Jharkhand Blood Crisis: High Court Orders Reform, Ground Reality Lags

Four years ago, at Jharkhand’s largest government hospital — Rajendra Institute of Medical Sciences (RIMS), Ranchi — 12-year-old Reshu Mahli died for want of one unit of blood.

Doctors at RIMS had written an “Emergency Life-Saving” request on the prescription for one unit of A-positive blood to save Reshu’s life. Despite this instruction written at the top of the prescription, staff at the RIMS blood bank did not provide the blood.

Reshu’s father, Ramesh Mahli, kept pleading with the blood bank staff until 2 am, but the staff remained unmoved, insisting on one condition alone: a donor must be produced, otherwise, blood would not be issued.

Ramesh wandered desperately in search of a donor, while his son Reshu continued to writhe in agony from sickle-cell anaemia. Ultimately, at around 9 am, Reshu succumbed to pain and died. Within 24 hours, Ramesh lost his son to a government system that failed him.

Public anger erupted after Reshu Mahli’s death. Protests broke out, opposition parties questioned the ruling government, and the incident was widely described as a collapse of the health system. There was hope that after Reshu’s death, the government would finally reform the healthcare system, especially by ensuring, under the National Blood Policy, that hospitals provide blood on a non-replacement basis. This would mean patients receive blood without having to produce a donor.

However, even after five years, the government neither enforced strict rules nor initiated any concrete steps to ensure that patients could receive blood without donors.

Now, hearing a Public Interest Litigation (PIL), the Jharkhand High Court has directed all hospitals in the state to provide bedside blood to patients without insisting on donors. Interestingly, the organisation that filed the PIL — Life Savers Ranchi — had approached the High Court precisely in the aftermath of Reshu Mahli’s death.

Atul Gera, a founding member of Life Savers Ranchi, told Outlook, “In fact, I filed this PIL against RIMS after Reshu’s death. The court order that has come now is not new. The state has issued similar orders nine times earlier, but they were never strictly enforced. That is why we had to approach the court. Now that the High Court has passed this order, I hope pressure on the government will increase, and it will be implemented. If not, it will amount to contempt of court.”

According to the guidelines of the National AIDS Control Organisation (NACO) and the National Health Mission (NHM), blood must be provided on a non-replacement basis. But in Jharkhand, both government and private blood banks insist that a patient’s relatives or acquaintances donate blood in exchange, otherwise, blood is denied. This practice exists not only in Jharkhand but across most hospitals in India.

In this context, the Jharkhand High Court’s verdict in PIL No. 2413/2021 is a significant step toward addressing the blood crisis. The court observed that many government and private hospitals in Jharkhand still impose a “blood for blood” or replacement-donor condition, which is not only inhuman but also a blatant violation of the National Blood Policy and national transfusion guidelines.

The petition pointed out that families of critically ill patients are pressured to arrange donors, causing treatment delays and, in many cases, loss of life.

During the hearing, the High Court made it clear that blood is not a private commodity but a part of the public health system. The court held that the replacement-donor system is unscientific and increases the risk of unsafe blood collection. On this basis, the court ordered that all government and private hospitals and blood banks in the state must provide blood to patients without imposing donor conditions. The court further directed the government to move toward a 100 per cent voluntary blood donation system, conduct regular inspections of blood banks, and develop a robust blood-management infrastructure in every district.

However, the Jharkhand AIDS Control Society maintains that there is a severe shortage of blood in the state, making non-replacement supply difficult. The Jharkhand Health Department echoes this view. 

Jharkhand Health Minister Irfan Ansari, speaking to Outlook on the High Court verdict, said, “If the court has passed an order, it will be complied with. But it is challenging. The demand for blood in the state is very high, while collection is low. If we do not collect blood, how will we supply it? That is why the process of taking blood from donors in exchange was considered practical. Still, since there is a court order, it will be followed, and solutions will be found.”

According to one report, Ranchi alone requires 350–400 units of blood every day. Another report states that nearly one million units of blood are required annually in the state, while only about 3.2 lakh units are collected. To meet this massive demand, Jharkhand has only around 60–70 blood banks.

As per rules, government and private blood banks are required to organise blood donation camps every month according to their needs. Social activists say that apart from government initiatives and NGOs, private hospitals rarely organise such camps.

A district Sadar hospital is the largest government healthcare unit in any district. Its authority is not limited to treatment alone, but it also carries administrative and legal responsibilities, including powers related to blood supply and emergencies.

