Blood donation the gift of life for transplant patients

Critical shortage threatens many

A shortage of donated blood means many patients have to delay possibly life-saving surgery

In this story: Agonizing ordeal 'Most severe shortage' in years Shortage 'unnecessary' Difficult choices until relief arrives RELATED STORIES, SITES

By Holly Firfer
CNN Medical Correspondent

(CNN) -- At age 62, Edward Lee was looking forward to retirement. But a critical illness coupled with a severe national blood shortage almost cut his dreams short.

"I have always been the type of person that felt like going and doing," Lee said, "but just over a month or so period I just seemed to lose all my energy."

In the aviation industry for many years, Lee traveled often. He blamed a high-fat diet on the road for his sluggishness. But as he felt worse, a trip to the emergency room showed it was more than that.

"They ran some blood tests and found my hemoglobin was extremely low."

ON CNN Watch Holly Firfer's full report on the U.S. blood shortage on Your Health Saturday 2:30 p.m. ET Sunday 3:00 p.m. ET     RESOURCES For more information on donating blood, call the Red Cross at 1-800-GIVE-LIFE, or America's Blood Centers at 1-888-BLOOD-88 Or visit these Web sites: American Red Cross Blood Services American Association of Blood Banks America's Blood Centers Armed Services Blood Program Office     AUDIO Dr. Bernadine Healy supports strong regulations about who can donate blood WAV sound Edward Lee says it's difficult to express his thanks to blood donors WAV sound Dr. Lannie Maes explains the difficulties of dealing with the blood shortage in the hospital WAV sound

Lee had a rare disorder that caused his stomach to bleed. Doctors pinpointed the problem to his liver, diagnosing him with a form of non-alcohol-related cirrhosis caused by fatty foods. His liver was shutting down, and he was bleeding internally. Because he was losing blood so quickly, he would need a transfusion every month to stay alive.

"I was leaking blood faster than I was producing it," Lee explained. "Every month I would take a pint of blood, two pints."

He was immediately put on the organ transplant list. He needed a liver, and he needed one soon.

"Mr. Lee was a pretty sick man," said Dr. Prabhakar Baliga of the Medical University of South Carolina, who performed the transplant. "He had multiple infections in his abdomen. He was, from a medical standpoint, a high-risk candidate.

"Unlike a kidney transplant situation, or placing a heart assist device in someone, in a liver transplant situation, there is nothing you can do to support a patient short of a transplant," Baliga explained.

Lee spent months on the transplant list, continuing to receive life saving transfusions even as his condition deteriorated.

And then it happened -- Lee received a phone call from the hospital, about 90 minutes away from his home in Varneville, South Carolina, informing him a liver was available.

"They called us one night at 8 p.m. and told us to come in. So we got in the car and headed to Charleston," Lee recalled. "We got about half way there and the cell phone in the car rang and they told us to go home. They didn't have enough blood."

Liver transplants have a success rate of about 85 percent, but the surgery requires as much as 75 pints of blood. Moreover, doctors like to have extra blood on reserve in case complications should arise.

Calling off Lee's surgery was the decision of the hospital's blood bank director, Dr. Lannie Maes. She calls it one of the hardest she ever had to make.

Edward Lee, shown with his wife Anita, had liver transplant surgery postponed several times because no blood was available

"He's a type-O with antibodies. Because of that, we didn't even have enough to support the liver transplant. We had to say no -- we couldn't support a liver for him. And that liver ended up going to somebody else."

It was an agonizing ordeal for Lee's wife, Anita.

"I just cried all the way back home. I thought he was just not going to live. I was afraid he was going to die."

As Lee's condition deteriorated over the following days, his wife reached an emotional breaking point.

"It was at such a point," she said, "I was even afraid to go to sleep at night. I wouldn't even leave the house to get a loaf of bread. Afraid he'd be dead when I came home. It was that bad."

The American Red Cross said U.S. blood supplies usually drop during the winter holidays, as many regular donors travel or suffer from winter illnesses such as the flu.

But this year has been particularly bad.

"This is probably the most severe shortage I have seen since I have been in medicine," Maes said.

Many blood banks have never bounced back from the expected lows in the beginning of the year, and many hospitals across the country are still facing a desperate shortage. Some facilities have even cancelled elective surgeries until the blood supply is back to safe levels: 80,000 units of blood available on any day across the nation.

The Medical University of South Carolina, where Edward Lee lay dying, is the only hospital in the region that performs organ transplants and the only emergency room equipped to take major trauma cases. The blood shortage forced the staff to juggle priorities.

