237 General Discussion The preceding chapters illustrate the work that chronicled our journey, beginning from scenario development in Part I to organizational resilience in Part II--the shift from anticipating external threats to a series of responses to an external threat. Therefore, this chapter will reflect on these two parts individually and together, and end with implications for practice and future research recommendations. 7.1 Reflections on Part I Transformational factors that would affect future RBC demand In Chapter 2, we explored both historical and future trends in RBC demand and its underlying drivers and contributing transformational factors. The historical drivers of safety and cost/cost-effectiveness will continue to be a cornerstone in all BE decision-making and management as the safety, quality, and affordability of blood products cannot be compromised. With regards to transformational factors, the detailed list of transformational factors in Chapter 2 are consolidated into ten themes in Chapter 4, which were ranked on a matrix of importance and uncertainty. The three themes most highly agreed upon concerned precision medicine, RBC replacements, and RBC improvements or alternative applications. Essentially, advances in these themes will inevitably change clinical practice, which will impact demand. Historically, as described in Chapter 2, changed perceptions regarding the safety of blood transfusions changed clinical practice, bringing about the shift from a liberal to a restrictive transfusion trigger and heralding an era of decreased transfusion use. This movement encompassed various surgical treatments and pharmaceutical products that minimized blood loss, the rise of Patient Blood Management (PBM), and changes in organizational practices that advocated for wiser and better use of RBCs. This movement continues into the present, along with great strides made in gene therapy1 (albeit currently for sickle cell disease2,3 and thalassemia) and cultured RBCs (cRBCs).4 Additionally, current research into all aspects of blood donation may also affect future practices: for example, Precision Transfusion Medicine (regarding both the products and the patients),5 donor and patient genotyping (to allow for good matching and prevention of allo-immunization, and for awareness of more donors with rare blood groups) and even storage practices as new research shows how stored blood reduces oxygen delivery and advocates for the evaluation of blood storage regimes and rejuvenation protocols.6 Some of these innovations are forecasted to take time in its development and need to overcome logistical and/or ethical issues. However, gene therapy from recent years has shown great strides in its development and approval, which
RkJQdWJsaXNoZXIy MTk4NDMw