SOFIA, Bulgaria — Her 85-year-old husband needed immediate surgery but doctors told her to find blood for the operation herself, so Slavka Petrova swallowed her anguish and went to haggle on the black market outside the national blood clinic.
It’s a grim reality for patients and families in Bulgaria, a struggling EU nation where donors are scarce, hospitals are strapped for funds and blood traders — mainly Gypsy, or Roma, men — are thriving.
Trading in blood and blood products is illegal in Bulgaria, punishable by a fine of up to $7,100.
However, proving an illegal blood transaction is difficult because the law requires an official complaint from the person who pays the donor and families are so desperate they consider the black market blood donors lifesavers.
On the day Mrs. Petrova approached the blood clinic, a dozen men were smoking cigarettes on street benches waiting for clients.
“Even before I had decided what to do, three men stood in front of me and one asked me what blood group I was looking for,” Mrs. Petrova, an 82-year-old former government employee, said.
The price can be prohibitive.
“When they told me that this would cost me [$355], I thought, my God, this is my whole pension,” she said. “I went mute for a while, and they decided to lower the price to [$285].”
Once a deal is struck, a donor hanging out nearby — or at most a phone call away — is summoned and turns up at the blood clinic masquerading as a relative.
He gets a proof of donation certificate and sells it to the desperate family. The blood heads off to be checked. If the blood is free of disease, it goes toward filling the clinic’s reserves.
In Bulgaria, the debate grows over whether the black-market donors are lifesavers or bloodsuckers.
Mariana Shipkovenska favors the first description. The former journalist had to rely on paid blood donors when her 89-year-old mother had surgery for a fractured thigh bone. She said she would have given blood herself; but, after a medical check, her doctor advised her not to.
“They are the ones that give you something priceless when you need it and you can’t find it anywhere else,” she said.
Traders also claim they provide a good service.
“I don’t think it is a crime to help people who are in need,” one blood trader said, refusing to give his name for fear of prosecution. “I haven’t been able to find a job for years now, and selling blood is a way for me and my family to survive.”
Health workers at the blood center are well aware of the illegal transactions but feel powerless to do anything. At most, they ask police to shoo the traders from the entrance door, but the men soon return.
The deputy director of the center, Natalia Masharova, admitted that there is no legal way to prevent the practice.
“Although it is not legal, everyone is free to come and donate blood,” she said.
Her boss at the center, Andrei Andreev, said the national clinic has enough blood to help those in need and urged people not to turn to the black market.
But Rumen Dimitrov, a surgeon at ISUL, one of the main hospitals in Sofia, the capital, said the lack of sufficient blood supplies is a problem he runs into every day.
“We often have to ask relatives of our patients for certificates for blood donations because we receive only one liter [about two pints] of blood for a surgery from the blood center. In some cases two or more liters are needed,” Dr. Dimitrov said.
“Because of a lack of enough blood, some scheduled surgeries are being postponed by weeks.”
Up until 1989, when the Balkan nation was under a communist government, Bulgarians were eager blood donors. Army conscripts were awarded a two-day home leave each time they donated blood.
But voluntary blood donation has been shrinking gradually here in the past two decades, leaving Bulgaria above only by Albania, Bosnia and Moldova in Europe in the percentage of voluntary donors — 23 per 1,000 people.
The average for the United States is 53 per thousand, according to the American Association of Blood Banks, a figure similar to most EU countries.
“Only a few become voluntary blood donors, because most people donate blood only if a relative or a friend needs it,” said Stavri Toshkov, a leading hematology expert.
“It is difficult to overcome the crisis of blood donation. Economic hardships have led to a deficit of such important values in society as solidarity, compassion and the willingness to help.”
The Red Cross and the Christian Orthodox Church launched a two-month campaign around Easter dubbed “Light a candle, donate blood,” hoping to raise awareness about the country’s chronic blood shortage.
“It is the only way to eliminate the illegal trade,” said Evelina Dinkova, one of the campaign’s main organizers.
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