decreased independence, and higher risk-management costs (Scott 1990). Some blood centers import blood because they can obtain this blood for less than their own costs of production (Anderson 1990). For years, blood banks have participated in systems to exchange blood among themselves to alleviate shortages. Blood banks in metropolitan areas that serve large trauma, tertiary, and transplantation centers most frequently experience shortages of whole blood, components, and type-specific blood units. Although experience has demonstrated that the American public is ever-willing to donate blood in times of local disaster or national emergency, this same public has often not donated blood in sufficient supply to meet the daily needs of the local community. Less than 5 percent of the U.S. population donates blood and in certain communities the percentage is even lower. Without resource-sharing networks, many individuals would not receive the blood transfusions necessary to maintain or restore their health.

BLOOD COLLECTION ORGANIZATIONS

The United States blood collection system is heterogeneous owing to the "random development of blood centers without regard … to patient referral patterns" (Scott 1990). The American Red Cross (ARC) collects approximately half the blood in the United States. In the non-ARC covered areas, blood is collected by one or more community or hospital blood banks. In most areas of the United States, there is only one local organization that collects blood. However, in some communities, including these where the ARC operates a blood program, blood may be collected by more than one organization. When this occurs, usually several hospitals and a community blood center (ARC or non-ARC) are involved.

The adequacy of the nation's blood supply varies at different times of the year and in different parts of the United States, but, in general, the United States is almost 100 percent self-sufficient in its blood supply. Approximately 2 percent of the U.S. blood supply is imported from western Europe (Wallace, et al. 1993). Sufficiency, however, varies among geographic areas of the United States on a continual basis. The extent to which the adequacy of the blood supply is related to the public image of blood banks and the association of blood with AIDS is not clear. Public opinion surveys indicate strong support for blood banks (Gallup 1991), and despite major public education efforts by blood banks, a high (35 percent) percentage of people believe they can contract AIDS or HIV by donating blood (CDC 1991).



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