Medical Q: eligibilty of blood donors?

Factual Questions
1

An ad in our subways says “Of 100 people, only 7 are eligible for donating blood. Only 3 do”* to encourage more people to donate.**

Now, I do know I could just call the Red Cross or look at their website to find the regulations on who can’t donate blood.

But I’m much more interested in the opinions of the medical dopers on how much those regulations make sense.

Some of the regulations I know of sound sensible: You must be below 65 years and above 18; of good health.
You must wait x weeks after a cold, x months after a surgery or your last donation etc.

But then there are things like: no gays at all because of risk of HIV - though they do test for HIV!
nobody who went to GB in the 80s because of BSE

etc.

And 7% of the population just sounds extremely low that I’m wondering why so many people get excluded. ***

So: are some of those rules**** still necessary?

Are medical doctors lobbying to change some rules or modify them?

In case of potential diseases, if blood is scarce, wouldn’t it make more sense to test individually instead of excluding everybody in the risk group?

Previously, my impression from the ad campaigns was that more people need to donate blood; but if only such a small percentage is eligible in the first place, then the research into artificial blood takes a different priority: even if everybody eligible donated, 7% would probably still not cover all the demand.

  • Summer season is especially bad because more holiday traffic means more accidents, but the main donors are away on vacation, leading to low supplies

** Another problem is that the old regular reliable donors are dying off, but no new donors are replacing them.

*** The other extreme was the scandal in France in the 80s/90s: a big pharma company producing medication for bleeders from blood didn’t test for HIV though the test was possible, because they would have had to throw out too much blood from low-regulation places in the US accepting druggies and homeless people. The company coldly calculated that a court trial would take longer than people with AIDS live, so even if sued it was worth the cost.
**** I realize that rules may differ from place to place, both by law and from different organizations.

2

I work in a blood bank, so I see the blood shortages firsthand. We’ve been at critically low levels of all Rh negative types, and B positive types, for over a month, and it’s definitely a problem. We’ve needed to recommend postponing elective surgeries, and we’ve temporarily switched some people to Rh Positive blood (I’ll come back and tell you more about that later, I gotta get to work soon).

There are a lot of rules, and we “medical types” have varying opinions on them, but it doesn’t matter. The fact is, once the blood supply gets critical enough that donor recruitment strategies are no longer getting the numbers up to where they should be, the Red Cross (or equivalent) will need to have a good look at their own rules and re-evaluate the risk-benefit ratio. It doesn’t make sense to test individually for everything, it would get too insanely expensive. So they screen for things like malaria and mad cow disease by asking about travel.

And the gay thing doesn’t take that many donors out of the pool, generally speaking. At the blood drives I’ve helped with, our main deferral problems come from low hemoglobin levels (we’re not taking your blood if you don’t have enough for yourself) and from travel to tropical locations where malaria is a risk. Recent tattoos are another big one, especially among the younger donors.

Research is ongoing into artificial blood, but it’s still a long way off. One idea with a lot of promise is taking blood of any type and stripping it of all significant antigens, essentially making everything into O-negative. You’d still need donors, but the types wouldn’t matter. Even better is research into reducing the need for blood, like new surgical techniques and cell-saver machines used in the operating room. These techniques, along with a much more conservative use of blood transfusions in general, have reduced the demand somewhat.

Sorry if this is choppy - I need to leave for work in a few minutes. I will try and come back tonight to clear up anything I missed.

3

Before I haul off and say “You’ve done it to yourself with your stupid rules, why should the “eligibles” have to donate more often because of your paranoia, the “shortage” is your own doing.” Can the Red Cross just up and change them, or is this a Federal Law matter, or an FDA regulation? Are we going to have to have a “Male Anal Sex Since 1977 Blood Donor Liberation Act of 2011” before the policies will change?

And for the doctors and other people in healthcare: Could someone start up a rival organization that WILL take blood donations from more people (with reasonable but less paranoid screening), and undercut the Red Cross? This is America- free enterprise and all.

4

What I meant is: ask questions first, but when you’ve narrowed down to only one risk-group, test for that risk in that individual. So instead of testing everybody for malaria, or asking and rejecting everybody with tropical travel, ask for tropical travel and then test only those with “yes” for malaria.

