263 Summary Summary This dissertation presents the exploratory work on the topics of scenario development and organizational resilience that was performed at Sanquin, the Dutch blood establishment (BE) and multi-expertise institute. Part I (Chapters 2-4) uses scenario development methodology to assess the external landscape for red blood cells (RBCs) and immunoglobulins (Ig). Chapter 2 forms the groundwork of the thesis in searching the landscape through a wide literature review and interviews with 42 (inter)national experts. By focusing on RBCs, the results show I) the historical trends and drivers of the product, and II) future trends and contributing transformational factors, both globally and specifically for the Netherlands. In I), the decline of RBCs is traced due to the factors such as safety and costs, reduced transfusion thresholds, surgical techniques, and organizational changes; simultaneously, there has also been an increase of RBC use in the fields of oncology and hematology and for the aging and migrant populations. In II), most experts believed that RBC demand will continue to decrease in the future due to contributing factors such as gene therapy, surgical techniques, and various other innovations; however, there were minority groups of experts who also perceived that RBC use could increase or stabilize due to demographic factors. Various transformational factors from literature are provided, such as innovations in RBC substitutions or modifications, gene therapy, and organizational/operational factors. Chapter 3 searches through the Ig landscape. As Ig demand has increased, this study sought to find which specialties contribute to current demand, new areas of medical need, and which transformational factors may impact demand and to what effect, both globally and specifically for the Netherlands. Through a scoping review and interviews with 15 experts, results showed how neurology, immunology, and hematology are specialties that contribute to current demand and there are several possible new areas of medical need. Societal, economic, political, legal, technological, and clinical factors were grouped into four categories: factors that could increase Ig demand (e.g., increasing elderly population, increasing weight, increasing secondary immunodeficiencies), decrease Ig demand (e.g., cost, regulations on off-label usage), factors that remain to be seen on how it impacts demand (e.g., evidence), and miscellaneous and important factors (e.g., market forces, legislation changes). These factors portray the complexity that Ig is embedded in.
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