Image: Donating blood
Corbis stock
Repeat donations by those ages 25 to 39 dropped 40 percent between 1995 and 2006, a new study says, making the teen donor pool even more valuable.
By JoNel Aleccia Health writer
msnbc.com
updated 5/20/2008 4:02:40 PM ET 2008-05-20T20:02:40

If all goes well, more than 140 students at Centennial High School in Gresham, Ore., will leave next Wednesday’s blood drive with nothing worse than bandaged arms and a craving for cookies.

Organizer Kathy Thiebes, a social studies teacher, said she’s done her best to make sure potential teen blood donors will show up well prepared, the better to reduce the risks of problems such as bruising, dizziness and fainting.

“We’ve spent the last two weeks saying, ‘Drink a lot of water, get a lot of rest, make sure you eat breakfast,’” said Thiebes, who has blanketed the 1,700-student school with fliers advertising the event.

That’s partly to protect individual students from injury, of course, especially in the wake of a new study that shows 16- and 17-year-olds are more prone to complications when they give blood.

But it’s also partly to protect what industry officials regard as the most promising source for future supply: young donors.

In a country where less than 40 percent of adults are eligible to give blood and a generation of devoted donors is aging, teenagers are becoming increasingly crucial to the nation’s blood stores, experts said.

About 8 percent of the 6 million units of whole blood collected annually by the American Red Cross now comes from 16- and 17-year-olds, according to the just-released study of reactions among that group.

“That was one of the most surprising findings of the study, to learn how much young donors contribute to the blood supply,” said Dr. Anne F. Eder, a Red Cross scientist who led the research published in the Journal of the American Medical Association.

When 18- and 19-year-olds are added, teenagers contribute about 15 percent of the blood collected by the Red Cross each year, the study showed. The Red Cross receives about half of the blood donated in the country, while the rest is provided by primarily by independent and non-profit community blood centers, which report comparable levels of teen donors.

“They’ve always been an important source,” said Dr. Louis Katz, executive vice president of medical affairs for the Mississippi Valley Regional Blood Center in Davenport, Iowa, who has studied blood issues for decades. “But proportionately, now, it’s changing.”

Donations by 16- to 19-year-old first-time donors increased by at least 10 percent during between 1995 and 2006, according to a Red Cross study of new and repeat donors published in the journal Transfusion in February. The only other groups to post increases were female first-time donors older than 50 and most donors older than 60.

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Donations drop among ages 25 to 49
Meanwhile, donations among people ages 25 to 49 fell by at least 10 percent overall, with a drop of more than 40 percent for repeat donors aged 25 to 39, according to the study. Because those groups make up the bulk of the population, the declines there are most worrisome, experts said.

“A severe shortage of blood and blood components may be forecast in the foreseeable future unless offset by significant increased supply or reduced usage,” concluded the study authors, led by the Shimian Zou of the Red Cross transmissible disease department.

Blood officials said they’ve seen the decline coming for decades. Americans raised during World War II regarded blood donation as a civic duty, like voting or belonging to a service club. For many, the habit has continued for life, said Dr. Ross M. Herron, chief medical officer for the Western Division of Red Cross Blood Services.

“They were the greatest generation of blood donors we ever had,” Herron said.

Their children, the baby boomers, continued to donate, but at lower levels. Their grandchildren have donated far less, he said.

“Generation X, they’re less likely to donate blood and also to do other civic engagement activities,” Herron said.

That attitude might be shifting among the generation known as the Millennials, however. Thiebes, the organizer at the high school in Oregon, said the kids who donate at her drives seem to understand why they're doing it.

"Of course, there's always the kids who do it because they want to get out of class," she said. "But some of these kids are really, really passionate about it."

Blood industry to blame, too
Changes in generations can’t account completely for the decline in donations, said Katz, who believes the blood industry has to accept some blame as well. Recruiting efforts have been slow to embrace technology such as e-mail and text-messages, for instance, relying instead on annoying evening telephone calls to bring in donors.

