Blood Shortage

By Susan Waltman

For years, you have been putting off having knee replacement surgery. But the pain has increased, and you finally schedule the procedure. The day before you are admitted to the hospital, the doctor calls and tells you that your surgery must be postponed. There is a critical blood shortage and all elective surgeries -- like knee and hip replacements -- are being put off.

This may be a real scenario in New York City in the near future.

Recently, the Food and Drug Administration recommended that the U.S. prohibit blood imported from Europe for fear that mad cow disease may spread through tainted blood. The proposal would also prohibit persons who have spent extended periods of time in Europe since 1980 from donating blood.

While the nation should be attentive to the risks of mad cow disease (the medical term is bovine spongiform encephalopathy), there have been no identified cases of mad cow being transferred through a blood transfusion.

The ban, however, will have a serious negative impact on New York City.

The New York metropolitan area is the only place in the nation that imports blood from Europe. The practice of importing blood began in the 1970's when European countries had an excess blood supply while the New York region struggled to meet the needs of its dense population.

A plan is already under way to end blood imports from Europe by 2004, but if the current Food and Drug Administration proposal is fully approved and implemented now, it could cost the New York area 25 percent of its blood supply.

In addition, there are many New Yorkers who frequently travel to Europe, and the New York Blood Center estimates that it stands to lose an additional 10 percent of donations from restrictions on travelers.

This proposal would mean that perfectly healthy New Yorkers who might donate blood regularly would no longer be able to donate blood.

BLOOD: YESTERDAY AND TODAY

In 1818, James Blundell, a British obstetrician, performed the first successful and documented transfusion of human blood to a patient. Using the patient's husband as a donor, the doctor extracted four ounces of blood from his arm and with a syringe successfully transfused blood to the patient.

It was not until 1937 that Bernard Fantus, at the Cook County Hospital in Chicago, established the first hospital blood bank to preserve and store donor blood. New York became one of the earliest cities to have a blood bank.

According to the New York Blood Center, 600,000 pints of blood are used each year in the metropolitan area (enough to fill a large swimming pool) for one million transfusions. Every day, 1,500 pints of blood must be collected to keep pace with demand. During a blood shortage, like the one now, deliveries of blood are cut back to local hospitals; a hospital may ask for 100 pints of blood and only receive 75 pints.

For years, the most reliable ways of replenishing local supplies have been through blood drives at schools, houses of worship, and work places. Faced with shortages, donor recruitment is getting more creative in New York City. Blood drives are being set up at nightclubs in Queens and the Bronx, and bloodmobiles are pulling up to courthouses in Suffolk and Nassau county and asking for donations from people waiting to be called for jury duty.

To donate blood in New York City, you can contact the New York Blood Center at 1-800-933-2566. Or to find when blood drives will be in your area, go online to the New York Blood Center Drive Locator.

Without new ways to replace the blood supply, New York City and New Jersey hospitals would be incapacitated. The lack of blood products would create a public health crisis that would jeopardize patient safety in a service area of approximately 18 million people. The remaining supply might have to be rationed, emergency procedures would likely receive priority, and elective surgeries would be eliminated or postponed.

New York, with its large population, has always struggled to maintain its blood supply.

The city relies on one source, the New York Blood Center, for about 85 percent of its blood, with the remainder coming from local hospitals and other small providers.

New York City also has fewer donors than the rest of the country. Only two percent of New Yorkers donate blood, compared to five percent nationally.

According to the Blood Center, the city experiences regular shortages in the summer and winter -- when students are away from school, people are on vacation or celebrating holidays -- but these shortages are becoming more frequent and lasting for longer periods of time. The need for blood is also increasing as New York's population grows older, more cancer patients seek treatment, and major surgeries like open-heart surgery and organ transplants become more common.

In addition, many hospitals in New York City are in a fragile financial condition and have some of the worst financial indicators anywhere in the nation. In 1999, New York hospitals ranked 42nd out of 45 states reporting for fiscal health. Hospitals have little extra cash flow to deal with an emergency such as a massive blood shortage. If the price of New York's already limited blood supply rises as it becomes more scarce, area hospitals may not be able to pay for the service fees of processing blood products (if the products are available at all) without limiting other hospital services.

To remedy this blood emergency, some steps have already been taken.

The New York Blood Center has declared an emergency blood donor appeal, with specific calls for Type O and Type B Negative blood. Also last week, the New York health care community learned that the U.S. Department of Health and Human Services is working on a proposal to send surplus blood from U.S. military bases in Europe to the New York City region.

Meanwhile, elected officials like Senators Hillary Clinton and Charles Schumer have written to the Health and Human Services Secretary Tommy Thompson to urge the agency to develop a plan to replenish the blood supplies in the area. Senator Schumer has called for $10 million in federal money for a publicity campaign and ten new blood mobiles. The state Department of Health announced it would spend $500,000 to inform New Yorkers of the problem.

The Food and Drug Administration needs to consider a timeframe for implementation that would give the city as much time possible to prepare. The federal government should also provide funding for research to develop a test to detect mad cow disease in the blood supply.

The Greater New York Hospital Association has alerted member hospitals of the possibility of a severe blood shortage and urged them to encourage their employees to donate blood. We will also be working with the Mayor's Office of Emergency Management to undertake a citywide blood donation campaign. The Food and Drug Administration must address the consequences of its proposed restrictions. The health of the New York City area patients depends on it.

Susan Waltman is Senior Vice President and General Counsel for the Greater New York Hospitals Association, which represents 200 hospitals and long term care facilities in the city and surrounding area.

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