Blood safety in India: Science and standardisation must lead the way
This article is authored by NK Ganguly, former director general, ICMR.
India stands at a critical crossroads in its health care journey. As the country grapples with an increasing burden of transfusion-dependent conditions such as thalassemia, the demand for safe, reliable, and pathogen-free blood has never been greater. While commendable progress has been made in expanding voluntary blood donation and improving transfusion services, the reality is that too many lives are still placed at risk due to uneven diagnostic standards and outdated screening practices. If we are to build a resilient, future-ready health care system, scientific innovation and standardised diagnostic protocols must form the foundation of India’s blood safety reforms.
At a recent roundtable hosted by the Thalassemia Patients Advocacy Group (TPAG), I underscored the fact that transfusion-transmitted infections (TTIs) such as HIV, Hepatitis B, Hepatitis C, and syphilis continue to pose a serious public health threat. Despite the availability of advanced diagnostic technologies, fragmented practices and inadequate enforcement of safety protocols have left patients vulnerable—particularly those who depend on regular transfusions for survival. This is not just a medical failure, but a systemic one.
A central part of this challenge lies in diagnostic safety. Today, while many blood banks rely on basic serological tests such as ELISA, these methods are unable to detect infections during the window period—the time between initial infection and detectability. It is here that Nucleic Acid Testing (NAT) becomes indispensable. NAT technology can identify viral infections at their earliest stage, closing the diagnostic gap that continues to expose patients to preventable risks. Science has spoken clearly: NAT is no longer an optional add-on but a necessity that must be scaled up and standardised across India.
Some private sector and metropolitan blood banks have already adopted NAT, demonstrating its feasibility and value. However, its limited reach highlights the deep inequities in our system. Rural blood banks, district hospitals, and many government facilities still lack access to such advanced tools due to cost and infrastructure barriers. To overcome this, the government must take a leadership role by subsidizing NAT implementation in public blood banks, establishing national quality control laboratories to validate diagnostic results, and integrating NAT into India’s official transfusion safety guidelines as a mandatory standard.
At the same time, diagnostic innovation must leverage advanced technology and be scaled to meet India’s needs. With cutting-edge R&D, modern automation, capacity building for laboratory technicians and pathologists, and strong partnerships with academic and private sector institutions, we can build a robust diagnostic ecosystem that delivers world-class blood screening solutions and is accessible to even the most remote health facilities.
However, technology and innovation alone will not solve the problem without regulatory vigilance. Fragmented laws and inconsistent enforcement have created a patchwork of practices that compromise patient safety. A systemic overhaul is overdue. What India needs is a unified national framework for blood safety—one that sets clear, enforceable standards for screening, storage, and distribution. This should include uniform diagnostic protocols, centralised digital registries to ensure traceability and transparency, and mandatory audits with penalties for violations.
Diagnostic safety must also be viewed in the larger context of healthcare justice. Safe blood cannot remain the privilege of those living in urban centres or those who can afford private care. It must be guaranteed for every citizen, irrespective of geography or income. Citizen-centric policies, underpinned by strong regulation, can ensure that vulnerable groups—particularly patients with chronic conditions such as thalassemia—are not condemned to a lifetime of unnecessary risk.
Public-private-academic collaboration will be essential to this effort. By combining the innovation potential of the private sector, the reach of public health systems, and the research strength of academic institutions, India can accelerate the scaling of high-precision diagnostic tools and create sustainable models for last-mile delivery of safe blood.
Blood safety is ultimately about more than infrastructure or technology—it is about protecting life and dignity. Every unsafe transfusion represents a failure of the system to uphold its most basic obligation to citizens. India must now move decisively toward evidence-based, scientifically validated practices, and place diagnostic safety at the heart of its health care reforms.
The time for half measures has passed. With the tools, knowledge, and capacity already at our disposal, what we need is the resolve to act. By making safe blood a national priority anchored in scientific innovation, standardised protocols, and strict regulatory oversight, India can save countless lives and strengthen its public health architecture for generations to come.
This article is authored by NK Ganguly, former director general, ICMR.
