Future-ready blood services: Building strategic foresight for the blood supply chain

Blood is an irreplaceable resource in the healthcare system, and ensuring its safe and timely delivery from donors to patients is the core function of the blood supply chain (BSC). Managing the BSC is increasingly challenging given the uncertainty surrounding interconnected factors such as demographic shifts, technological advances, and evolving clinical practices. Conventional planning approaches are insufficient to capture these complexities, motivating the development of narrative scenarios.

We developed narrative scenarios for the BSC using a decomposition-based scenario development framework. Through a systematic literature review and expert consultations, we identified 10 key uncertainty factors and defined four development paths for each. We elicited pairwise consistency ratings between development paths from BSC experts and used them to select four internally consistent and maximally diverse scenarios.

Four internally consistent scenarios were developed: Strained Resilience, Thriving Transformation, Adaptive Automation, and Regulatory Rigidity. Cross-scenario analysis reveals three structural findings: (i) where synthetic blood alternatives emerge, they complement rather than replace voluntary donation, (ii) apparent stability can mask underlying fragility, and (iii) long-term resilience is determined by social and institutional conditions rather than operational capacity alone.

Our findings identify donor engagement, institutional trust, cybersecurity resilience, and regulatory agility as robust strategic priorities for the BSC across a wide range of possible futures. The scenarios reveal that factors conventionally excluded from BSC analytical models, such as civic trust and regulatory flexibility, are among the most consequential drivers of long-term system resilience.