August 28, 2024
This article originally appeared in AABB News, a benefit of AABB membership. Join AABB today to read the rest of this month’s issue.
Recently in Ghana, a pregnant woman at the Akatsi District Hospital – serving a population in a rural part of the country – was diagnosed with an ectopic pregnancy that required immediate surgery to avoid the risk of severe internal bleeding, infection, and potentially, death. The hospital only had one unit of blood available, and doctors needed more blood supplies to perform the emergency procedure. Relying on ground delivery for blood products was risky due to poor road conditions and long transport times to the remote area. Time was of the essence; every second counted.
The hospital sent an emergency request for packed red blood cells (CRC) O+ via WhatsApp to one of Ghana’s distribution hubs. An hour after the request, the blood units were delivered by drones and administered immediately after a successful surgery to replenish the patient’s blood loss. The timely delivery of blood helped to save the patient’s life.
Unfortunately, not every patient in rural settings and remote areas has the same successful outcome. Millions of people die worldwide from preventable deaths each year in the world’s blood deserts, defined as geographic areas without timely, reliable and affordable access to life-saving blood components, in at least 75% of cases where transfusion is needed. Blood deserts exist worldwide, particularly in rural communities and low- and middle-income countries (LMICs) where the nearest blood bank may be hours away in an urban area.
The Blood D.E.S.E.R.T. (Blood Delivery via Emerging Strategies for Emergency Remote Transfusion) Coalition, a group of global blood experts dedicated to eliminating blood deserts and improving global blood infrastructure, cited an annual 102-million-unit blood shortage in LMICs and noted that every single country in sub-Saharan Africa and south Asia is in deficit. The group also cited that hemorrhage is responsible for approximately one-fourth of maternal deaths globally and up to 40% of deaths among trauma patients who reach the hospital.
“The world does not have enough blood where it is needed; locations with very low or no blood access are blood deserts,” said Meghan Delaney, DO, MPH, chief of pathology and laboratory medicine division at Children’s National Hospital and co-lead of Defining Blood DESERTS Division. “It’s critically important to define blood deserts so that we all recognize the humanitarian and public health issue and find ways to improve access to blood transfusion for patients in need. We believe nobody should die from lack of transfusion.”
To address insufficient blood supply and offer hope to people in blood deserts with limited access, the Blood DESERT coalition recommends key innovative strategies, including the use of drone technology. Drone-based blood delivery can expand blood availability, shorten delivery times in emergency situations and reduce blood product wastage.
“We realize the implementation of drone technology can potentially improve access to blood by ensuring that blood moves from where it is, if available, to where it is needed in the blood deserts. However, we are looking for ways to bridge existing knowledge gaps through research to guide the implementation of drone blood delivery in LMIC settings,” stated Lucy Asamoah-Akuoko, MD, MPH, PhD, head of research, planning, monitoring and evaluation at National Blood Service Ghana and principal investigator of the National Institutes of Health (NIH) BLOODSAFE in Ghana.
Asamoah-Akuoko, who leads the Blood DESERT Coalition’s drone-based blood delivery division, noted knowledge gaps include cost-effectiveness, temperature regulation and device efficiency. “We need to ensure that temperature regulation can maintain the quality of the products and the drones are efficient with regards to the payload, cost effectiveness of operations and many other factors,” she told AABB News. “We must bridge these gaps for the safe and effective use of technology that has the potential to save lives by making blood available in blood deserts.”
Although the use of drones is a relatively new advancement in medicine, these unmanned aerial vehicles are revolutionizing blood delivery in deep rural settings. In 2016, the Rwandan government partnered with Zipline, a California-based robotics company, to launch the world’s first national drone delivery service to transport blood products to remote facilities. In Rwanda today, approximately 75% of blood delivered outside of its capital, Kigali, is delivered by drone. Rwanda’s national drone delivery program also addresses the country’s mountainous landscape and geographical barriers, as flying drones bypass impassable roads, reducing delivery times from four hours to 15 minutes in some cases.
In 2019, the government of Ghana partnered with Zipline to deliver blood, medical supplies and vaccines to rural parts of the country through autonomous drones. To date, Zipline has completed more than 519,000 drone delivery flights across Ghana, including more than 16,000 units of blood products. Ghana’s drone delivery program has expanded to six Zipline distribution centers in remote areas that can reach more than 2,000 hospitals and health centers across the country, solidifying Ghana as the world’s largest medical drone delivery network.
Asamoah-Akuoko discussed the delivery process, noting that blood centers provide blood products to Zipline’s network of distribution facilities. To order a blood product, a health care professional sends a request via WhatsApp or SMS. Orders are received by Zipline at a distribution center. Once the blood is packaged, drones deliver the products to remote medical facilities.
