Echoing the term "snake head", a special new word - "blood head" - has appeared in the Chinese vocabulary in recent years, referring to a person who profits from organizing people to sell their blood.

Since Shanghai has a constant shortage of blood supplies, every district and county in the city is given the task of collecting a certain amount of blood annually.

The lower-level governments have to fulfil their quota by requiring factories and companies in their jurisdictions to ask their staff to participate in blood donation.

"Usually, about 10 per cent of the staff in any company will go for blood donations every year," said Lu Jinong, an official with the Shanghai Blood Centre.

Yang Xi, a radio programme anchorman, signs an authorization to donate his blood stem cells at the No 307 Hospital in Beijing on Monday. A shortage of blood and blood products plagues China's major cities, including Beijing and Shanghai. [Xinhua]

However, the widespread reluctance to give blood has made some companies look to outsiders to donate on the company's behalf, rewarding them monetarily as a bonus. One group of people who spotted a money-making opportunity contacted these companies and started organizing laid-off locals and out-of-town labourers to earn "blood money".

The companies promised to give the blood heads about 1,000 yuan (US$120) for 200 millilitres of blood, while the blood heads passed on about 500 yuan (US$60) to the donors.

After 1998, when the city abolished its policy of paying every blood donor 80 yuan (US$9.70) for 200 millilitres of blood, voluntary blood donation was advocated around the country. However, those companies in a comparatively healthy financial state started encouraging staff to donate, using monetary lures.

According to the relevant regulations, those employees selected to give blood are to undergo a physical examination one week before donating to ensure the quality of the blood.

On the day of donation, the donors are required to show their ID cards and work certificates to doctors.

However, supplying fake ID cards was not a problem in the city.

Sometimes employees would take a physical examination and, if they passed, replacement donors would give blood as if they were safe.

"It was very dangerous. And blood quality is threatened, because the fake donors skipped the physical exam and did not disclose their disease histories on the application forms," Lu said.

Employed donors

According to the Xinhua News Agency, police investigated 11 work units that employed blood heads and arrested five blood heads last year in Shanghai.

The donors who had been employed were mainly impoverished laid-off workers and migrant labourers from other provinces. More recently, college students have also become prey for blood heads.

According to the official website of People's Daily, blood heads distributed flyers on campuses to attract student donors.

Blood heads reasoned that college students would have better quality blood, look more like company staff and would therefore seldom be suspected by doctors.

The online article said that blood heads usually dealt with groups of people who were willing to donate blood for money but unaware that a large part of the fee would be kept by the "brokers". Blood heads have also begun seeking donors over the Internet.

This May, the Police Bureau in Shanghai's Yangpu District arrested six blood heads who posted online messages recruiting young people willing to sell their blood at a price of 800 yuan (US$96) for 400 millilitres. After deducting this sum, the blood heads stood to make a 1,400-yuan (US$170) profit on every 400 millilitres collected.

"Most of the donors were students who needed money," said Yang Jiong, an official with the police bureau.

The Chinese Blood Donation Law enacted in 1998 stipulates that a donor must wait six months between donations. However, blood head "staff" donated frequently, sometimes several times within one month. Some of the donors may not have realized such behaviour was illegal.

Asked whether he was willing to donate 200 millilitres of blood for 600 yuan (US$72), an out-of-town worker said he certainly was, as it was quite a large sum of money to him.

In order to kill the blood head phenomenon, the municipal government has installed ID-examination machines at every blood-collection station to screen out fake ID cards and donors.

"However, this may not be a very effective approach, because even counterfeit currency can sometimes fool money-examination machines at banks - with cards it is much easier," said Shen Kaiqian, a doctor at a blood-collection station in Pudong.

Doctors are authorized to confiscate suspicious cards and are required to stay on the alert for anyone with needle marks on their arms.

It is reported that as many as 20 per cent of the officially reported AIDS patients and HIV carriers in the country were infected due to illegal blood donations.

Farmers targeted

"Selling blood - as long as I'm alive and until the end of my life," has long been a popular saying among farmers who make a living exchanging blood or blood plasma for cash in Henan, Qinghai, Gansu and other poverty-stricken provinces.

About 20 per cent of the officially reported AIDS patients and HIV carriers in the country were infected due to illegal blood donations, according to Sun Jiangping, an expert at China's Disease Prevention and Control Centre.

Gong Wenxia, a villager in Baishui County, Shaanxi Province, holds 75 yuan (US$9) in her hand after donating blood plasma at a collection station. Many villagers in poverty-striken areas still depend on their blood for money, unaware of the possible threat to their own lives and those of the recipients.[newsphoto.com.cn]

In some regions of these provinces, 80 per cent of villagers sell their blood frequently.

But unlike blood heads operating in the big cities, the rural blood heads were themselves farmers and did not make much money. For 400 millilitres of blood they received 150 yuan (US$18), of which the blood head kept 15 yuan (US$1.80).

The country's Blood Donation Law stresses that blood donations must be voluntary but allows payment for blood plasma because of its commercial uses.

In 2001, 59 of the 220 plasma collection stations around the country were closed down.

However, on the border of Anhui and Henan provinces, some stations were still engaged in the illegal "trade", according to an investigative report by China Central Television (CCTV).