“We were a little complacent because we had the World War II donors and the boomers,” he said. “If we would find the right way to ask, we wouldn’t be in trouble.”

Katz, who is 58, said he doesn’t believe his 20-something children are less civic-minded than their grandparents. Part of the problem, he said, is that donation is more difficult now because of stricter standards for blood collection.

Blood programs limit donations from people who have recently acquired piercings or tattoos, or those who have traveled to countries prone to certain diseases such as malaria or bovine spongiform encephalopathy, or mad cow disease.

“So, my daughter gets a tattoo and she’s out for a year,” Katz said. “My son spends a year in the United Kingdom and he’s out for mad cow.”

The changes have made it more difficult for blood suppliers to meet what they describe as the “unremitting need” for donors. Between 2001 and 2004, overall donations decreased by .2 percent, even as transfusions increased by 2 percent, according to the Red Cross.

Though the difference isn’t great, it’s enough to send blood officials seeking new sources, including younger teens. If the practice of collecting blood from 16-years were extended nationally, it could bring in an additional 200,000 units a year, according to Red Cross estimates.

Some 22 states or U.S. territories now allow 16-year-olds to donate with parental consent, and two states, Oregon and Kansas, allow it without consent, Red Cross officials said. California allows donation by 15-year-olds with written approval by a parent and a doctor.

Boy collapses after donating
Most of the states allow 17-year-olds to donate without parental permission, though there are exceptions.

And with good reason, said Paul Nazar, 50, of Brooksville, Fla. His son, Elliott, was 17 last year when he collapsed in a classroom after donating blood during a drive at Hernando High School.  The boy was underweight and suffered from asthma, conditions that officials from LifeSouth Community Blood Centers failed to recognize, Nazar said. Elliott was rushed to the hospital by ambulance, where doctors treated him for low blood pressure. He has since recovered.

After a months-long tussle with the local school board and the blood center, Nazar said the district agreed to require parental permission for 17-year-olds to donate. Officials from the district and the blood center didn’t return phone calls and e-mails about the issue.

“I would think that if they wanted to take children’s blood at the age of 17, they would want to make sure it’s safe,” he said.

Safety of the young donors is a top concern nationwide, said Eder, who led the team that analyzed more than 1.7 million donations collected at nine regional Red Cross centers during 2006.

Researchers found that 16- and 17-year-olds were more likely to suffer complications after donation, with nearly 11 percent of the youngest donors encountering reactions ranging from mild bruising to serious injuries caused by falls after passing out. Similar reactions occurred in about 8 percent of 18- and 19-year-olds and only about 3 percent of those older than 20.

“The issue that we’re most concerned about is that the young donors do contribute and we want them to have a good experience,” she said. “Any donor can have a reaction and we hope that any chance of a reaction doesn’t keep donors away.”

Indeed, only about half of 16-year-olds who had a minor reaction returned to give blood the next year, compared to nearly three-quarters of kids who had no complications. Only about a third of those with major complications that required medical attention returned to donate, the study showed.

Taking steps to reduce reactions
It’s a challenge for blood centers, which operate the high school drives where about 80 percent of kids first donate, said Dr. Dan Waxman, chief medical officer for the Indiana Blood Center and an officer with the AABB, the agency formerly known as the American Association of Blood Banks, and America’s Blood Centers, a network of community centers.

Waxman said his sites have taken several steps to reduce reactions among high school donors, including making sure kids are rested, fed and well-hydrated immediately before they give blood. Technicians also have begun taking slightly smaller donations from first-time teen donors, reducing the typical 450-milileter donations by 1 percent to 2 percent.

Finally, Waxman’s teams have started having kids recover on gym mats on the floor instead of at tables and chairs, where any dizziness or fainting could result in falls. “If there are any symptoms, they’re already down,” he said.

So  far, reaction rates are down at least 8 percent among the youngest donors, he said.

Having a good experience with high school donation can only bode well for the future, said Waxman and others.

“Donating blood is the one true volunteer act that saves lives,” he said. “If I can start drawing a student in at 16, when they’re a sophomore, hopefully I will educate them and create a donor for life.”

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