Facebook’s blood donation tool could fuel Indian blood black maket

Shayanne Gal/Business Insider

• Facebook’s blood donation feature in India risks being
  abused by black market blood peddlers.
• Local blood donation experts told Business Insider the
  product can be used to illegally sell blood in the
  country.
• Facebook says it has only seen one report through its
  platform, though one expert said victims were unlikely to
  report the issue and that he has heard reports of blood
  selling.
• 
  “The Facebook blood donation tool is not only
  trying to save lives but also indirectly helping to create a
  very disastrous and illegal blood donation activities,” said
  one blood donor organisation founder.
  
• 
  This black market pre-dates Facebook’s time in
  the country, but there are fears that the way Facebook connects
  donors and recipients could exacerbate it.
  

Several public health officials in India are calling for Facebook
to make changes to its blood donation tool, warning that the tech
project — although well-meaning — risks fueling a dangerous black
market for blood and harming the country’s fragile blood
collection system. 

Facebook’s one-year-old blood donation feature has already helped
facilitate tens of thousands of donations since it was launched,
saving lives by making it easier for people in need of
transfusions to find willing donors with matching blood types.

But the tool’s person-to-person format is ringing alarm bells
among experts and professionals in the field, who say that it’s
too easy for unscrupulous characters to latch onto, leaving
vulnerable people at risk of paying exorbitant prices and
receiving tainted blood, among other issues.

Facebook said that it has only had one report of forbidden
behavior on the tool — but the head of one Indian blood donor
organization said he has been told about incidents of black
market blood selling on Facebook and suggested victims of black
marketers were unlikely to report them to the social media firm.

“These types of products … definitely bring in black marketing,
and it’s definitely promoting it unknowingly, because it was not
the intent of Facebook to promote black marketing,” said
Biswaroop Biswas, the National Secretary of the Federation of
Indian Blood Donor Organisations (FIBDO), a coalition of 126
blood donation groups across India.

The issue, which has not been previously been reported,
illustrates the ongoing challenges Facebook faces in its efforts
to ensure that its 2-billion member social network is not
exploited for nefarious ends, whether that be interfering in US
elections or promoting ethnic cleansing in Myanmar.  

The company is walking a delicate tightrope with the India blood
donation tool, as it tries balance the unprecedented power, and
undeniable benefits, that its technology brings with the
potential for it to exacerbate thorny and endemic problems within
the country.

In an interview, Facebook health product manager Hema
Budaraju said: “What I would like to emphasize is our role is to
get more and more blood banks to adopt our features, and to
actually build up the culture of blood donation. And as you’re
already well aware, this system doesn’t exist in the US, right?
It’s because donors are motivated [to give blood
regularly].”

“That’s the world we are trying to get to, and we are
working constantly with NGOs and blood banks.”

India has a worrying black market in blood

India quite simply doesn’t have enough blood to go around.

There is an
annual deficit of more than one million units of
blood in the country — meaning patients can sometimes be
forced to search for their own sources of blood, asking their
social circle for donations or even paying illegal black
marketers extortionate sums.

As Facebook grew in the country, it became an avenue for people
to request blood donations from others in their network. In
response, Facebook launched a tool in 2017 to try and facilitate
donations more formally.

Initially available in India and now also live in Pakistan,
Bangladesh, and Brazil, Facebook’s blood donation tool allows
organisations and individuals to put out requests for blood
donors on the social network at short-notice. Users can
voluntarily register themselves on Facebook as blood donors, and
then, when a request is put out nearby, they may be notified (or
view them in a centralized hub).

These requests may be sent by medical institutions like hospitals
and blood banks as part of broad donation drives, or individuals
who require blood on behalf on themselves or a family member
imminently, and who may or may not be in a medical institution.

More than 11 million people have now signed up for the
service across the four countries it operates in, and it has
facilitated tens of thousands of donations. 

A
publicity photo from Facebook showing a request on the blood
donation tool.

Facebook

There is an existing black market for blood in India, preying on
desperate sufferers amid blood shortages. FIBDO expressed
concerns that Facebook’s product may help fuel this. Black
market agents can register on the platform as donors, Biswas
said. Then, when notifications and requests go out, the agents
can contact the requester directly, offering them blood for a
fee.

