45 Past, present, and future of red blood cells 2.4 DISCUSSION This study explored and compared perspectives of 1) historical trends of RBC demand in the past 20 years and underlying drivers to these trends, and 2) transformational factors that would impact the future demand of RBCs for the medium term to a specific effect, using both semi-structured interviews and a literature review. With regard to historical trends and drivers, we found the most prominent trend to be the decline of RBC demand. We found the underlying drivers to be safety, cost, the lowered transfusion trigger based on scientific evidence, surgical techniques and pharmacologic agents, and organizational changes. While these drivers are widely reported elsewhere,4,12,14,54,55 it does verify that experts are readily cognizant of these factors. Furthermore, these drivers will also become important drivers for the future. In assessing experts’ opinions and literature on clinical and technological developments that may impact future demand, the commonality between them is the need to overcome barriers of safety, costs, organizational/ operational issues, and regulatory/ethical affairs to become viable.51,56,57 If the decline in RBC demand were to indeed continue, the Netherlands would be uniquely affected. It currently has one of the lowest RBC transfusion rates in the world, at 23.8 per 1000 inhabitants (written communication).58 While this is certainly an asset for patient care, it challenges continual operations and services of the blood bank organization, as grappled in other high-income countries such as the United States and United Kingdom.5,20 Therefore, it is at such a time as this that blood banks may begin exploring and adapting to opportunities with regard to productions, policy, and organizational structure and culture. Opportunities in productions include focusing on plasma-derived medicinal products (intravenous immunoglobulin has caused plasma demand to rise exponentially worldwide with increased demands foreseen into the next 10 years) or even other types of products from blood. With regard to policy, blood banks could consider a dynamic adaptive approach, in which a robust policy is initially developed that would consider the variability of plausible futures but is intentionally changed over time. It is explicitly adaptive so that changes in the organization become analytical and deliberative instead of ad hoc and responsive.59 With regard to the organization, blood banks may consider incorporating other functions, like processing, handling, and transplanting other bodily products as a service to hospitals or even opening up available research facilities for external scientists. Finally, reviewing a blood bank’s culture (in its attitudes and practices) may be crucial in identifying elements that may hinder the organization from becoming internally innovative, and therefore making necessary changes to adequately respond to external innovations and foreseen changes in the future.
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