38 Chapter 2 Expectation that future RBC demand will increase Seven Sanquin and international experts (17%) believed that RBC demand will increase in the medium-term future, which was nearly identical among the years of experience (16% vs. 17%). Experts agreed that the common transformational factor was the aging population acquiring cancer and non-communicable diseases whose treatments require blood transfusion. An international expert explained how the sheer numbers alone of the elderly will increase demand, even if they receive treatments that require less blood: “Some of the modern therapy requires less blood, but by the sheer number of more [aging] patients, we will definitely level this out, and there are some new therapies which have the adverse event of making the patient anemic or thrombocytopenic as well.” (International Expert 40) Demography-based studies also reflect this idea that the aging population will have increased demand with subsequent reduction of the donor pool,13,15–18,21,42,51 yet carefully nuancing how this effect can certainly be counteracted by clinical developments, as proven historically.13,14,19 Expectation that future RBC demand will decrease Seventeen experts overall (45%), especially the majority of non-Sanquin experts, of which 53% of those with up to 20 years of experience and 39% of those with 21+ years of experience, believed that RBC demand will continue decreasing into the future. They gave 11 underlying factors that they believe will contribute to this trend (Table 2.2). Gene therapy and better surgical techniques were mentioned by all groups. Experts spoke of gene therapy, ranging from hemoglobinopathy to cancer treatments, with optimism, emphasizing its potential to “cure the disease” that will lead to a substantive reduction in blood products. Additionally, experts indicated that “surgical techniques are still improving” (Dutch Expert 19) and surgical innovations will continue so that “fewer patients are treated,” thus decreasing blood loss and demand. Experts from the Netherlands spoke about innovations related to hemoglobinopathy and hemophilia, which included sickle cell medications, matching strategies, and prevention of alloimmunization with technological tools. If these innovations were successful, it would minimize the constant transfusion needs of these patient groups. Finally, Sanquin experts spoke about the innovations of RBC clearance solution and restrictive use in performing cesarean sections, whereas one international
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