Table 1.

Identified infrastructure limitations and cultural barriers preventing optimal transfusion practice with and proposed solutions

Identified barrier	Proposed solutions
Too few safe donors	Consistent testing kit supply, ensure unpaid donors, ensure adequate screening practices
Donor seasonality	Improve blood banking and distribution practices
Culture and misconceptions	Recruit cultural leaders as stakeholders, community education campaigns
Delays in care	Centralized blood banking with rural distribution policies, Satellite blood banks, novel blood transportation methods such as drone flights, rural whole blood donation protocols, improved triage, and critical care transport
Indications for transfusion vary widely	Identify those who benefit from more widely available whole blood (peripartum, trauma, childhood anemia) versus the less common component therapy (hematologic malignancy, hemophilia, liver disease)
Protocols are lacking	Protocols for blood collection, banking, distribution, guidelines for blood handling, storage, transfusion practices
Progress creates greater demand	Prioritization by healthcare system leadership, advocacy by perioperative providers
Rethinking whole blood versus component therapy	Consider whole blood donation/transfusion practices in remote areas (“the field”) for trauma, obstetric, or life-threatening bleeding until infrastructure supports widely available blood banking and distribution