(P-PH-3) Next Steps for Implementing Intraoperative Autotransfusion to Address the Global Transfusion Gap: Conclusions from an International Working Group

Background/Case Studies: Despite the importance of blood transfusions to life-saving medical care, millions of people live in “blood deserts” where there is no access to transfusion, particularly in rural parts of low- and middle-income countries (LMICs). Intraoperative autotransfusion (IAT) is a well-established method for meeting emergent demands for blood and, with broader implementation, could strengthen blood ecosystems in settings with limited access to allogeneic transfusion. IAT consists of collecting and reinfusing uncontaminated blood lost into a body cavity back into the same patient, minimizing risk of transfusion transmitted infections (TTIs), eliminating the need for typing, and potentially decreasing time to transfusion. It has been shown to be a safe, cost-effective method of providing transfusions in multiple contexts and specialties.

Study

Design/Methods: Five international experts in transfusion medicine, surgery, public policy, and industry were invited to participate in a working group exploring current barriers to widespread implementation of IAT in LMIC blood deserts. Through a series of 10 virtual workshops and 6 focussed interviews over 8 weeks, as well as an extensive review of the literature, the study team outlined the current state of available technology, existing obstacles that must be bridged prior to implementation, and a series of recommendations to advance implementation.

Results/Findings: The barriers preventing widespread adoption of IAT can be grouped into three main categories: provider-based, technological, and regulatory. All categories can be at least partially addressed through further, focussed research investigating the efficacy and safety of devices designed for LMIC-settings, appropriate patient cases for IAT use, current uptake of available devices, and provider experiences using autotransfusion. However, data alone is necessary but insufficient to truly change practice; this robust evidence base must be used to establish guidelines for IAT use, build multidisciplinary provider trainings, direct policy development and modification to include IAT, and also address specific provider concerns.

Conclusions: Especially when applied in combination with other techniques, intraoperative autotransfusion is a promising approach to provide blood products when allogeneic transfusions are not available. Large-scale implementation of autotransfusion as a viable part of a larger strategy to address global blood deserts will require collaboration and collective investment from many stakeholders throughout the global community.

Importance of research: Promoting accessibility of blood transfusions is an important step towards addressing the global mortality burden from surgical emergencies. Blood deserts persist due to challenges transporting and storing blood in rural and remote regions. Intraoperative autotransfusion presents a viable alternative strategy for facilities with severe blood deficiency. This work identifies important next steps to facilitate autotransfusion implementation in low- and middle-income countries.