He said he has spoken to people who have been approached by black
market blood sellers on Facebook. 

Budaraju said the company has multiple safeguards in place to
protect users. New accounts aren’t sent notifications about
requests, and “the registrations we receive are doubly checked
against fake and spammy accounts.” Users are also able to report
other users if they ask for money in return for blood, and she
said there has only been one instance of a report through
the platform to date — a post that was soliciting blood in
exchange for money, in Bangladesh. (The user was subsequently
made unable to use the blood donation tool.)

However, Biswas, who also sits on the governing body of the
National Blood Transfusion Council, was skeptical that users
would report black market issues to Facebook, suggesting they
would simply pay up in a time of need instead. “If you need blood
and people ask for money … Will [you] report or just go
with the donor [and] pay him?”

Chethan Gowda, student founder of blood donor organisation Khoon,
said unscrupulous middlemen could also potentially use the
platform to sell blood at extortionate rates: “The racket
personnel can also request for blood, arrange for a donor through
Facebook and on the other hand charge huge amount from the
patient family, wherein the blood donor who turned up to donate
blood will have no idea of what’s going on on the other
end.”

And black market blood that hasn’t been vetted carries a
risk of being misclassified, tainted or otherwise dangerous,
health experts say.

Gowda added: “The Facebook blood donation tool is not only
trying to save lives but also indirectly helping to create a very
disastrous and illegal blood donation activities.”

These problems all pre-date Facebook — but now it has to deal
with them

These kinds of problems long pre-date Facebook’s entry into the
blood donation space, and also take place on other online
platforms, Biswas said. Facebook also continues to work with NGOs
and blood donor organisations in India to encourage donations,
including NTR Trust, the National Blood Transfusion Council, and
Giants International. 

“There are known issues of scams/exploitation or bad actors
in blood donation in some of the countries where our feature is
available,” Budaraju said in an email. “
We’ve worked
closely with partner organizations and NGOs to understand those
concerns and the challenges they deal with in order to build a
product that helps makes it easier for people to sign-up to be
blood donors and find opportunities to donate nearby while also
mitigating these risks. While there may be a few bad actors, we
see a lot more good happening as a result of this
feature.”

She said that partners “highlighted a few concerns about
potential … scam[s] or abuse that could happen on Facebook,
which is why we’ve designed the product with a number
of safeguards in place. No partners have raised
issues since we launched the product in each country, but we
continue to work closely with them to ensure the feature is as
safe and useful as possible.”

But the concerns of the Indian organizations who spoke to
Business Insider point to how as Facebook moves into new markets
and experiments with new tools designed to do good, it has been
forced to grapple with unprecedented new challenges that would
have been unimaginable when it was founded as a simple network
for college students in 2004.

Facebook has stumbled in India before, with Free Basics — a
program to provide a free, limited internet service to users in
emerging markets.
Facebook promoted it as a magnanimous project, but it was met
with protests, and the company was accused of “digital
colonialism” and violating net neutrality principles.

A
nurse takes blood from a volunteer on April 17, 2007, Manchester,
England.
Christopher Furlong/Getty
Images

India wants to move away from ‘replacement’ blood
donations

India has set itself a goal: By 2020, it wants to hit 100%
voluntary blood donation.

This means 100% of the blood used in the country will come from
volunteers proactively going to hospitals, blood banks, and
donation drives to donate, which will then be distributed as
necessary. At present, a portion of India’s blood donations come
from what is known as “replacement blood donations” — when a
donor agrees to give blood specifically for someone in their
network, rather than to the general blood bank.

This system can be problematic, with donors sometimes feeling
pressured to donate blood to those in their community, and the
lack of anonymity sometimes causing issues with donors attempting
to extract favors (if not outright payment) from the
recipients. 

FIBDO is concerned that Facebook’s mechanism for connecting
donors and recipients directly can encourage replacement blood
donation. “When they got in touch with us, we told them this
is not the way you people will be able to help the society,”
Biswas said. He believes that Facebook’s one-to-one model
effectively violates India’s National Blood Policy, which calls
for a movement away from replacement donors, and he would like to
see Facebook remove one-to-one donation options.

