[Editorial] Barriers to voluntary blood donation in LMICs: a state of play

Barriers to voluntary blood donation in LMICs: a state of play Article Info Publication History: Published June 13, 2026 DOI: 10.1016/j.langlo.2026.104011 External LinkAlso available on ScienceDirect External Link Copyright: © 2026 The Author(s). Published by Elsevier Ltd. Linked Articles June 14 is World Blood Donor Day: an event to raise awareness of the need for safe blood and blood products globally. A 2019 modelling study on global blood need found that every country in central, eastern, and western sub-Saharan Africa, Oceania, and south Asia had insufficient blood to meet their needs. Some would be defined as blood deserts: an area where blood components cannot be accessed in a safe or timely way in at least 75% of cases where a transfusion is needed. On this World Blood Donor Day, it is essential to highlight the barriers to voluntary blood donation and initiatives to tackle blood deserts. An Article published online first explores these issues. In this qualitative study in Kenya, Linda Barnes and colleagues found that fragmented blood donation and transfusion systems, alongside substantial structural, cultural, and health-related barriers, either preclude individuals from donating or make it much harder for them to do so. Research indicates that anaemia is one of the leading factors for donation deferrals, accounting for 78% of female deferrals and 38% of male deferrals in India and up to 74% of female and 39% of male deferrals in sub-Saharan Africa. The presence of bloodborne infectious diseases (eg, malaria) also presents a substantial barrier to blood donation and reduces the potential pool of eligible, healthy donors. These ineligibilities are compounded by missing infrastructure to adequately screen blood donations and assess their safety for transfusion. WHO recommends that all blood donations be screened for HIV, hepatitis B virus, hepatitis C virus, and syphilis. In 2018, 113 (66%) of 171 reporting countries had specific legislation covering the safety and quality of blood transfusion. However, the presence of such legislation was disparate across income groups: 63% of middle-income countries had legislation, compared with just 39% of low-income countries. Structural issues also present a barrier to promoting voluntary donations. Blood donation centres are often established in urban centres, making it substantially harder for donors from rural areas to donate. Deficiencies in infrastructure, such as an unreliable supply of electricity for refrigeration, can also result in the wastage of collected blood products; this in turn feeds into a cultural distrust of the voluntary blood donation process, including beliefs that donated blood is used for nefarious purposes (eg, sold to the patient as opposed to given to them freely) and that donation can leave the donor more susceptible to infections, premature ageing, and infertility. Innovative global initiatives to address the lack of voluntary blood donations are vital. Drone-based delivery of blood products can overcome challenges experienced by road vehicles (eg, traffic), as well as removing the need for blood banking infrastructure at the receiving site. A 2022 study on drone-based delivery in Rwanda found that 14 of 20 included hospitals delivered blood faster by drone than by car. A 2024 consensus statement also highlighted drone-based technologies, alongside so-called walking blood banks (mobilisation of type-compatible or universally compatible donors from the community with screening for transfusion-transmitted infections) and intraoperative autotransfusion, as a means of ensuring timely access to needed blood products. Interventions that are potentially easier to implement and lower cost include organising mobile blood clinics that visit rural areas, free transport to urban donation centres, and radio, TV, and social media campaigns to improve knowledge and dispel myths around blood donation. This World Blood Donor Day, we call for a renewed focus on addressing global blood deserts through scalable, multisectoral, implementable interventions. These should be guided by country-based research conducted with key stakeholders to establish the barriers and enablers to voluntary donation and ensure that developed interventions are feasible, relevant, and culturally specific. By shining a light on blood deserts, and the barriers faced by donors to voluntary blood donation, it is our hope that the global health community can come together to ensure this life-saving resource is available to all.