Would that be feasible?

Do you know or suspect why hemoglobin levels are so low - are people not eating enough red meat (clichee) or are there other reasons for it?

Forgot to mention in the OP: in another thread on the board, somebody mentioned a disease which is kinda like the opposite of anemia: instead of too low, people have too much iron in their blood. The treatment is to regularly let blood, but for some reason, this blood is thrown out. Could it not be diluted or filtered or whatever and still be used?

I’ve heard of machines used in scheduled surgeries where the blood that’s sucked out during cutting is cleaned and put back (though I wonder why this is a recent development - shouldn’t people have thought of that earlier?).

And if medically possible for a scheduled surgery (that is, you’re not too sick) you can donate your own blood a few months before and freeze it.

I’ve also heard a bit of the opposite: instead of donating full blood, the blood is taken out, some parts (platelets?) are filtered out and the rest is given back. The advantage is apparently that the blood donor doesn’t feel wobbly and recovery is much quicker - weeks instead of months - so people can donate more often.

Can these extracted bits be mixed with saline solution or plasma to make “good enough blood”? Or are they used only for bleeders and the like?

Related Q: if a woman had Tbc during childhood, recovered, the Tbc was “encapsulated” and, when she was in her 30s, was told in the 1970s not to breastfeed her children because she could pass on Tbc - how can she still be allowed to donate blood in the 1980s and onward? Is encapsulated Tbc not present in the blood, yet in the breast milk?

Thanks, and no problem - this isn’t “need answer fast”, but rather general question.

5

I believe it takes a while for someone infected with HIV to be shown as positive. So you could have it and be shown as negative in tests. Apologies I can’t provide a cite right now but hopefully someone will back me up!

6

I can’t donate because I travel to India a few times a year and the malaria risk is a blocker. The blood supply is critical, and frankly, we’ve had some serious problems where tests don’t always screen out problem blood. I used to donate often before this travel issue and will start donating again if and when I stop traveling to India.

But to the OP, we have a blood drive in our company and they had to reject over 1/3 of the donors because of travel to India. I recommended that they publicize that restriction before the next blood drive and save a lot of us some time.

7

There are more organizations beside the Red Cross, I only used Red Cross as example because they’re the best known and one of (the?) biggest.

They also (regularly?) seem to get into scandals for paying the donors a relative pittance and selling the blood at a much higher price to hospitals, which some people think is not appropriate for a charity. (In the 1990s, this might have been one of the reasons why our local Health house switched to gift baskets instead of 40 DM as they did before; I assume they also realized that paying money in cash attracted people down on their luck which were not really healthy enough that you wanted their blood).

Do they still pay cash in the US?

8

Wouldn’t you run into the other side of the problem - that most people won’t even show up if they know only so few are eligible in the first place?

I remember how surprised I was at this new direction of ads - always before I had assumed that most people were healthy enough to be able to, but not civic enough (too afraid of needles) to do their public duty; but with the new ads, it seems as if the crisis is self-made with too-tight regulations and that’s it not worth bothering going in the first place. (I don’t think that was the intention…)

9

That’s what I heard in the 80s and 90s, when one of the big “advantages” promised to donors was that they would be tested anonymously for HIV.

But I thought that a new test generation had been developed (late 90s?) that was quicker?

Even then, if you’re in a big city, you’d want regular donors anyway. So can’t you test “potential donor John Smith” and write him back 3 months later “Congrats, your test was negative, your OJ and cookies are waiting here for you to give blood”?

10

Most people will start producing antibodies in the first 6 weeks, and a sufficiently sensitive test can detect this. Such tests are more expensive, and the only people I’ve heard of using them regularly are porn actors/sex workers. For the rest of us, the vast majority, >90%, will test positive 3 months after exposure on a standard HIV test. And at 6 months, if you’ve got it, it’s gonna show up.

11

And the point, no matter what the disease is, is that the people who engage in the “risky behaviors” (travel to India and tattoos to take non-gay examples) are doing those things willingly. OTOH, the people who need the blood did not. Even though there really may be a very small chance of catching anything from a piercing, tattoo, or travel to exotic place… Well, wouldn’t you like to be the unlucky person who received blood from someone who consented to that risk, while you didn’t? Not to mention if you need the blood you probably are not in the best health at the moment.

