On a Friday afternoon in August, a few donors trickle in to the Baltimore Red Cross donation room, filling only a small fraction of the dozen or so steel-blue beds.
Nationwide, regional branches of the Red Cross, the humanitarian organization that collects, processes, and distributes blood in the United States, have been struggling in kind.
American blood banks experienced one of their driest summers in history this year, the extreme of a seasonal drought that is leading some experts to question the growing list of safety criteria for blood donors.
Sixty-six million Americans are excluded from donating blood based on a list that some doctors call overly restrictive. The figure, recently calculated by researchers at the University of Minnesota, represents more than a third of adult Americans who would otherwise be eligible.
In Washington’s Georgetown University Hospital, officials came close to canceling nonemergency operations several times this summer.
The hospital counts on having at least 130 units of this blood on hand. But “there have been times in the past few days where we’ve had only eight units,” said Dr. Gerald Sandler, the director of transfusion medicine.
“This is the worst blood shortage that I have experienced since I began directing transfusion services in 1968,” Sandler said, citing overseas travel restrictions as a major factor.
Many potential donors may be turned off from donating altogether after being turned away at blood drives, said Dr. Harvey Klein, chief of transfusion medicine at the National Institutes of Health.
The restrictions do not faze the most faithful donors, like Towson, Maryland resident Carol Cook. He had been donating platelets at least once a month since 1995, until he came down with Lyme Disease last summer and was excluded from donating.
“I was naturally upset that I wouldn’t be able to come down and donate as regularly as I had and I’d have to wait a year. So the year is up, and I’m back,” Cook said.
Only 5 percent of eligible donors currently give, according to the Red Cross. And three-quarters of rejected first-time donors never return, Klein said.
“Getting people motivated to donate ... is not easy. Therefore, deferring people who have made that decision, who are active blood donors, is a disaster,” he said.
Half a day's supply
“Some of the criteria clearly are more stringent than they need to be. And this really affects the day to day availability of blood. It’s one of the reasons that we don’t have enough blood on the shelf,” Klein said.
In many of its facilities, the American Red Cross has only half a day’s supply of blood rather than the three to five day reserve needed to prepare for emergencies, according to regional Red Cross Chief Executive Officer Gary Ouellette.
In recent years, a quarter of American hospitals have been forced to postpone or even cancel nonemergency operations — including heart bypass procedures and hip replacements — due to lack of blood, Klein said.
After the HIV epidemic first tainted the nation’s blood supply in the 1970s and 80s, infecting thousands of hemophiliac patients among others, the Food and Drug Administration began scrutinizing donors even more carefully and blocking them based on their travel and sexual practices.
Screening donors is a critical part of protecting the blood supply, particularly against new diseases that tests cannot detect in the blood itself, said Dr. Alan Williams, associate director for regulatory affairs in the FDA’s Office of Blood Research and Review.
But some experts say the precautions go too far.
For example, since mad cow disease — a lethal brain disorder known formally as bovine spongiform encephalopathy — broke out among British cattle in the 1980s, only 55 people have contracted the human version of the disease.
Of those, only four seem to have caught the disease from transfused blood. Yet anyone who visited Britain for more than three months since 1986 is barred from donating blood in the United States for life, said Klein.
Feel-good measures
“These are really not safety measures as much as they are feel-good measures,” Klein said.
“Travel to so-called malarial areas is another very good example of probable overkill because of precaution. Really, malaria isn’t introduced into the United States by people who spend five days in Cancun,” he added.
The FDA recently removed exclusions aimed at West Nile virus symptoms once a blood test for the disease was developed, Williams said. But the British travel restriction has been upheld over several reviews by his committee.
Williams and Klein agree there is no such thing as 100 percent risk-free blood. And availability is also a safety issue.
Katie McGuire of the American Red Cross said the growing list of restrictions has created extra challenges in recruiting volunteers. This summer, the organization raffled American Idol concert tickets and collaborated with sports teams in attempts to attract younger donors, particularly as usually avid baby-boomer donors slip into poor health.
Jennifer Garfinkel, a spokesperson for the American Association of Blood Banks, said that, in disaster situations, ”It’s the blood on the shelves that saves lives. It has already been processed, tested, given the green light to be transfused.”