On Sunday evening, a group of young men in dirty clothing squatted at the gates of the National Blood Transfusion Center, watching for ambulances and waiting for a call from a blood broker.
The men, mostly street-dwellers with little or no other income, said one word from the brokers could mean a meal and a quick $5 profit, all for just one unit of their blood.
“We all have no money so we come to sell,” explained Out Sopheak, 23, who said he has sold his blood 10 times in the past two years.
“We sit here from 5 pm until 7 or sometimes 11 at night. If the ambulance comes then we are very happy because we hope we can sell our blood to the brokers,” he said.
“The broker is inside the center here, inside the hospital,” Out Sopheak alleged. “If the family of the victim comes and wants to buy blood directly from the blood seller, the brokers will not allow it. They say, ‘Oh, your blood pressure cannot pass.’ But if it is through them, it is OK.”
A dearth of voluntary blood donors has meant that maintaining the country’s blood stores has been an ongoing problem.
The government’s solution has been to look to patients or their families for replacement donors, creating a market for blood sellers among those who can’t or won’t give blood themselves.
Dr Hok Kim Cheng, the deputy director of the NBTC, which is responsible for Cambodia’s blood supply, denied that brokering blood sales takes place at the center or among his staff.
“There is no system to buy or sell blood—it is national policy about blood use,” he said.
“This problem is according to the family of the patient. A lot of the families pay someone to give blood,” he said. “We have no system to buy blood from replacement donors. The problem exists that the family of the patient does not want to give [blood].”
But, he added: “If this program happens, our staff doesn’t tell us about this. We have talked about this problem with our staff.”
Hok Kim Cheng said that legitimate, voluntary blood donation, which has totaled about 1,000 units per month this year, has been increasing about 15 percent from year to year. But the factor that blood supply experts consider crucial—the ratio of voluntary donors to replacement donors—remains troublingly low.
Currently, 25 percent of blood is received from voluntary donors and 75 percent comes from replacement donors, Hok Kim Cheng said.
Dr Massimo Ghidinelli, who is HIV/AIDS adviser at the World Health Organization, noted that in countries that have been more successful in eliciting voluntary donations, their donations constitute half the blood supply.
“We have warned, repeatedly, the Ministry of Health. We consider blood safety a pillar of public health,” he said. “Clearly, when there are reports that indicate the possibility of trading in blood, coming especially from a high-risk group, our concerns are justified.”
A sustainable system to develop a safe, quality blood supply is desperately needed, he said.
“The whole concept related to blood safety is not only about disease; it’s about quality and availability of blood. It should be available, and it can only be available at the highest levels of quality and safety if there is a high voluntary blood donation base. Unfortunately, there doesn’t seem to be the desirable vast improvement that we would like to see.”
Of particular concern, he said, were studies connecting drug use and issues like blood selling.
A Mith Samlanh/Friends survey released last month stated that “those children and youth that are selling blood are frequently substance using, and a proportion are injecting substance users,” making them vulnerable to HIV/AIDS and blood-borne infections.
Minister of Health Nuth Sokhom referred calls to Secretary of State for Health Monna Ouk. Monna Ouk declined to comment for this story.
Outside the National Blood Transfusion Center, the blood sellers said they sleep on the streets or in parks, and that they barely had enough money for food, never mind drugs.
Lin Lina, 22, said he was a waiter until his workplace was shut down. Now he goes to the center as often as four times each week, in the hope that someone will need his type-B blood. “After they take the blood, they give banana, bread and eggs to eat, and money—$5,” Lin Lina said.
He said that ambulance drivers sometimes called him into the center to give his blood. “One time is $15, but the broker gets $10 and we only get $5.”
Giving blood as often as the blood sellers report doing so is not advised. Dr Uy Sam Onn, who manages the Cambodian Red Cross blood donation program, said men should not give blood more often than every three months. But those outside the center said the doctors had never questioned them.
On Sunday, reporters watched as Lin Lina and others rushed to the gate of the NBTC. A man who identified himself to reporters as a center “technician,” but who would not give his name, invited one of them inside.
Out Sopheak said he hoped he would not be selling blood for long. “If I had a job to do, I would not want to sell my blood, because when I sell blood I don’t have any energy—I lose all my strength,” he said.