12

You are talking about apheresis donors. http://en.wikipedia.org/wiki/Apheresis I used to be an apheresis donor. My blood type is shared by about 4% of the population. I was told that an apheresis donation is equivalent to 10 whole blood donations.

I was on a first name basis with everyone at the blood bank because they would call and I would show up. After the donation I would actually feel good rather than groggy. It took over an hour for each donation.

Then I got a melanoma and that put me on the rejected list because there was a chance that cancer cells could still be in my blood. It’s been over 10 years with no recurrence but AFAIK I’m permanently rejected.

13

Cell savers aren’t perfect, and they aren’t as simple as just taking what’s sucked up and piping it back into you. You have to have another person in the room running it, usually. They have to communicate with the surgeons and know when to have it clean cells, when to have it pipe cells back, etc…

In a nut shell, a surgeon sucks up the blood and it gets sent into a large holding chamber on an IV pole above the machine. You can’t put that right back into the patient, because although it’s mostly blood, there could be other things in there, too. So periodically the operator of the cell saver will send some of that material into the washing chamber. Sterile saline gets piped in, and the chamber spins really fast. The red blood cells, being pretty heavy (compared to the blood plasma, the saline, and whatever else might be in there,) get pushed out to the endge of the chamber and the undesired material gets sucked out. The good cells are then transfered to a holding bag where they are mixed with saline to make them easier to move back into the body.

No matter how well the machine and operator work, some cells will still be lost, others will get damaged/killed by the process, and even though the RBCs are the most important part of the blood, at least in this case, you still do want all that other stuff that is getting tossed by the machine, so some actual blood is still needed.

Plus the machines are expensive…try telling the OR management that they need to buy one for every room…plus a back up or two for when one goes down (which, since they will now be getting used a lot more will be more frequent,) plus paying for more staff to operate them.

14

I’m pretty sure that in the US at least, it’s a federal agency (CDC? FDA?) that requires the “if you’re a man who’s had sex with a man since 1970 (?), you’re ineligible” rule, and that the Red Cross would love to make that less strict.

There are indeed other blood-drawing agencies in the US; Lifesource is one that comes to mind, plus hospitals will request donors to come directly to their own blood banks as well.

15

Can you explain this a bit more - are you saying French companies were importing blood from the USA, from places that didn’t screen the donors at all? Do you have a cite for that, or did you just notice you had almost finished an entire OP without getting a dig in against the USA?

Are you talking about this scandal? Because it doesn’t mention the USA at all, except as the manufacturer of an HIV screening test that the French declined to import and use.

I’ve been donating blood for 26 years at Red Cross blood drives in the USA, and the biggest reward I’ve been given is a cheap T-shirt. Some local organizations pay cash for blood, but the Red Cross doesn’t. Cite.

16

Too late to edit - from the Red Cross FAQ:

So according to them, blood for human transfusion cannot come from people being paid for the donation.

17

Other reasons I know of for not being able to donate blood, that have happened to people I know:

  • Past cancer/chemotherapy
  • Past hepatitis
  • Past early-stage cervical cancer, for 5 years after the end of treatment, even when treatment didn’t involve chemotherapy
  • Crohn’s disease

There must be a bunch of other health reasons to disqualify people that you might not think about.

18

So we could have an “informed consent” type of thing for patients that might need blood. E.g. let people decide whether or not they would be willing to accept blood from ex-cancer patients, men who have had sex with men, people who have recently been to India, etc. Then, it’s their choice and their responsibility. I, personally, would not see any big deal in accepting blood from a man who last had anal sex in 1985 and has been tested hundreds of times for HIV and came back negative each time - yet he would be banned from even trying to donate under the current rules. Why can’t I choose?

19

Cite?

My local blood donation concern (which actually is not the Red Cross but a local organization) also, iirc, bans people who have ever traded sex for drugs or money. Come on guys, even if it was a legal brothel in Nevada?

20

Here’s a cite that it’s an FDA requirement. No idea if the Red Cross would “love” to make it less strict - I think the Red Cross simply follows the government regulations.