INTRODUCTION:
Ensuring the safety of blood transfusions remains a major public health challenge in sub-Saharan Africa (SSA), particularly in the Democratic Republic of Congo (DRC). Political instability, inadequate health infrastructure, and the absence of a comprehensive hemovigilance system all exacerbate transfusion-related risks. Consequently, blood transfusion recipients are exposed to preventable post-transfusion complications. Furthermore, sociocultural mistrust of blood donation contributes to chronic shortages of safe blood products. This narrative review aims to examine the current challenges related to transfusion safety in SSA, focusing specifically on the DRC.

METHODS:
An integrative narrative review was conducted between January and April 2025. English and French keywords were used, including “transfusion safety”, “sub-Saharan Africa”, “blood transfusion risks”, “post-transfusion surveillance”, “transfusion-transmitted infections”, “hemovigilance”, and “DRC”, either on their own or in combination with Boolean operators. Original research articles, systematic reviews, institutional reports and recommendations from public health organisations published between 2000 and 2025 were included. Selection focused on literature addressing transfusion safety systems, clinical practices in settings with limited resources, and surveillance models in low- and middle-income countries.

RESULTS:
The DRC still lacks an operational national haemovigilance system. Transfusion management remains decentralised, fragmented and insufficiently standardised, which compromises the quality and safety of care. Limited traceability and incomplete screening practices may expose recipients to preventable transfusion-related risks. Nevertheless, several local initiatives supported by non-governmental organisations, academic institutions and international programmes are emerging. Key opportunities identified include developing digital surveillance tools, networking sentinel laboratories, improving access to safe blood in peripheral health facilities and establishing regional centres for continuing education and applied research in transfusion safety.

CONCLUSIONS:
Ensuring long-term transfusion safety in the DRC requires a systemic, integrated, multisectoral approach based on contextual innovation, institutional strengthening and local research capacity development. Sustained political commitment and strengthened partnerships are vital for establishing an effective and resilient hemovigilance system.