It is midday in Hyderabad, the sweltering capital of southern India’s giant state of Telangana, and a young boy needs help. His hemoglobin levels are dangerously low, and he urgently needs his monthly blood transfusion. The child has thalassemia, a genetic disorder that prevents his body from producing enough of the oxygen-carrying protein in his red blood cells. There is an extra challenge: His hospital is running low on his blood type.    

But word is spreading about his predicament. A notification from the Aarohi Blood Bank in downtown Hyderabad pops up on thousands of Facebook feeds across the city. Just a single unit of A negative (A-) blood will be the boy’s lifeline, reads the alert. It is not long before the post has garnered multiple likes, shares, and comments. The chances of a voluntary walk-in donation at the blood bank that could enable a life-saving transfusion for the boy has dramatically increased.

It is all thanks to Facebook’s Blood Donations feature, which uses technology to leverage the social network’s unparalleled reach — and taps into the goodwill of the world’s population — to recruit millions of new blood donors. “It’s inspiring to see how many people are willing to opt in and do this,” says Kang-Xing Jin, Facebook’s Head of Health. He hopes that Sunday, June 14, which is World Blood Donor Day 2020, will prompt millions more people to sign up as blood donors. The COVID-19 pandemic has led to blood shortages around the world due to shelter-in-place orders limiting people’s ability to donate. To support efforts to ensure a consistent blood supply, Facebook is announcing the expansion of its Blood Donations feature into new countries. This expansion will connect more people to their local blood banks and alert them when there is a shortage and where it is safe to donate.

Since launching the feature in 2017, after a hackathon at Facebook’s Menlo Park headquarters a year earlier, more than 70 million people in six countries have signed up to be blood donors. The feature allows approved organizations in the United States, India, Brazil, Pakistan, and Bangladesh — and now South Africa, Senegal, Kenya, Egypt, Burkina Faso, and Côte d’Ivoire, to create Page posts that notify nearby donors when blood is needed, offering hope to millions of patients, including thalassemic children in India’s government hospitals, Brazilians needing emergency surgery in Rio de Janeiro, and many others.

“Hackathons provide some of Facebook’s best ideas,” says Jin, referring to the 2016 event. “We explored how we could incubate the product as part of Facebook’s social impact platform.” They were ahead of the game. In 2017, a team of engineers in Menlo Park were researching new product features when they noticed a recurring Facebook post from people in India: They were requesting help from their communities for blood donations. The Menlo Park engineers wanted to support their efforts and threw themselves into product development. Their first stop was extensive research from World Health Organization (WHO) materials to learn about the situation.

The engineers quickly discovered the scale of the problem. Providing a steady supply of safe and adequate blood is a challenge for every country on earth. But the challenge is particularly acute in India, which has a population of 1.3 billion. WHO recommends that between 1 and 3 percent of any country’s population should donate blood to satisfy that nation’s needs. But India is well short of meeting that 1 percent recommendation. At the time of launch, the country was approximately 1.9 million units short of its 13 million unit target, according to the latest available statistics. 

A one-off glut of donations will not instantly solve the issue. India’s blood banks need millions of new, regular blood donors to meet demand on an ongoing basis. New donors will help the country better cope with stressful periods such as holiday seasons, national emergencies, and epidemics.

Unlike the United States, where most blood donations are voluntary and the recipient rarely knows the donor, India has a large proportion of replacement donations. In these, a friend or family member of the recipient donates blood to replace the stores of blood used in a transfusion. This is far from ideal. In fact, several organizations, including WHO, the International Federation of Red Cross and Red Crescent Societies, the Council of Europe, and the International Society of Blood Transfusion, state that voluntary blood donations are essential to the safety and sustainability of the world’s blood supplies. This is because replacement donations cannot meet an entire community’s demand for blood.

“A lot of this replacement model happens offline,” explains Arti Kulkarni, a Product Manager at Facebook. “Often when you have a surgery in India, you will need five people who will donate blood for you.” These replacement donors are providing blood to individual patients only on request, and there is no guarantee that blood will be replaced in terms of group or volume. This means that Indian hospitals who rely on replacement donors can rarely maintain sufficient stores of blood to meet the transfusion needs of all their patients, particularly in emergency situations or for regular transfusions. “We wanted to supply those blood banks on an ongoing basis to help ease the burden,” says Kulkarni. “If you’re going for surgery, you’ll know that there is blood and you don’t have to worry about it.”