By convincing one farmer to "donate" plasma, a blood head could earn 2 yuan (24 US cents).

Hundreds of Henan farmers took buses to neighbouring Anhui Province to "donate" plasma, with some donating as many as 13 times a month. Needle-marks covered their arms.

In a CCTV interview, a farmer surnamed Chen, together with his wife, saved 8,600 yuan (US$1,040) for their son's high school tuition fees and another 60,000 yuan (US$7,200) towards his college education from blood donations.

Chen has been making regular donations for 34 years. Every time he gives blood, he has to give the blood heads 15 yuan.

In fact, plasma donations by residents from other provinces are forbidden by law but it seems to have become a custom among farmers in poorer areas to sell blood to alleviate their poverty.

Answering the call

For a long time, blood donations in Shanghai had a compulsory element: people chosen as donors had to give blood and, in return, were compensated and even rewarded with holidays by their work units or companies.

A student walks past a billboard promoting blood donation in Shanghai. The city has been advocating a voluntary system to replace the compulsory one. The Chinese characters read "Project Hope for life." [newsphoto.com.cn]

Eight companies in Shanghai's Minhang District recently declared that they would eliminate compensation for blood donors, effectively throwing a stone into a tranquil lake and embarrassing many enterprises that still maintain the blood-for-pay system to encourage more employees to donate.

"When we received the quota for nine blood donors last year, I was so surprised because in Taiwan it all comes from volunteers, "said Ricky Lin of Shanghai Les Enfants Co Ltd, one of the eight companies.

Although donors could receive money and a holiday for their efforts, staff were unwilling to participate. So Lin decided not to enforce the demand. Instead, he held a party and invited the company's employees from Taiwan to attend and donate blood in a non-compulsory way. As a result, 27 workers donated blood at the party, far more than required by the quota.

This year Lin held a similar party in September for local staff, about 30 of whom donated blood. The compensation was not monetary but in the form of food and drink.

"They told me they were happy and not nervous about blood donation now," he said.

Compulsory fear

Up to the present day, more than 60 per cent of the city's blood supply has been dependent on compulsory donations rather than volunteers who receive no money or holidays.

Compulsory blood donation started in 1989 as a means of meeting the local demand for blood at hospitals. The city's compulsory blood donation regulations say that anyone who donates blood can obtain compensation from the blood collection organizations. At first, compensation ranged from 8 to 60 yuan (96 US cents to US$7.25) per person.

Song Qi, an official with the Shanghai Blood Administrative Office, said: "But now, some well-run enterprises can pay compensation as high as 1,000 yuan (US$120) and give one or two weekdays off with the aim of encouraging and rewarding donors.

"But such compensation leads to some bad misunderstandings. People think blood donation harms their health and that's why they need compensation and rest."

Blood donation is especially unpopular with older employees.

Sheng Chongming, a retiree who used to work for a now-closed State-owned enterprise, said most of her colleagues were somewhat reluctant to donate blood.

"Every year, the factory would pick some workers according to the amount of blood required. The factory would pay people about 700 yuan (US$85) each. But thinking it would harm their health, not many people were willing. Some who had good relationships with the factory leaders could avoid donating. It was not fair," she said.

The quota for each district was fixed by the city government every year and passed on to the districts, then to bureaux, committees and offices, then to enterprises and institutions such as the factory where Sheng worked.

Lack of volunteers

Last year, the city began to change the compulsory system to one that was volunteer-based.

"It is the trend," said Song.

The volunteer system of donating blood was originally introduced around the world during the 1930s. Now, more than 90 countries and regions have such a system and all the blood needed by hospitals comes from volunteers.

To make blood donation more convenient, Shanghai increased the number of mobile blood collection stations - specially fitted buses - last March. In 2002, the more than 72,000 bags (200 ml per bag) of blood collected accounted for 20 per cent of the city's total usage. "It is a good start," Song said. "But the rate of development for voluntary blood donations is still not fast enough compared with other cities in the country."

The reality is that Shanghai, with its population of 16 million, needs 100,000 to 150,000 volunteers a year instead of the current 30,000 to meet demand.

In an average city, if just 3 to 4 per cent of residents participate in blood donation, a sufficient store of blood can be guaranteed. The rate in Shanghai today is only 1.2 per cent.

"To push it along, I think the policy should be adjusted," Song said.

In Qingdao in East China's Shandong Province, one donation of 1,000 ml can guarantee its donor free blood up to the same amount for life. In Shenzhen in South China's Guangdong Province, a similar donor can have lifelong, unlimited access to free blood.

But in Shanghai, no matter how much you donate, you can only get five times the donation volume for five years. "The preferential policy is not so encouraging " we have suggested to the local people's congress that they adjust the regulation," Song said.

Among the current number of volunteers, almost half are from other provinces now working in Shanghai who are described as "new Shanghainese". According to statistics at the Blood Administration Office, most are young and highly educated.

As the first university in Shanghai to promote voluntary blood donation over the compulsory system, Shanghai Jiaotong University welcomed the second batch of blood collection buses on November 19.

"That was really a stirring scene," said Zhang Sanlin, a graduate student at the university. "I was on my way to the canteen and saw this awe-inspiring spectacle going on right in front of the building. Undergraduate students who had just been dismissed from their morning classes quickly gathered around the blood collection bus."

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