on blood donation”. The Nigerian policy on voluntary blood donation as contained in the National Health Act aimed at achieving the WHO 100% voluntary blood donation target. One hundred percent voluntary blood donation is used to reduce transfusion transmissible infections (TTIs) and blood-related mortality. However, this policy has generated another possible challenge with respect to the availability of safe blood for patients in need of a transfusion. According to the WHO, the minimum number of donations required to meet the national blood demand is 1% of the population. Hence, our target is to obtain 1% of our population as voluntary donors. It was estimated that out of 836,969,536 people in the WHO African region in 2010, over 8,000,000 units of blood were required to meet the annual target. A total of 3,486,192 blood units were collected, leaving a shortfall of over 4,500,000. Notably, a good percentage of these units were obtained from paid donors. This severe shortage of blood units has led to the death of several patients who would have survived if not because of a lack of blood units for transfusion. On a global scale, maternal mortality remains a significant concern, with more than half a million women losing their lives each year due to complications related to pregnancy and childbirth. Among these complications, severe bleeding is the leading cause of maternal mortality, contributing to up to 44% of maternal deaths in sub-Saharan Africa.\u003csup\u003e14\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003ePreventable deaths and deteriorating medical conditions due to low blood units appear to be some visible outcomes of the voluntary blood policy document if not well implemented.\u003c/p\u003e\n\u003cp\u003eThe majority of healthcare workers, 83 (77.6%), opined that health facilities cannot cope with the demand for blood units by solely relying on voluntary blood donation. However, 7 (6.5%) of them were optimistic that the blood unit requirement could be actualized through voluntary blood donation, whereas 17 (15.9%) of the respondents had neither conviction.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"605\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of Blood donations\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVoluntary donations\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCommercial or paid donations\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1819\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e99.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1822\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e91.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e82\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTotal blood units donated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1894\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1904\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTable 4: Number of blood donations at the UNIMED THC Akure Complex between April 2022 and August 2023.\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA comparison of the practices of our health facilities with the policy document regarding voluntary blood donation (Table 4) revealed that a total of 1904 units of blood were donated between April 2022 and August 2023 at the University of Medical Sciences Teaching Hospital, Akure complex. Of these, only 10 units were donated by voluntary donors, accounting for 0.5% of the total units donated, whereas 1894 (99.5%) were from commercial or paid Donors. Seven (70.0%) of the voluntary blood donations were female, whereas 3 (30.0%) were male. The reverse was the case when commercial or paid donations were considered, with the male gender accounting for 1819 (96.0%) and the female gender accounting for the remaining 75 (4.0%). This finding corroborates the findings presented in Table 2 regarding the significance of gender for the practice of voluntary donation. In general, males have a greater propensity for paid blood donation, whereas females are more predisposed to voluntary donation. While the WHO projected that, in the year 2020, member states would have attained 100% voluntary blood donation, this study revealed that Nigeria only has less than 1% compliance in the year 2023 according to this study. This is far from the legal framework. The remaining 99.5% were donated by paid donors and family replacement. Notably, the majority of the family replacement donations were equally donated by commercial blood donors.\u003c/p\u003e\n\u003cp\u003eThe graph in figure 1, shows blood transfusion litigation (blue) and judicial outcomes (orange) from 1980\u0026ndash;2020. Cases surged in the late 1980s, peaking at about 50 in 1994 amid concerns over HIV and hepatitis, then fell steadily with improved safety measures. Judicial outcomes rose only after the late 1990s, peaking at over 50 around 2015\u0026ndash;2016 before declining as most cases were resolved and new filings decreased\u003cstrong\u003e\u003cem\u003e.