Challenges in Sustaining the U.S. Blood System
In 2017, an article in the New England Journal of Medicine entitled “Crisis in the Sustainability of the U.S. Blood System” declared that “a once reliable system is faltering”.1 Two years later, an act was passed charging the Secretary of Health and Human Services with identifying how best to maintain adequacy in the national inventory.2 While modest improvement might, under other circumstances, have been forthcoming, the arrival of the COVID pandemic put paid to any evidence for progress. Some of the deleterious effects of the pandemic on donor recruitment and collections persist. In particular, with more individuals working from home, previously successful blood drives at businesses now yield only a fraction of former donations.
The continuing challenges to donor recruitment, as evidenced by the frequency with which urgent needs for donors are reported in the media, occur against the background of two compounding events.
First, hospitals’ demand for blood and blood components, particularly platelets, has increased dramatically. The first illustration shows the apheresis platelet shipments, by months since January 2011, at Carter BloodCare. The steep increase from January 2022 to the current time reflects a 30% growth in demand over a little more than a two-year period.
The second compounding effect relates to aging of the donor base. In the second illustration, the percentage contribution to the annual platelet inventory, by age group, between 2001 and 2020 is shown. Whereas significant contributions to the annual inventory in the year 2001 were made by donors between 41 and 50, the bulk of the platelet inventory is now made by donations from 56- to 65-year-olds. An inescapable prediction here is that the individuals in this age group are more likely to become transfusion recipients than they are likely to continue as donors.
The National Heart, Lung, and Blood Institute and the Office of the Assistant Secretary for Health must be commended for their recognition of these two challenges and their determination to promote research which identifies what the new incentives might be to ensure that younger individuals respond to recruitment appeals. Donor attitudes are certainly different these days, as are their behaviors, and research toward finding answers to donor recruitment questions are not only essential, but also urgent.
References:
1. Klein HG, Hrouda C, Epstein JS. Crisis in the sustainability of the U.S. blood system. N Engl J Med. 2017;377(15): 1485-1488.
2. Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019: Section 209 [cited 2024 June 18]. Available from: https://www.congress.gov/bill/116th-congress/senate-bill/1379.
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