Ranchi Sadar Hospital’s Civil Surgeon, Dr Prabhat, told Outlook that the High Court’s directions are being followed. “The High Court order will be implemented 100 per cent. In view of this, donor camps will be increased,” he said.

Yet, on the ground, the situation remains unchanged. Five days after the order, a major private hospital in Ranchi still pressured a patient’s family to arrange donors. Shambhu (name changed), a relative of a patient, told Outlook, “We brought our patient to Ranchi in a serious condition, as blood was coming from his mouth. The hospital transfused two units of blood. When a third unit was needed, we were told to bring three donors. Only after we called two relatives from Jamshedpur and one from Bokaro and arranged donations was the third unit given.”

Meanwhile, long queues continue outside the RIMS blood bank, with patients’ families waiting for blood. Blood is still not being provided without donors. On December 24, Outlook spoke to several donors and patient relatives at the RIMS blood bank. Among them were Haradant Munda and Basa Jamuda from Chakradharpur in West Singhbhum district. Their patient had suffered a serious head injury in an accident and was admitted to a private hospital in Ranchi, which asked them to arrange two units of blood. They came to RIMS for this purpose.

Haradant Munda said, “After hours of waiting and donating blood, RIMS finally gave two units. Every year, I organise a blood camp in memory of my late brother and collect 30–40 units for the Chaibasa blood bank. Yet today, I am facing so much trouble here. Hospitals should arrange blood themselves, but they do not.”

Many donors standing outside the blood bank expressed similar anger, “We are fit, so we can donate. But many relatives who accompany patients are not fit. They face immense difficulty finding donors. At the very least, blood banks should provide blood without donors to such patients.”

Organisations working to motivate blood donors say that the biggest crisis is faced by patients who have no donors. For instance, if a patient comes from Palamu to Ranchi and is prescribed four units of blood, the accompanying relative may need to find ten people, because several may be rejected during screening. Such desperation often pushes families toward brokers who sell blood. These paid donors frequently conceal their medical history, increasing risks.

Delays in treatment due to lack of blood are common, and in many cases, patients lose their lives. Reshu Mahli’s death is the starkest example of this, and there may be many more unrecorded deaths where blood was not provided in time.

In October this year, another shocking case emerged from West Singhbhum (Chaibasa), where five children suffering from thalassemia were transfused with HIV-positive blood and later tested HIV-positive themselves. After the incident, the state government sent a high-level inquiry team and suspended several officials. The Jharkhand High Court also took cognisance of the matter and sought a report from the Health Department. The incident raised serious questions about blood-safety protocols and blood-bank operations.

Gera says delays in treatment cause both loss of life and financial damage.

“Many deaths occur due to non-availability of blood on time, but the cause of death is often manipulated. Doctors rarely record ‘non-availability of blood’ as the reason,” he says.

He adds that when hospitals ask families to arrange blood, days are lost searching for donors, while hospital charges keep rising daily.

The blood-shortage crisis in Jharkhand is closely linked to widespread anaemia, which has a deep impact on public health. According to the latest National Family Health Survey (NFHS‑5) (2019–21), nearly 67 per cent of children under five in Jharkhand are anaemic. About 65.3 per cent of women (15–49 years) are anaemic, while the figure for men is around 30 per cent.

Reports indicate that around 10,000 children in the state suffer from thalassemia and sickle-cell disease, while about 1,500 others have different blood disorders.

To regulate safe blood collection, testing, storage, and transfusion in India, institutional mechanisms exist at both the central and state levels. Their objective is to ensure that transfused blood is safe and does not spread infections such as HIV or Hepatitis-B/C.

At the central level, the National Blood Transfusion Council (NBTC) is the apex body, established in 2001. NBTC implements the National Blood Policy, sets standards for blood banks, promotes voluntary blood donation, and frames blood-safety guidelines. It functions under the AIDS control programme and plays a technical and policy-making role. 

At the state level, every state has a State Blood Transfusion Council (SBTC), formed in phases after 2001. SBTCs oversee blood banks, licensing, inspections, blood availability, and emergency coordination. They ensure that blood testing follows prescribed standards.

In addition, NACO plays a crucial role, as prevention of HIV and other blood-borne infections is directly linked to blood transfusion safety. In essence, NBTC frames policy, SBTC implements it on the ground, and NACO monitors infection control.

Reshu Mahli’s death exposed a systemic failure in Jharkhand’s blood-supply system that persists despite repeated government orders and now a High Court mandate. While the court has clearly outlawed the replacement-donor practice, enforcement remains weak. Avoidable deaths, unsafe transfusions, and exploitation of desperate families will continue until blood is treated as a public health right, and not a negotiated commodity.