\u003c/em\u003e\u003c/strong\u003e In like manner, Nigeria\u0026apos;s legal framework for voluntary blood donation is comprehensive, with well-defined punishments for defaulters, including donors who demand payments and healthcare workers who commercialise blood donation. However, there have been no documented cases of penalizing such offenders, suggesting that the legal framework exists mainly to fulfil WHO membership requirements rather than to enforce actual compliance. This poor implementation aligns with the theory of legal realism, indicating that the Nigerian government may not be fully prepared to enforce these laws.\u003c/p\u003e\n\u003cp\u003eDeterrence theory posits that the threat of punishment deters crime. Individuals, acting as rational decision-makers, will avoid criminal acts if the perceived costs or risks outweigh the benefits; thus, donors would avoid accepting \u003cs\u003eN\u003c/s\u003e10,000 to \u003cs\u003eN\u003c/s\u003e15,000 for a blood unit if facing a fine of \u003cs\u003eN\u003c/s\u003e100,000 or up to a year in prison. This theory, which is influential in criminal justice, suggests that stricter enforcement could reduce commercial donations.\u003c/p\u003e\n\u003cp\u003eThe Chinese Government, in Article 59 of the Tort Law, 2005,\u003csup\u003e15\u003c/sup\u003e classified blood transfusion damage as no-fault liability, mandating that hospitals compensate patients for transfusion-related infections. This approach, which focused on fairness and justice, led to more rigorous blood screening in China. Nigeria could adopt a similar commitment to ensure ethical practices and thorough blood screening.\u003c/p\u003e\n\u003cp\u003eGiven the experience of China, in 1998, recruiting voluntary blood donors in China was a significant challenge, with only 8% of blood donations being unpaid. By 2005, this figure rose dramatically to 95.5%.\u003csup\u003e16\u003c/sup\u003eA significant milestone occurred in 2009 when all clinical blood supplies in China were exclusively sourced from unpaid donations. This marked a notable transformation in the country\u0026apos;s blood donation practices, emphasizing the shift toward voluntary and altruistic contributions to ensure the safety and sustainability of the blood supply.\u003c/p\u003e\n\u003cp\u003eThe Chinese government achieved this through a series of laws and policies aimed at improving blood safety following an HIV outbreak among paid donors in two provinces in China.\u003csup\u003e17\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eFrom figure 2, initially, in 1998, the Chinese government allowed employer-organized blood donations as a transitional measure. By 2005, they prohibited employer-organized donations and coordinated donations by local blood stations, shifting to a partially mandatory and incentivized unpaid approach.\u003c/p\u003e\n\u003cp\u003eEventually, China moved to a mutual blood donation system (family replacement), and by 2011, mutual blood donation was cancelled, resulting in 100% voluntary nonremunerated donation.\u003csup\u003e19\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eIn contrast, Nigeria\u0026apos;s policy criminalized paid blood donation without penalizing offenders or providing alternative measures. This policy expected Nigerians to adapt instantly, without a plan for noncompliance or a transition period. Effective change should be a gradual process, not an immediate destination. By learning from China\u0026apos;s phased approach, Nigeria can develop a more effective strategy for transitioning to a fully voluntary blood donation system.\u003c/p\u003e"},{"header":"CONCLUSION AND RECOMMENDATION","content":"\u003cp\u003eWhy do we enact laws? While social contract thinkers such as Thomas Hobbles, John Locke, and Jean-Jacques Rousseau argue for social order and stability, philosophers such as Immanuel Kant argue that laws should be based on universal principles of morality, for moral justice, to protect individual rights, ensure fairness, and prevent harm. \u003csup\u003e20\u003c/sup\u003e Utilitarian thinkers such as Jeremy Bentham and John Stuart Mill argue that laws should maximize happiness or minimize suffering for the greatest number of people.\u003csup\u003e21\u003c/sup\u003e In the same vein, some legal philosophers, such as John Austin and H.L.A. Hart, advocate for a positivist view of law. They argue that the existence and validity of laws depend solely on their enactment by a recognized authority.\u003csup\u003e22\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eThe law governing voluntary blood donation in Nigeria fulfils all the schools of thought and philosophical views mentioned above. However, legal provisions do not seem to exist in practice because of poor implementation and inadequate enforcement.