Rather than sending unnecessary alerts to hundreds of millions of people, anyone in the countries currently supported — South Africa, Senegal, Kenya, Egypt, Burkina Faso, India, Brazil, Pakistan, Bangladesh, and the United States — can sign up on Facebook to be a blood donor. Facebook works closely with local authorities and national blood services so that only registered blood banks can request blood. 

Those who have signed up to be blood donors on Facebook are shown opportunities to donate in their area. Blood banks are able to generate alerts about acute shortages or immediate needs through posts like these, which are shown to registered blood donors in their area. Donors can choose to call the blood bank directly to make an appointment — or set a reminder on Facebook to see nearby opportunities to donate.

Then it is just a case of tapping into that goodwill, explains Kulkarni. “A blood bank that needs to replenish supplies can send messages to a pool of people in the local vicinity that have opted in,” she says. Back in Hyderabad, you can see this recruitment in action. “Sorry, but I have [A] positive,” writes one Facebook user on the post about the child with thalassemia. “You can still donate for other patients,” replies the blood bank. 

The system sounds simple, but there is plenty going on behind the scenes. There was little doubt of the need to boost the ranks of blood donors in India and Brazil, but engineers were looking for a fine balance. “We needed to find the right trade-off between the number of notifications required to maximize conversion — without flooding the blood banks,” says Kulkarni. “This is about consistent donations.”

The COVID-19 pandemic has underlined this continuous need for blood. The new coronavirus has taken its toll on the world’s blood supplies because of shelter-in-place and social distancing measures. This may be occurring in tandem with lower demand for blood because of fewer transplants and elective surgeries and procedures, but it is a problem in waiting.  “When things reopen, we may see a surge in cities such as New York, and blood banks will need to fill back up,” explains Tzachi Ezra, an Engineering Manager at Facebook. 

To avoid such feast-or-famine scenarios, Facebook engineers built a series of machine learning systems that fine-tune the reach and frequency of notifications. “This was based on an analysis of people’s previous interactions with the Blood Donations feature and their overall interaction with Facebook,” explains Ezra. “We wanted to gain people’s trust and ensure that donating blood was a positive experience without causing donor fatigue,” he adds. 

Menlo Park’s engineers may have led the way in building the feature, but having boots on the ground was invaluable to the product’s growth. Partnership teams in India set up and maintained dialogues with the country’s National Blood Transfusion Council (NBTC) and various state agencies. This encouraged NBTC, which oversees policy relating to blood bank operations, to participate, and it showed the value of the product, explains Kulkarni. 

The tens of millions of people who have signed up to be blood donors are just one part of the success story. Hemorio, Rio de Janeiro’s main blood bank, which posts blood type–specific requests to its Facebook Page on a weekly basis, credits the Blood Donations feature with helping increase the number of blood donors by 5 percent in 2018 and 10 percent in 2019. By building up its donor base, the Brazilian blood bank’s staff also spends less time scouting for donors and more time on other valuable tasks.

Kulkarni, who immigrated to the United States from India, is especially thrilled that Facebook Blood Donations has raised awareness among people who always wanted to donate but weren’t aware of the opportunities. She cites the success of Fortis Mulund Blood Bank in India’s largest city, Mumbai, where a Facebook drive has accounted for 68 percent of its voluntary walk-in blood donors. “It allows us to tap into donors we didn’t have access to before,” says Dr. Lalit Dhantole, the Head of Transfusion Medicine at Fortis Hospitals. 

Facebook plans to expand this feature to more countries in 2020, with the continued goal of boosting the ranks of voluntary donors. “Our vision with blood donations is to bring about a behavioral change by making it easier for people to go out and donate on regular basis,” says Kulkarni.

Meanwhile, back in Hyderabad, the boy’s case has been closed. He has the blood he needs. “In some ways, Facebook is just a reflection of people and how they communicate,” says Jin. “It’s powerful to see the good and generosity of people to give to their communities and save lives.”