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Why tracking HIV-infected blood is a prime example for permissioned blockchain

The blood donation service in Africa faces challenges due to the lack of safe and regular blood donations. A number of infectious diseases make the screening in resource-poor environments even more difficult. Between 5–15% of new HIV infections in Africa can be attributed to unsafe blood transfusions. The political and practical foundations regarding blood transfusion have been laid almost exclusively by Europe and North America and are often unsuitable for the African context. The development of blood donation service increased over time but the resulting blood products are no meeting the highest standards and reliability concerns.


There is a company that addresses these problems with its own-developed product in Africa. With this product, they want to improve the blood supply process and used Blockchain as the underlying technology. But how does it fit?


In this article, I will show you how blockchain brings trust to the blood donation process and what insights can be shared from the client I am working for.


The use case, a problem that makes the solver a superhero.


Before we go straight to the benefits of the blockchain solution we should understand the As-Is process and the needs of each participant. We have the following key player interacting in the eco-system:

  • the blood bank is saving the blood from the donator in medical blood bags,

  • the screening company is investigating the blood bag before it gets approved or rejected due to HIV or other diseases,

  • the regulator is verifying the screening results of the screening center,

  • the hospital is transfusing the blood from the medical blood bag to the receiver.

Regarding the current situation, there are three needs to be solved

  • Transparency: As in other use cases the non-transparency leads to trust issues among all participants. Here, it is a question about life and death for the blood transfusion receiver to get reliability on that blood through transparency. Due to the fact that everyone is managing his own source of truth within their databases, trust issues can raise even further. For example, the blood bank has to send all received blood donations to the screening but there is no possibility that the screening center can be sure if all created medical bags were received. Additionally, this leads to uncertainty in the verification of the test results and creates a bottleneck in the work of a regulator because he is forced to only verify samples from the total amount.

  • Prevention of Fraud: Many countries and even continents are fighting against fraud in this industry. There is a big issue that the donated blood is landing on the black market instead of going the right path to the deserved receiver. In this eco-system, it is not guaranteed that all donated and screened blood bags will be delivered to the hospital. This need has a high linkage to transparency so that the solving of one is connected to the other.

  • Consensus: Here is a need for agreed terms between all participants. Questions such as "Which hospital should receive which blood bag?" or "Which screening center has the most reliable verification process?" have to be answered. In the current process, there is complex decision-making about the distribution of the bag. The supply doesn't fit always the demand within the hospitals. Therefore, it is likely that many hospitals will have more bags than they actually need and others will have less. The balance is missing here.

The listed needs or issues belong together and can't be handled independently. It is necessary that a solution have to be found which relocate the current process into a new to-be process and address these needs. As I said at the beginning of this article, the client operating in Africa is tackling these needs with his solution. Of course, there are several more needs but these are the ones that highlight the usage of blockchain as the only solution.


The prime example of blockchain


The company I supported, implemented the solution on Hyperledger Fabric. They created a digital twin of a medical blood bag which is equipped with an IoT Tag to map transactions from the physical world to a digital asset. The medical blood bag is getting activated once the donator decided to start the process. Then it will be delivered to the screening center where a device can scan these bags and also saves the result of the testing in the blockchain. The regulator has the possibility to check regularly the screening results of the screening center and identify false positives received from hospitals.

The network contains two different types of participants. One of them is the member, who is holding a node which means that he takes part in the consensus mechanism in the blockchain and also having the ledger. The other type is the user, who is basically only using the benefits of the blockchain without holding a node and contribute to any consensus mechanism.


Therefore, the user-group will contain the donator and the blood receiver. Both are interested in providing or reading data instead of participating in the consensus mechanism. Of course, it is not technically feasible for them to hold a node and no monetary benefit. The members are organizations such as blood banks, regulators, screeners, and hospitals because they want to solve the needs described above together.


...they want to solve the needs described above together.

I just want to highlight this sentence because it means so much to the permission blockchain community. They act as an eco-system instead of a company with their own interest. They understood that only if they act as equal partners together in an eco-system then the needs will turn into value. I will write more about my thoughts in another article and will link it here.


It is also valuable to highlight how Hyperledger Fabric will solve the needs of the participants. (If you do not want to scroll up: Transparency, Fraud prevention, and Consensus are getting solved.)


  • Transparency: With the characteristic that the data is shared decentral within a distributed environment, transparency among all participants is giving. At the point where the donator starts to giving his blood by scanning the tag on the bag, the network will be informed about a new asset. The screening center can now expect how many bags were created and have to be screened, the regulator is informed about the total bags allocated, and the hospital is now seeing how and which bags are screened and verified. In addition to that, the regulator is able to monitor the data in a much precise way. He can see all the bags created, screened, and delivered to a hospital. He could also identify which screening center has higher false-positive results and could need to improve his verification process.

  • Fraud: Due to solving transparency it is possible to reduce fraud to almost zero. The digitalization of the bag means that all participants in the network know about its existence. If a bag is activated and contains blood, the status of the bag shows which process step it is in. This also allows you to identify at which node (organization) it has been "physically lost" and will be highlighted to each participant. In addition, the reliability of these bags is maximized, because only fully processed bags arrive at the blood recipient. The black-market will lose its ability to fake screen or sell blood bags to people, who are avoiding the normal procedure.

  • Consensus: Remember my highlighted sentence. They want to solve their needs together. With decentralized systems such as the Blockchain, there is no central authority who set the business rules. The implementation of smart contracts takes this challenge and depicts precisely these business rules in digital form. In addition, It has the feature that all participants agree on the rules in a consensus process. For example, bags are only delivered to hospitals if they meet certain requirements such as several levels of verification procedures. These requirements are known and agreed upon by all network participants. Same for delivery rules of blood bags to hospitals. The smart contract can decide by analyzing the demand in specific regions and try to distribute it in an optimized way.

This solution and these resulting advantages are an absolute prime example of Blockchain. As you can see, Blockchain brings trust to an untrusted network. We don't want to imply anything to either party, but even if we would do it, it is impossible to deviate from the process thanks to blockchain. In my opinion, this fulfillment of needs cannot be achieved by any other technology with the same effort. If you have another opinion. Let me know.

Conclusion


As I just said, this presented solution (or let's say part of the solution) is a prime example for the purpose of blockchain. It changes the thinking of creating value for one organization to a whole eco-system. I believe that only if we think in eco-systems instead of companies we will reach the real purpose of permissioned blockchain. Additionally, it is way more than a solution because it is not only creating value for the participants. It is basically saving the lives of people, who deserved to live with the highest health standards possible.


It is a win-win-win situation for everybody and especially for humanity.


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