The blood management system in Korea was initiated in 1952 with the establishment of the first blood storage facilities in the navy during the Korean War (1950-1953). The National Blood Center was opened in 1954, and the services of the Korean Red Cross (KRC) Blood Center were commenced in 1958 after blood services were transferred from the National Blood Center to the KRC.

Before policy introduction in the 1980s, blood collection and blood supply were mostly performed by private blood centers and hospitals. Until 1999, blood was collected from paid donors because the selling of blood was prohibited by law. The Blood Management Act was enacted in 1970, and the Act was reformed in 1981 to authorize the KRC with exclusive responsibility for the national blood service.

During this period, Blood Donation Houses for blood collection were built at many places, and the number of such centers increased from 21 in 1994 to 93 in 1999. In addition, the infrastructure for blood service, including the Plasma Fractionation Center (1991) and the Blood Transfusion Research Center (1997) was established. As a result of these initiatives, Korea achieved a national blood donation rate of 5% in 1997, and the annual number of blood donations reached 2.5 million.

Blood-related accidents such as release of inappropriate blood from the KRC and transfusion-transmitted infections occurred in the early 2000s. These accidents reduced the people's trust in blood services, thereby resulting in great difficulties in performing these services. However, this crisis was used as an opportunity, and in 2004, the government and transfusion experts together formed a task force team for "Blood Safety Management Improvement." Further, the "Total Improvement Plan for Blood Safety Management" was implemented for 5 years. The KRC introduced blood donor registration in 2000 to secure safe and stable blood supply and initiated platelet component collection in 2001. The introduction of these systems has initiated a qualitative transition from group donation to individual donation and from whole-blood donation to blood-component donation.

As we take a look at the history of Korea's blood management, it can be seen that following changes in paradigm were made. Firstly, qualitative improvements for securing blood safety were achieved from quantitative growth for self-sufficient blood supply. Secondly, the focus of the blood donation system, which was centered on group donation, has changed to registered donors, thereby increasing the safety of the donated blood. Thirdly, blood-supply management is gradually being strengthened to ensure stable supply and to prevent a blood-supply crisis, which had occurred in the past because of the lack of planning and control. Fourthly, in the past, blood centers were independently operated, but now they are being operated systematically and professionally under the leadership of the blood service management. Lastly, the change in blood services based on non-profit business to government-run blood services is changing the paradigm of blood management.

The number of blood donations showed a decreasing trend for several years after the incidents of blood-related accidents in the early 2000s, but these numbers have slowly recovered and have reached a new record of 2.57 million in 2009 (Fig. 2). In particular, the percentage of "non-group" donors increased from 45.6% in 2005 to 62.5% in 2009, which was a desirable trend.

Blood safety management has shown a successful outcome since the implementation of the Total Improvement Plan for Blood Safety Management. This plan originally had 5 goals. The first goal was to ensure that safe blood was obtained from the first step of donor recruitment and blood collection. The second goal was to ensure safety by bringing in professionalism in the blood testing system, which was accomplished by establishing a multiple-verification and surveillance system, merger and acquisition of the Blood Testing Centers, and expansion of the infrastructure for blood safety, including test automation and data integration. The third goal was to establish a system for providing safe and appropriate transfusion management and blood supply. The fourth goal was to secure professionalism and independence of the KRC Blood Service Organization. Further, the last goal was to strengthen government surveillance of blood services and to increase financial support.

The management of blood safety from blood donation to transfusion has shown an improvement; significantly, no transfusion-transmitted infections caused by human immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV) have been detected since 2005 (Table 1).

The core projects in terms of blood supply include diversification of donor population and promotion of blood donation. Currently, most of the donors are students, soldiers, and people under 30 years of age; however, diversification of this donor population is essential. Of the 2.35 million blood donations in 2008, 51% and 16% were by students and soldiers, respectively. The donors in the age group of 16-19 years, 20-29 years, and 30-39 years comprised 36%, 44%, and 13%, respectively, of the donor population. In terms of price policy, the price of blood had temporarily increased for 3 years since 2007. This increase in blood price led to the implementation of many projects, including the development of Blood Information Management System (BIMS), introduction of nucleic acid amplification test (NAT), and establishment of a blood center sample storage facility. Since the increase in blood price was temporary and was set to expire this year, readjustment of blood price should be currently under way.

The core objective of this project was to evaluate the results and effects of the "Total Improvement Plan for Blood Safety Management" and to determine the direction of policy to achieve a better system for the management of blood safety. In addition, the authorities are planning to establish government-managed transfusion services in medical facilities, which was not considered to be as important as the establishment of a system for the management of blood donation and manufacture of blood products. To this end, studies are expected to be performed to systematically set up government-managed transfusion services in medical facilities, including small- to medium-sized hospitals.