Blood bank refusal, wrong billing, or a forced replacement donor

Reviewed on: 2026-06-12.

Do these five things, in this order, while the patient's treatment continues.

1. Keep the doctor's requisition slip safe and photograph it. It proves a valid clinical demand for blood existed. Ask the ward for a copy if it kept the original.
2. Ask for any refusal in writing, with the staff member's name and time. A blood bank that will not issue a unit against a valid requisition should state its reason on paper. National Blood Transfusion Council (NBTC) guidance is clear that a replacement donor cannot be demanded as a condition for issuing blood. Demanding one and refusing the unit until a donor appears is exactly what you escalate.
3. Demand an itemised printed bill, never a lump sum. Blood is not sold in India. Blood banks recover only a processing charge for testing, screening, and component separation, and NBTC has capped these charges.
4. Check e-RaktKosh (eraktkosh.mohfw.gov.in) on your phone. It shows licensed blood banks near you and live stock by blood group and component. If the bank in front of you claims “no stock”, e-RaktKosh either confirms that or contradicts it, and it points you to the next nearest unit either way.
5. If the demand or refusal stands, complain the same day to the blood bank's medical officer in-charge and the hospital medical superintendent, in writing, and keep a dated copy.

NBTC, under the National Blood Policy, prescribes ceiling rates for processing charges, revised from time to time. The figures below are the widely applied NBTC ceilings; states can fix lower rates, and many government schemes issue blood free to BPL patients, thalassaemia and haemophilia patients, and pregnant women. Verify the current list for your state through the State Blood Transfusion Council or an RTI.

Anything beyond these, such as a “donor motivation fee”, an “emergency issue surcharge”, or an unexplained “service charge”, does not belong on the bill. Cross-matching and screening are part of the processing charge, not extras. If the patient is in a category the state issues blood to free of charge, the entire processing charge may be waived; ask the counter to confirm the concession in writing.

The National Blood Policy aims at one hundred percent voluntary, non-remunerated donation. NBTC guidelines direct blood banks not to insist on replacement donors as a precondition, and never in an emergency. In practice, families are still told “bring two donors or no blood”. State calmly that NBTC guidelines prohibit conditional issue, ask for the demand in writing, and if the unit is still withheld, go straight to the medical officer in-charge. Volunteering a donor of your own accord is allowed; making it a condition is not. Keep any donor slip the bank gives you. That paper wins the complaint later.

1. Blood bank in-charge, then the hospital medical superintendent. Most billing and refusal disputes die here once they are in writing.
2. State Blood Transfusion Council (SBTC). The policy body for blood banks in your state. Send the requisition slip, bill, and your hospital complaint.
3. State Drugs Control authority. Blood banks are licensed under the Drugs and Cosmetics Act, 1940 and its rules; the State Drugs Controller can inspect and act against the licence for overcharging and conditional issue. This is the complaint blood banks take most seriously.
4. Consumer commission, for a private blood bank or hospital. Overcharging beyond the capped rates is a straightforward deficiency claim on e-Daakhil (edaakhil.nic.in), with the itemised bill and the ceiling list as your two exhibits.

To: The Medical Officer In-charge, Blood Bank, [hospital name]
Copy: The Medical Superintendent

Subject: [Refusal to issue blood without a replacement donor /
Processing charge above the NBTC ceiling] for patient [name],
requisition dated [date]

Sir or Madam,

The patient [name], admitted in [ward], was prescribed [component and
units] by Dr [name] vide requisition slip dated [date] (copy enclosed).

On [date, time], your counter [refused issue unless I produced a
replacement donor / charged Rs [amount] against the NBTC ceiling of
Rs [amount] for this component].

NBTC guidelines under the National Blood Policy bar replacement-donor
insistence as a condition of issue and cap processing charges. I
request you to [issue the unit against the valid requisition / correct
the bill to the ceiling rate and refund Rs [amount]], and to reply in
writing today.

Failing this, I will complain to the State Blood Transfusion Council
and the State Drugs Control authority, which licenses this blood bank.

[Name, relationship to patient, mobile, date]
Enclosures: requisition slip, itemised bill or receipt

Government blood banks, government hospitals, SBTCs, and State Drugs Control authorities are all public authorities. That makes RTI a real weapon in this dispute, not an afterthought. File with the relevant Public Information Officer for:

• the current approved processing charge list for each component in your state, which is the benchmark for any refund claim;
• the state policy on replacement donors and on free issue categories;
• the licence and inspection record of the blood bank, where disclosable; and
• the action taken on the complaint you filed with the SBTC or the drugs controller.

A private blood bank itself is outside the RTI Act, but its regulator is not, so you can still extract the licence position and complaint action through the State Drugs Controller. See how to file RTI online, and first appeals if the PIO stays silent past 30 days.

No. NBTC guidelines under the National Blood Policy bar conditional issue against replacement donors, and emergencies are absolute. If a valid requisition exists and stock exists, the unit should be issued on the processing charge. Get the refusal in writing and escalate to the medical officer in-charge the same hour.

Open e-RaktKosh, the national blood bank portal run by the health ministry. It lists licensed blood banks with live stock by group and component. If it shows stock at that bank, raise it with the in-charge. If stock is genuinely out, e-RaktKosh shows the nearest alternatives, and the treating hospital should help arrange transfer of a unit.

Only the processing charge applies, capped by NBTC at about Rs 1,550 per unit of whole blood or packed cells in private blood banks and about Rs 1,100 in government ones, with lower caps for plasma and platelets. States may set lower rates, and several categories of patients get blood free in government facilities. Demand an itemised bill and compare it with the displayed list.

It is hard but not hopeless. Write to the blood bank in-charge the same day naming the counter staff, amount, time, and witnesses, and ask for a receipt or refund. Complain in parallel to the State Drugs Controller, since unreceipted collection is a licensing issue. Next time, no payment without a stamped receipt.

The blood bank licensee answers to the drugs controller, and the hospital answers for its own billing if the charge appeared on the hospital bill. Complain to both: the medical superintendent for the bill, the drugs controller for the licence. For a private hospital, the consumer commission can hear both strands together.

You may offer it freely, but it cannot be extracted as a price for the unit, and it does not replace the processing charge, which covers testing and separation costs. Do not let the counter record your voluntary offer as a “replacement donor” condition.

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Download the blood bank dispute checklist (PDF).