\u003c/p\u003e\n\u003cp\u003eNigeria, like many African countries, has struggled to implement the legal provision guiding voluntary blood donation. Nigeria has less than 1% compliance with the law governing voluntary blood donation. Attempts to implement voluntary nonremunerated blood donation have generated another loop of blood shortages. While the aim of the WHO in advocating voluntary nonremunerated blood donation is to ensure safe blood units, this aim would never be achieved should patients die because of the lack or inadequate supply of blood units or should their conditions worsen because of the lack of a timely supply of blood units. This is referred to as second-order effects, which is also antithetical to the original intent of the blood donation policy.\u003c/p\u003e\n\u003cp\u003eChina has demonstrated the potential to achieve 100% voluntary blood donation while nearing blood unit adequacy through the effective implementation of laws and regulations. Nigeria has the necessary policy framework to achieve similar success, but poor implementation hinders progress.\u003c/p\u003e\n\u003cp\u003eTo address this, the National Blood Service Commission should collaborate with other ministries to combat commercial blood donation and address blood shortages. The National Orientation Agency should lead proper orientation efforts, and the Ministry of Information should use mass media, including telemedicine, to raise awareness. The Ministry of Education should integrate blood donation into the secondary school curriculum and establish blood donor clubs. Engagement with religious and civil society organizations, as well as student bodies, is crucial for effective sensitization.\u003c/p\u003e\n\u003cp\u003eThe National Assembly should amend the National Health Act of 2014 to impose strict penalties on healthcare workers who facilitate paid blood donations. The Federal Ministries of Finance and Budget and Economic Planning should prioritize voluntary blood donation by allocating a minimum of 10% PAYE tax to sustain the system, with similar commitments from state ministries.\u003c/p\u003e\n\u003cp\u003eThe National Blood Service Commission should create a donor database and an electronic tracking system to retain voluntary donors. Policies should be developed to gradually transition from paid to voluntary donations. Equally, a voluntary donor club should be established, with experienced donors serving as ambassadors and decentralized at the state level for better coordination. A national hemovigilance system should be implemented, including hospital transfusion committees, to monitor and improve transfusion safety.\u003c/p\u003e\n\u003cp\u003eThe Commission should approve licenced private blood collection sites under strict regulations and create a task force to oversee licence validity and audit practices. Every state should establish a State Blood Service Commission to regulate blood donation practices and set up mobile blood collection points to make donations more accessible.\u003c/p\u003e\n\u003cp\u003eNon-financial incentives for voluntary donors, such as a day off work, customized items, and an electronic card for appointment scheduling, should be provided. Donors should also have access to free blood units and prioritized consideration when needed.\u003c/p\u003e\n\u003cp\u003eThe primary healthcare system should develop a community-directed initiative for regular engagement, with Community Blood Donor champions providing feedback and recruiting new members.\u003c/p\u003e\n\u003cp\u003eNigeria should study and adapt China\u0026apos;s blood donation policies. A blood policy amendment committee, including the Director General of the National Blood Service Commission, the Minister of Health, and the Chairperson of the House Committee on Health, should be established. This committee should engage experienced consultants to develop amendments to the existing law, incorporating these recommendations.\u003c/p\u003e"},{"header":"LIST OF ABBREVIATIONS","content":"\u003cp\u003eVoluntary, Non-remunerated Blood Donation\u0026nbsp;-\u0026nbsp;VNRBD\u003c/p\u003e\n\u003cp\u003eAfrican Health Organization\u0026nbsp;-\u0026nbsp;AHO\u003c/p\u003e\n\u003cp\u003eWorld Health Organization\u0026nbsp;-\u0026nbsp;WHO\u003c/p\u003e\n\u003cp\u003eTransfusion-Transmissible Infections\u0026nbsp;-\u0026nbsp;TTIs\u003c/p\u003e\n\u003cp\u003eNational Health Act\u0026nbsp;-\u0026nbsp;NHA\u003c/p\u003e\n\u003cp\u003eHealth Care Workers \u0026ndash; HCWs\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the University of Medical Sciences, Ondo City, Ondo State, Nigeria, with the approval number: NHREC/TR/UNIMED-HREC-Ondo St/22/06/21.\u0026nbsp;All methods were performed in accordance with the Declaration of Helsinki (2024 revision).