143 Mapping opportunities and threats for the future demand of red blood cells in the Netherlands 4.1 Introduction In the 203 years that have passed since James Blundell’s first human-to-human blood transfusion, practices have transformed. The present day may be akin to the “best of times” due to unprecedented innovations and developments within healthcare and practice,1 but also the “worst of times” as these changes also highlight decreasing demand for red blood cells (RBCs), historically supplied in the largest amounts and with the greatest decrease in demand, thereby impacting blood establishments (BEs).2,3 Many BEs in high- income countries are experiencing uncertainty regarding the future of the organization as their traditional methods of service are being challenged in the face of decreasing revenues. This is exemplified in the case of Sanquin, the national Dutch BE, which has experienced a 43% decrease in RBC demand from 1995 to 2017 and has consequentially scaled down services.4,5 Because Western blood transfusion practices are changing and seem to be continuously decreasing, there is an increasing interest and need in anticipating the future demand for blood products and the organizational implications thereof to actively prepare for various foreseeable long-term developments.2,3,5-8 Some quantitative studies project the future blood demand by simply extrapolating historical trends, for example, demographical changes.7-9 However, these do not incorporate potential changes that might structurally affect future RBC demand (e.g., medical practice, technological innovations, crises). Therefore, to fill in this gap of quantitative literature, we used a scenario approach which seeks to explore multiple plausible future situations by incorporating expert judgment and systematically identifying key drivers that may impact future demand most significantly,10 (i.e., increasing or decreasing demand). This method helps to be prepared for the uncertainty of the future by incorporating the interaction of possible trends, events, and developments as input into strategic, holistic decision-making.11 This approach has been widely used in many fields,12 including business,13 transportation,14 and agriculture,15 although to the best of our knowledge, not yet in blood transfusion. This article presents how we have used a scenario approach to prepare for alternate levels of future RBC demand by mapping key categories of opportunities and threats with suggestions for mitigating potential risks for Sanquin, the Dutch national BE.
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