The tumor was growing, and the family of cancer patient Xia Jianqing was growing desperate.
Doctors at a military hospital in Beijing had warned Xia’s family that he would die without the blood needed for a lifesaving operation. But the hospital had no blood to spare, forcing the family to shop for blood on the street out of desperation.
The patient’s sister, Xia Guoqing, said they turned to one of the many criminals who roam Beijing hospitals, the local Red Cross Society of China Blood Center, and even city streets offering bags of blood.
The family paid more than 10,000 yuan, she said, and doctors performed the operation.
There was nothing unique about the Xia family’s early 2012 experience. Serious blood shortages at hospitals across the country have been pushing patients and their families to buy from illegal sellers every day since at least early 2011.
“Many relatives of patients who need blood for an operation have no choice but to come to us,” said a seller who declined to be named standing outside the Red Cross center in Beijing.
Police have cracked down on the underground trade over the past year, arresting increasing numbers of “blood hawkers” in Beijing, Guangzhou, Wuhan, and other cities.
Five hawkers were separately convicted of organized crime charges and illegal blood trafficking during the first six months of 2012 in Beijing’s Haidian District Court.
And in July, in the largest blood-related trial of the year, the Haidian procuratorate indicted twelve people on similar charges, including men named Wang Haitao and Xue Shengkai, whose customers several months earlier had included the Xias.
Authorities say some members of the Wang-Xue gang regularly solicited customers inside hospitals. Others scoured streets and the Internet for people willing to sell blood. Their arrests, which could lead to sentences of up to five years in jail, shut down the business.
But as long as blood is in short supply and desperate patients are willing, officials say, the illegal trade is likely to continue.
“Do you need blood?” was the question posed by a man in his thirties, sporting a crew cut and a black tote bag, whenever someone passed him in the hallway of a respected Beijing military hospital in October.
Shortages are commonplace in growing cities such as Beijing, Shanghai, Chengdu, and Guangzhou. And the problem “is spreading across the entire country,” said the director of Tianjin’s Municipal Blood Center, Yang Wenling.
Beijing’s citywide stocks on November 26 held only about 10,000 200-milliliter units of blood, officials say, which is only about half of what the city’s hospitals need.
To encourage Beijingers to donate, the Red Cross recently rolled out special policies offering preferential treatment to employees of companies and organizations that sponsor blood drives. Any of these employees who need blood would be first in line.
These preferential policies underscore the severity of the blood shortages, which have deepened in recent years. Since October, official websites for health agencies in Inner Mongolia Autonomous Region and Zhejiang province, for example, have been urging people to donate any type of blood.
The central government’s Ministry of Health says the amount of blood used in medical procedures across the country has increased up to 15 percent annually in recent years, far outpacing legal donations. Surgeries using blood rose more than 18 percent in 2010 over the previous year, but blood collections outside the illegal trade increased only 7.7 percent.
Under China’s system, blood centers handle collections from voluntary donors. They’re supposed to collect enough to meet the demands of hospitals and other health care facilities.
If supplies from pro bono donations fall short of needs, the national Blood Donation Law encourages patients to organize personal blood sourcing, perhaps by persuading family members, friends, coworkers, and neighbors to donate blood through a so-called “mutual aid” project. Few hospitals in China provide personal collection and storage services for people who want to bank their own blood.
Before 2011, mutual aid donations accounted for a small portion of all donations. Most sources were donors who rolled up their sleeves at Red Cross drives or on university campuses, and whose blood was processed, banked, and distributed to hospitals on an as-needed basis.
But over the past two years, mutual aid donations have skyrocketed. A doctor working at a military hospital told Caixin that “because of the blood shortage in Beijing, almost every operation in 2012 required a mutual aid donation.”
And the mutual aid system’s loopholes are wide enough for plenty of illegal activity.
Because the Xia family hailed from Jiangxi province, they could not organize a mutual aid donation in Beijing. They would have needed at least ten relatives and friends to provide the 4,000 cc’s doctors said they needed for the operation. Hawkers offered the only viable alternative.