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u0026nbsp;\u003c/strong\u003eAn informed consent to be a part of the study was obtained from every Participant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number:\u003c/strong\u003e Not Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe Authors did not receive any funding for this research\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOO:\u0026nbsp;\u003c/strong\u003eConceived and designed the research, wrote the article performed data analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLE:\u0026nbsp;\u003c/strong\u003eSupervised the research process and corrected the article\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOJ:\u0026nbsp;\u003c/strong\u003eCollected the data, contributed to data analysis and article writing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding Author:\u003c/strong\u003e Oni Oluwatosin\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEmail:\u003c/strong\u003e [email protected]\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. Law for Universal Health Coverage (September 2022) \u0026lt;www.who.int/health-topics/health-law#tab=tab_1\u0026gt;accessed 31 August 2023.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Blood safety and availability (2023) \u0026lt;https://www.who.int/news-room/fact-sheets/detail/blood-safety-and-availability\u0026gt;accessed 2 June 2023\u003c/li\u003e\n\u003cli\u003eNational Blood Transfusion Service, Federal Ministry of Health Nigeria, the National Blood Policy. Abuja: National Blood Transfusion Service, Federal Ministry of Health (2016).\u003c/li\u003e\n\u003cli\u003eNigerian National Blood Policy Revised November 2005 s xiv \u0026lt;https://nairametrics.com/wp-content/uploads/2012/01/FMOH_Nigerian_National_Blood_Policy.pdf\u0026gt; accessed 2 June 2023.\u003c/li\u003e\n\u003cli\u003eAwan, S. A., Junaid, A., \u0026amp; Sheikh, S. Transfusion Transmissible Infections: Maximizing Donor Surveillance. Cureus, 10(12), e3787 (2021).\u003c/li\u003e\n\u003cli\u003eNational Health Act 2014 (NHA 2014), ss 47 and 48.\u003c/li\u003e\n\u003cli\u003eNational Health Act (2014, see note 6) \u003c/li\u003e\n\u003cli\u003eOkocha EC, Aneke JC, Ezeh TU and others, \u0026lsquo;The epidemiology of transfusion-transmissible infections among blood donors in Nnewi, South‒East Nigeria\u0026rsquo;. African Journal of Medical and Health Science 125: 14 (2015).\u003c/li\u003e\n\u003cli\u003eibid.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Global database on blood safety report 2001 \u0026ndash; 2002. \u0026lt;https://cdn.who.int/media/docs/default-source/biologicals/blood-products/document-migration/gdbs_report_2001-2002.pdf?sfvrsn=ee745a28_3\u0026amp;download=true\u0026gt; accessed 31 August 2023.\u003c/li\u003e\n\u003cli\u003eSalaudeen A and Odeh E, \u0026lsquo;Knowledge and behavior towards voluntary blood donation among students of a tertiary institution in Nigeria. \u0026rsquo;Nigerian Journal of Clinical Practice, 303 (2023).\u003c/li\u003e\n\u003cli\u003eibid.\u003c/li\u003e\n\u003cli\u003eUgwu AO, Madu AJ, Efobi CC and other \u0026lsquo;Pattern of blood donation and characteristics of blood donors in Enugu, Southeast Nigeria\u0026rsquo;. Niger J Clin Pract 21:1438-43 (2018).\u003c/li\u003e\n\u003cli\u003eWHO, \u0026lsquo;The World Health Report, 2005. Make every mother and child count. Geneva\u0026rsquo; \u0026lt;https://iris.who.int/bitstream/handle/10665/43131/9241562900.pdf?sequence=1\u0026gt; accessed on 7 September 2023.\u003c/li\u003e\n\u003cli\u003eTort Law of the People\u0026apos;s Republic of China 2005, article 59.\u003c/li\u003e\n\u003cli\u003eGao D, Li H and Wang K. \u0026lsquo;The development of a legal framework for blood donation and blood safety in China over 24\u0026thinsp;years\u0026rsquo; [2020] 20. BMC Health Serv Res 1099-1100 .\u003c/li\u003e\n\u003cli\u003eIbid.\u003c/li\u003e\n\u003cli\u003eIbid.\u003c/li\u003e\n\u003cli\u003eIbid. \u003c/li\u003e\n\u003cli\u003eJohnson, Robert and Adam Cureton, \u0026quot;Kant\u0026rsquo;s Moral Philosophy\u0026quot;, The Stanford Encyclopedia of Philosophy [Fall 2022 Edition ], https://plato.stanford.edu/archives/fall2022/entries/kant-moral/ accessed on 2 November 2023.\u003c/li\u003e\n\u003cli\u003eDriver, Julia, \u0026quot;The History of Utilitarianism\u0026quot;, The Stanford Encyclopedia of Philosophy [Winter 2022 Edition], Edward N. Zalta \u0026amp; Uri Nodelman (eds.), https://plato.stanford.edu/archives/win2022/entries/utilitarianism-history/ accessed on 1 November 2023.\u003c/li\u003e\n\u003cli\u003eGreen, Leslie and Thomas Adams, \u0026quot;Legal Positivism\u0026quot;, The Stanford Encyclopedia of Philosophy [Winter 2019 Edition], Edward N. Zalta (ed.), \u0026lt;https://plato.stanford.edu/archives/win2019/entries/legal-positivism/\u0026gt; accessed on 31 October 2023.