"Several times we were down to zero O-positive (blood) on the shelf with a bleeding patient," Maes said. "What we did was take the blood that was already allocated for other surgeries and give it to that patient until we (could) get more in." But having to make the call to cancel surgeries for lack of blood is what Maes dreads every day she comes to work.

"That's one of the most frustrating aspects. There is only a certain amount we can do. I call the head of the medical chief of staff and the head of anesthesia and say, 'We are all on alert. At this point I don't know that I can support any of these surgeries.'"

Such a situation is "truly heartbreaking," said Dr. Bernadine Healy, president of the American Red Cross. "It's outrageous. It's unnecessary. It cannot happen."

Although blood donations are actually at an all-time high -- up 3 percent from last year -- Healy said the increased demand by an aging population for medical treatments like heart surgeries, transplants, and chemotherapy, all of which require large amounts of blood, have driven demand to twice the rate of collection.

Statistics show half of Americans are eligible to give blood -- donors only need to be 17 years old, weigh 110 pounds and be in good health. Still, only 5 percent donate.

"I think there is another thing we have to realize," Healy said. "Many of the donors who kind of grew up as the World War II generation -- people who understand the need for blood during the war -- a lot of those people and those who came immediately after them, their children, are often not eligible to give blood anymore." Older people often have health conditions that preclude them from donating.

Adding to the problem: Blood doesn't last long. Its shelf life ranges from 5 days for red blood cells, to 42 days for platelets, to up to one year for plasma.

Critics also blame the shortage on tighter restrictions for who can give blood. Potential donors are now asked 41 questions about their health, sexual behavior and drug use in an effort to prevent transmitting disease through the blood supply.

As recently as last April, the Food and Drug Administration, which oversees the safety of donated blood, eliminated any donor who lived in Great Britain for 6 months or more starting in the late 1980's, for fear of transmitting so-called "mad cow" disease. Donors must wait one year from the time of a tattoo or body pierce to prevent the potential transmission of HIV or hepatitis infection. And gay men are banned from giving blood completely.

Healy said these are all reasonable precautions.

"The CDC (Centers for Disease Control and Prevention) has shown that if conditions were relaxed to allow 50,000 gay donors to give blood in any year, that roughly 1,200 HIV-positive units would be drawn. And with all of our very good testing, multiple testing, as many as 2 to 3 units of HIV-positive blood would be slipped into the system and be transmitted. That concern, that potential 2 to 3 units, has made the Red Cross support the decision that we should not change the rules."

Healy adds that until 1992, blood was not screened for hepatitis C. Subsequently, perhaps 1 million Americans who were transfused prior to that year may have contracted the disease.

The Red Cross said if every eligible donor gave blood just once a year, the national blood shortage would end.

Until then, Maes and her staff must gather every morning to discuss how to meet the blood needs of the hospital. She checks the inventory with the surgery schedule and, surprisingly, the operating room often runs on her ability to support the day's procedures.

"It's my worst nightmare to have to go into the emergency room or the O.R. and tell them that I don't have any products."

Baliga, who operated on Edward Lee, agreed. "Frequently we are frustrated because it is a situation where you have the potential for saving someone's life, and you know the resources are available in the community, and yet you feel like your hands are tied."

Edward Lee was in that situation. Incredibly, three more livers became available during the month of June. Each one had to be turned away because there wasn't enough blood for the surgery,

"For some reason I thought I was going to die. And I just asked that I be saved. And then I felt like I would be so I just had this very calm feeling, peaceful -- like, reassuring -- feeling like I was not about to die."

Maes and her staff at the hospital's blood bank -- and those who donated blood to the American Red Cross -- gave Lee the gift of life.

According to his doctors, Lee had only a few days to live when they got the news that a fourth liver was available. And on that day there was enough blood, thanks to Maes.

"We were stashing units away one and two at a time so we could have enough to support the liver transplant," she explained.

Baliga performed the surgery. "Everything went very smoothly. His surgery was very uneventful, and that's the way we like it."

The transplant was a success. Edward Lee said he feels great, and today, he is living life to the fullest. And, he added, not a day goes by when he doesn't think of those blood donors who helped save his life.

"What can you say? There is no way you can show your appreciation because it's just a lifesaving thing to do. It's unselfish, it's charity, it's charitable, and I can't say enough. I can't thank them enough for all they have done. Thanks is just a word, compared to what it really means."

'Frightening' U.S. blood shortage delaying surgery
September 19, 2000
Evidence suggests that giving blood has health benefits
April 26, 2000
Blood centers cite urgent need for donors
January 31, 2000

Medical University of South Carolina
National Heart, Lung and Blood Institute

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