Abstract: BACKGROUND: Blood transfusion services are critical for healthcare delivery, ensuring timely access to safe and adequate blood for surgeries, trauma care, obstetric emergencies, and hematological conditions. In India, BTS has witnessed remarkable progress over the past three decades under the leadership of the Ministry of Health and Family Welfare, Government of India. The system has evolved from a fragmented, donor-paid model to a nationally coordinated, policy-driven framework supported by legal mandates, national guidelines, and digital platforms such as e-RaktKosh, which have improved transparency, traceability, and operational efficiency. MATERIALS AND METHODS: This study reviews policy documents, national datasets, and operational guidelines from 1992 to 2025. The key sources include National Blood Transfusion Council guidelines, National AIDS Control Program documents, and e-RaktKosh analytics. Descriptive methods were used to assess the trends in blood collection, voluntary donation, infrastructure development, and quality-assurance mechanisms. RESULTS: India’s annual blood collection increased from 12.6 million units in 2023 to 14.6 million units in 2024, with continued growth anticipated in 2025. Voluntary donation reached 74.55% and 72% of blood centres had component separation units. Nucleic Acid Testing expanded substantially, with 234 centres operational nationwide. Major milestones included the ban on professional donors (1996), adoption of the National Blood Policy (2002), governance transition to Directorate General of Health Services (2021), and implementation of External Quality Assessment Scheme and Voluntary Blood Donation Guidelines (2025). CONCLUSION: BTS in India has transformed into a regulated, technology-enabled, policy-driven system. Continued reforms under the 2026–2031 roadmap aim to achieve 100% voluntary donation, strengthen quality standards, and ensure equitable access to safe blood across the country.
Khobragade et al. (2026) studied this question.