\u003c/li\u003e\n\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":"discover-health-systems","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dihs","sideBox":"Learn more about [Discover Health Systems](https://www.springer.com/44250)","snPcode":"44250","submissionUrl":"https://submission.nature.com/new-submission/44250/3","title":"Discover Health Systems","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Compliance, legal framework, Blood donation, voluntary donors","lastPublishedDoi":"10.21203/rs.3.rs-7597198/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7597198/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eIn compliance with WHO standards, the Nigerian government established laws to prevent paid blood donation. However, Nigeria struggles to provide safe and adequate blood supply, negatively affecting health indicators. This study compared blood donation practices in Nigeria with existing laws using primary and secondary data.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA descriptive and analytical cross-sectional survey was conducted in Akure, Nigeria, involving 805 eligible donors (aged 18\u0026ndash;65) and 102 healthcare workers. Primary data were collected via structured questionnaires assessing knowledge, practices, and perceptions. Secondary data from a hospital blood bank captured donation types. Data were analyzed using SPSS version 21, with descriptive statistics and chi-square tests for associations.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAmong eligible donors, 38.5% had donated blood previously, but only 8.0% were regular donors and 4.3% donated voluntarily. Awareness of the legal framework prohibiting paid donation was low (29.7%). Secondary data showed\u0026thinsp;\u0026lt;\u0026thinsp;1% voluntary donations. Healthcare workers reported frequent delays (72.0%) and patient deaths (43.0%) due to blood shortages. Gender was significantly associated with willingness to donate voluntarily (p\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eCompliance with voluntary non-remunerated blood donation laws is poor in Nigeria, leading to blood shortages. Key recommendations include phased transition from paid to voluntary systems, enhanced public sensitization, establishment of donor databases, and stricter enforcement with penalties for non-compliance.\u003c/p\u003e","manuscriptTitle":"Assessment of Legal and Regulatory Compliance in Blood Donation Practices in Nigeria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-10 05:23:51","doi":"10.21203/rs.3.rs-7597198/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-30T06:47:51+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-27T05:46:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"211121604504858150676420317755100266081","date":"2025-11-23T15:37:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-19T20:46:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"128216092593397255850889126649042644214","date":"2025-11-17T13:56:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"280946360883493270329698447199654318375","date":"2025-11-17T04:43:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"149456230181386817399616037119982985079","date":"2025-11-14T13:32:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-13T10:09:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-05T12:28:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"282145883701521326020276054486049811046","date":"2025-11-04T12:31:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"196003541641745684552498126183891022938","date":"2025-11-03T09:09:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"321450265275599141423374703897302034180","date":"2025-10-30T14:49:57+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-28T09:36:48+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-13T07:47:10+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-06T10:27:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-05T03:09:07+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Health Systems","date":"2025-10-05T03:06:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-health-systems","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dihs","sideBox":"Learn more about [Discover Health Systems](https://www.springer.com/44250)","snPcode":"44250","submissionUrl":"https://submission.nature.com/new-submission/44250/3","title":"Discover Health Systems","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ce155313-67ed-488a-b596-66d47f0be027","owner":[],"postedDate":"November 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-13T08:40:58+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-10 05:23:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7597198","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7597198","identity":"rs-7597198","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}