Facebook disagrees, arguing that its one-to-one model is a step
forward from the status quo, and that it too wants to see a 100%
voluntary blood donation model implemented as soon as
possible. 

Without Facebook’s tools, people needing donations might ask
people in real life for a donation, applying significant
pressure, Budaraju said. In contrast, Facebook’s notifications
will also go to people outside a recipient’s existing social
circle, to people who have already registered and signaled their
willingness to donate. The recipient is also unaware of the
potential donors’ identities unless they choose to respond and
share information about themselves.

“In some ways I fundamentally believe the current system that we
built on Facebook, even when used in the person-to-person, is a
step towards voluntary, because people are under no coercion, do
not have social pressures, are choosing to respond of their own
volition and going in to donate,” Facebook’s Budaraju said. “So
it’s actually the opposite of the replacement system.”

Facebook’s
founder and CEO Mark Zuckerberg.
REUTERS/Charles Platiau

There are worries around blood wastage

Another area of concern is around potential blood wastage.

Srijan Pal Singh, the CEO of developmental NGO The Kalam Centre,
said that Facebook’s focus on increasing blood donations, without
building out further blood storage infrastructure, could result
in some of the blood drawn being wasted. 

“The time we worked with them, it seemed all about creating more
units, but that’s not the idea. It’s not about creating more
units, it’s about helping more lives, and there’s a difference
between the two,” he said.

“It’s a well-known fact, three million units of blood was wasted
in five years [in India] so unless you have the mechanism to
store this blood it doesn’t make sense.”

Facebook responded that it believes that other organisations in
the blood donation ecosystem are better placed to work on these
problems than it. “We are still a relatively young product, we
are focusing on .. Facebook’s strengths in terms of education,
communication, context, and in bringing awareness, and to build
simple tools for blood banks and hospitals,”Budaraju said.

“I don’t know that we would be the most effective people to think
about storage and infrastructure.”

‘People will try to abuse those services in every way possible’

It’s difficult to assess to what extent some of these concerns
might actually be happening on Facebook.

Khoon’s Chethan Gowda conceded that it’s hard to measure whether
the illegal behavior he has seen elsewhere is taking place on
Facebook. “Concrete example[s] of a similar scenario
happening through the Facebook blood donation tool is tough,” he
said. “As there’s no track on the request.”

Singh urged Facebook to get ahead of the problem. “When you have
so much outreach and access, a lot of these touts and brokers may
emerge, this is a possibility that I also hope Facebook sees will
come up,” he said. “When they are implementing this platform with
all this good intent they should not end up becoming a victim of
encouraging a whole black market brokerage.”

Biswas said he is confident that black market selling is already
taking place on Facebook, and has spoken to people who have been
approached by blood sellers on the platform: “These things are
happening. And as you can see when the people are in need of
blood, they won’t come out to say to the donor organisations
afterwards that people are coming and asking for money.” 

Despite these alleged flaws, Facebook believes it has built a
significant improvement on the previous status quo — desperate
patients and their families posting unregulated and unmonitored
requests for blood directly onto Facebook and other platforms
across the web. Both Facebook and FIBDO agree that a priority is
education and promoting a cultural shift towards voluntary blood
donation; Facebook plans to roll out educational resources for
donors in the product soon. 

The company also continues to work with NGOs and blood donation
organisations, who have heralded its work to drive blood
donations and save lives. “Facebook has long been a
positive platform for people in India to connect with Blood
Donors and help those in need. NTR Trust welcomes Facebook’s
efforts to help make it even easier for people to donate blood in
India,” Vishnu Vardhan, CEO of non-profit organisation NTR Trust,
said in a statement when the feature first launched. “We look
forward to working together to raise awareness of the importance
of donating blood and collectively catalyze sustainable access to
safe blood in India. What Facebook is doing has the potential to
bring tectonic shifts in Blood Banking in India.”

On Friday,
Facebook CEO Mark Zuckerberg published a post on the social
network reflecting on Facebook’s efforts to fix its platform
over the last year.

“What I’ve learned so far is that when you build services that
are used by billions of people across countries and cultures, you
will see all of the good humanity is capable of, and people will
try to abuse those services in every way possible,” he wrote.

“It is our responsibility to amplify the good and mitigate the
bad.”