Xia’s sister found a blood seller easily from among the rows of hawkers who regularly stand outside the front door of the Red Cross center in Beijing. Many work in twos or threes, and most carry tote bags. They approach anyone walking past who looks distressed.
The sister said she cut a deal with a tall man who wanted 20,000 yuan for 4,000 cc’s but eventually came down to 12,000 yuan for 3,600 cc’s. A family member, she decided, would provide the rest.
On an agreed-upon day, the hawker and nine blood donors he organized arrived at the hospital where Xia awaited surgery. They stepped into a room where nurses drew donations. The sister was told by the hawker to “pay after these people donate and the hospital confirms the patient got the blood he needs,” she said.
One blood-giver was Su Liang, 20, who said he answered a hawker’s online pitch for 500 yuan per donation.
Hawkers earn twice to three times what they pay donors, as black market blood typically costs 1,500 to 2,000 yuan per 400 cc’s.
“The law requires mutual aid donors to be family or friends of a patient,” said a hawker who called himself Yang Yang. “But how many friends and relatives can one expect people from outside of Beijing to assemble? In the end, most of them come to us.”
Hospital officials and doctors may not participate in the illegal trade, but neither do they interfere after telling a patient that he or she needs blood that only the mutual aid system can provide.
It’s hard for a hospital to prove whether a blood volunteer who shows up at the donation room is a patient’s kin or friend. This gives hawkers plenty of wiggle room.
In the hope of promoting legal operations, the Beijing city government has tried standardizing procedures for blood donations by, for example, requiring hospitals and blood centers to verify each donor’s identity. But doctors would rather see patients get the blood they need than follow this rule, said one hawker, so many ignore the identification rule.
On the other hand, the illegal blood trade is risky from a health perspective.
Blood processed via the official system run by the Red Cross includes quality checks. But for-profit donors can lie when filling out the required personal health survey, leaving the blood supply vulnerable to infections, including HIV.
China has followed a blood-donation strategy typical around the world since 1948, when the International Red Cross called on every nation to implement a pro bono blood donation system. The global health community has reached a consensus that only donated, not sold, blood can ensure a safe supply.
And China has suffered the consequences of blood marketing. “In the early 1990s,” said Zhuo Xiaoqin, professor at the Beijing University of Traditional Chinese Medicine, “an AIDS epidemic broke out in some provinces, caused by illegally sold blood.”
In August 2011, the Wuhan government shut down the city’s entire system for mutual aid donations because it was being abused by underground blood dealers. The system has yet to re-open.
The Ministry of Health has taken steps to control mutual aid donations, too. The ministry says mutual aid donations may not account for more than 5 percent of the blood stored by a center.
Liu Jiang, director of Beijing’s Red Cross center, blames the mutual aid system for encouraging illegal blood trading. He told Caixin that in Beijing, mutual aid donors accounted for about 10 percent of the estimated 400,000 blood donations recorded in 2012, up from only 3 percent the year before.
The system is also bogged down by a blood certification process that benefits local government treasuries and hinders cross-border use of donated blood.
Few blood centers will accept donation certificates from other jurisdictions in China, although officials in Shanghai, as well as Zhejiang and Jiangsu provinces, are exploring whether to allow cross-border certification.
A Guangdong province man who traveled to Beijing for treatment was shocked to learn that the blood he brought from his hometown of Foshan was not acceptable. He was told that a Beijing hospital could only use blood donated in Beijing.
“Why can’t we use a Foshan blood donation certificate in Beijing?” he asked.
A Shandong province health department employee who asked to remain anonymous offered an answer to the Foshan man’s question: “This is related to (government) finance department payment methods,” he said. “Blood centers are funded through local government allocations, so the money is paid where a donation occurs.
“If someone donates in Henan and then wants to use blood for free in Shandong, who will pick up the tab?” he said. “Even in Shandong, we are just now starting to allow reimbursements from different parts of the province, for repayments between prefecture-level finance departments. If we want to cross provincial lines, then the finance departments in different provinces must work together.”