The drones can carry 1.75 kg (3.85lb) and a maximum of three blood products in one flight and fly at speeds of 101 km/h (62.75 mph) at an altitude of 80-120 meters above ground level. In Ghana, the maximum flight time is 40 minutes. The drone at the launch site is set in motion by a supercapacitor-powered electrical catapult launcher, and at the end of flight a hook is used to capture and decelerate the drone. When near the delivery site, the drone lowers its altitude and drops the blood product (packaged in an IV bag) without landing using a parachute, and then returns to the distribution hub.
“Distance can be a significant factor in very remote areas,” Asamoah-Akuoko said. “Drone blood delivery has managed to address such barriers in mountainous regions in Rwanda and in flood-prone areas and very widespread areas with low populations in Ghana that make it difficult to access blood by road.”
Findings from a study that examined blood product delivery time and wastage in Rwanda revealed that drone delivery led to faster delivery times and reductions in blood component wastage in health facilities after analyzing nearly 13,000 blood product drone orders between March 17, 2017, and Dec 31, 2019. Based on the researchers’ findings, drone delivery was 79 minutes faster using estimated driving times and 98 min faster based on Google Maps estimates. Notably, the time savings from drone delivery varied widely, from 3 minutes to 211 minutes across the 20 facilities studied.
These findings support the use of drone delivery in areas like Rwanda, where postpartum hemorrhaging is the leading cause of death for pregnant women, and nearly half of all the units of blood delivered nationwide are for complications in childbirth, according to Rwanda’s Ministry of Health. In 2023, Zipline delivered a total of 28,754 units of blood to patients in Rwanda in critical condition, the majority of whom were women in critical moments of delivery.
“Drone technology helps to ensure that no lives are lost in these areas due to the lack of access to blood,” Asamoah-Akuoko stated.
The South African National Blood Service (SANBS) launched its drone blood delivery project in 2019 to transport blood to remote areas such as KwaZulu-Natal (KZN) and Eastern Cape, where the delivery of blood could take up to 18 hours in extreme cases due to road infrastructure conditions, vehicle and driver availability. Since then, the SANBS has faced several hurdles in getting the project operational. Lebohang Toko , who became the first drone pilot for SANBS at age 29, spoke to AABB News about the project’s challenges and plans to move forward. One of the challenges was that the Tron drones that were acquired for the proof of concept have proven to be unsuitable for day-to-day blood delivery.
“It’s been an uphill battle throughout these past five years,” Toko said, noting the unexpected regulatory delays her team has experienced. “I don’t think any of us anticipated so many regulatory hurdles. It took a while to comply with the South African Civil Aviation Authority [SACAA] regulations to obtain our operating license from the SACAA in 2022. We’ve been approved to fly 10 kilometers between two Gauteng hospitals; however, in KZN, we will have to deliver blood over 45 km distance. Therefore, we will have to apply additionally for these distances.”
Toko noted their new custom designed drones from Wingcopter are expected to arrive early next year and are totally suitable for these longer distances and make provision for cold chain stability essential for long distance blood delivery. Their delay in arriving has also been due to regulatory requirements, as all commercial drones must comply with local and international regulations, Toko pointed out.
The trailblazer began her career at SANBS in 2011 as a trainee medical technician and currently works as a technical support officer for the processing and issuing division. Despite the numerous obstacles and lengthy process, Toko, now 34, remains optimistic about the project’s take-off in the near future.
“We haven’t been able to operationalize the route because of stakeholder challenges, but I’m hoping this will be a different conversation next year,” Toko said. “I'm really praying we can take off soon.”
Asamoah-Akuoko discussed key considerations and common barriers to successful implementation of drones in blood deserts. We need to acknowledge that drone blood delivery implementation comes with its own set of challenges despite its potential, she added.
“Drone delivery should supplement, not replace, national blood transfusion services. That said, we need to look at establishing efficient blood banking systems,” Asamoah-Akuoko said. “We also need to ensure cost effectiveness and financial models that are sustainable, partly due to heavy government investment in implementation because the political environment is a major factor for sustainability in many blood deserts, especially in LMICs. One government may favor the implementation of innovative technologies for the improvement of health delivery, while the next might not be willing to invest the required resources.”
Toko noted that technological advancements can transform the transfusion medicine field and reduce the maternal mortality rate in her country and beyond. She is excited about innovation and encourages others to embrace technology. The future, she said, is now.
“We speak about the future when the future is actually here. We have AI smart technology now, so we can change the narrative to make a difference,” Toko said. “Feedback from hospital personnel says it can take up to 18 hours to get blood products to a mother who’s bleeding after giving birth. That means we’ve essentially lost her, and we are failing our people. The use of drones and smart fridges in rural areas can get blood to where it needs to be at a quicker time to save lives.”
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