Abstract
BACKGROUND: Population aging poses major challenges to health-care systems by increasing the prevalence of chronic diseases and raising the demand for blood transfusion. Blood is essential in surgery, cancer therapy, and critical care, which are frequently used in older adults. However, declining birth rates and diminishing younger cohorts threaten the sustainability of the blood donor pool. METHODS: In this study, we integrated demographic data from the Taiwanese household registration system, annual blood supply and demand data from the Taiwan Blood Services Foundation, and national population projection data from the National Development Council of Taiwan to forecast the supply-and-demand dynamics of blood in Taiwan through 2060. RESULTS: An analysis of population pyramids revealed Taiwan’s progression toward a superaged society, with profound implications for blood supply management. It also revealed a marked reduction in the absolute number and proportion of young first-time donors. According to population projections, the number of individuals eligible to donate blood (aged 17–65 years) is expected to decrease from 16 million in 2025 to approximately 8.7 million by 2060. We identified a projected crossover point around 2027, when demand is expected to exceed supply. If current trends persist, this shortfall is forecasted to surpass 1 million units annually by 2060. CONCLUSIONS: The SWOT analysis further identified internal strengths and weaknesses, alongside external opportunities and threats. Based on this, some strategic directions were proposed to enhance recruitment, optimize utilization, adopt emerging technologies, and safeguard long-term sustainability. Ensuring blood availability is essential for healthy aging, as equitable access to transfusion supports medical interventions that preserve functional ability and improve quality of life in older adults. Overall, these findings highlight the urgent need for developing proactive donor recruitment strategies, reconsidering transfusion eligibility criteria, and enhancing patient management to ensure the availability of blood as a key resource. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-026-14150-9.