The blood system in Ukraine: Experience in martial law conditions

Efficient blood and blood components supply is key to the stable operation of a health care system, especially to a civilian population and military under martial law. The blood system is an important component of a state's defense capability and national security. Since 2022, Ukraine has advanced experience in self-sufficiency with whole blood and blood components in the conditions of a land war, without importing blood components.

In October 2022, a Ukrainian transfusion medicine delegation-headed by Specialized State Institution «Ukrainian Transplant Coordination Center» (SSI «UTCC»), the national coordinator of Ukraine's blood system-visited several Midwestern US blood banks, including Northwestern Memorial Hospital, to exchange information on blood system organization, transfusion practice, and disaster preparedness. During a daylong seminar and follow-up communications, delegation members described the Ukrainian blood system, wartime challenges, and plans to meet European Union standards, while also learning about US laboratory standards, transfusion practices, and emerging blood components such as cold-stored platelets. The approaches presented during this exchange have since demonstrated sustained effectiveness and systemic resilience across subsequent years of full-scale conflict, through to the present day.

In 2021, Ukraine had 24 regional blood establishments and 385 hospital blood banks collecting whole blood and blood components. The donor rate was 7.5 per 1000 inhabitants, and 44% of donors were first-time donors. Most donors (95%) were voluntary donors aged 18-45 years. The national blood system served both civilian and military needs. Since the invasion, some blood establishments and hospital blood banks have been damaged, destroyed, or occupied. These disruptions created urgent challenges, including coordination of blood system activities to maintain a continuous blood supply for civilian and military healthcare systems, management of the donor pool, development and management of national whole blood and blood component inventories, implementation of new transfusion practices and basic transfusion training for the security and defense forces, and traceability and hemovigilance during the prehospital stage of medical evacuation. In response, the Ministry of Health of Ukraine established the Operational Headquarters to coordinate the blood system under martial law. Blood establishments now report blood stocks daily, and some operate on a 24-h cycle to increase collection volumes. New approaches to donor recruitment and blood collection were developed to improve donor safety, and organizational partnerships and national donor campaigns were launched, including "Your blood can fight. Become a donor." The production, supply, logistics, and redistribution of whole blood and blood components to areas of need were centralized and codified into law, resulting in a more efficient blood supply network. To meet emergency needs, group O Rh-negative whole blood was prioritized, followed by group-compatible red blood cells and lyophilized plasma. Despite severe wartime challenges, Ukraine's blood system has met the increased demand for transfusion support since the start of the invasion without relying on imported labile blood products.

Military conflict, particularly land war, presents unique challenges to blood establishments and current transfusion practices that require urgent solutions. Exchange of experience on these issues strengthens the capacity of the blood system, defense capability and national security of states.